What Causes Pelvic or Low Back Pain?

Your back is a strong base that supports the body's anatomical structures. It helps you stand erect, locomote, and carry weights around.

The lower back comprises numerous bones (vertebrae), muscles, and ligaments. Different pathologies can alter the harmonious operation of the structures and lead to chronic pelvic pain.

Causes and Risk Factors for Pelvic or Low Back Pain

Pelvic low back pain is a common condition, especially amongst adults globally. 

7.50% of the entire global population, or 577 million people suffer from low back pain at some point in their life.

Therefore, it is crucial to find the underlying reason for this debilitating condition and protect yourself.

Injury and Stress Fractures

Athletic individuals are prone to injuries and trauma. Repetitive mechanical movements, such as exercise or sports, can induce stress fractures in the lumbar and sacral (pelvic) bones. These fractures can cause severe low back pain. 

Multiple lumbar (transverse process) stress fractures were the cause of chronic low back pain in a young cricketer. Pelvic pain arising from pelvic stress fractures is not unusual in enthusiastic female athletes. Such fractures usually go undiagnosed.

Thus, if you indulge in sports activities and suffer pelvic aches, you might consider an underlying stress fracture. 

SI Joint Pain/Dysfunction 

The sacroiliac joint is a major weight-bearing joint formed by the joining of the sacral and the iliac bones (pelvic bones). The sacroiliac joint can become dysfunctional, leading to sharp pain radiating from the lower back to the buttocks.

Pelvic low back pain arising from a sacroiliac joint dysfunction is known as SI joint pain. 

SI dysfunction is the underlying cause in almost 15-30% of chronic low back pain cases. Inflammation of the joints (sacroiliitis) causes appreciable pelvic pain and can be attributed to different factors, including injury, gout, and improper posture.

Vertebral Disc Slip

A disc is a cushioning structure between two spinal bones (vertebrae) and can get dislodged from its position and become herniated. Injury or trauma can lead to disc slip. The slipped disc then puts pressure on the nearby nerves. 

If the disc slip occurs in the low back region (lumbar region), it can result in chronic low back pain. Lumbar disc herniation may be the underlying cause of low back pain and sciatica.

The sciatic nerve innervates the lower back, buttocks, legs, and foot region. Inflammation of this nerve (sciatica) is primarily due to disc herniation.

Degenerative Diseases

An array of spine degenerative diseases can also contribute to pelvic and low back pain. They include the following.

Scoliosis

Scoliosis is a condition characterized by an abnormal curvature of the spine. It is usually diagnosed at an early age. The condition can affect different spine regions (thoracic, lumbar, cervical, etc.).

Young scoliosis patients frequently present with low back pain. The prevalence of low back pain in scoliosis patients ranges between 34.7 and 42%.

The extent of lumbar scoliosis plays an essential role in determining the severity of the pain.

Degenerative Disc Disease

Unlike scoliosis, degenerative disc disease (DDD) is a pelvic pain condition in the adult population.

The human body undergoes degenerative changes with time. The degeneration of the lumbar discs in older adults can cause chronic low back aches. 

Facet Joint Syndrome

Another degenerative disorder linked to pelvic and low back pain is facet joint syndrome. Degenerative joint changes can affect the spine bones and lead to the breakdown of facet joints (vertebrae).

The cartilage lining these joints becomes inflamed and traps the nearby nerves. Thus, it can cause severe low back and neck pain.

Arthritis 

Osteoarthritis and rheumatoid arthritis can contribute to excruciating chronic low back pain. As arthritis is a chronic condition, pelvic pain is debilitating. It seriously reduces the patients’ quality of life.

Studies suggest a clear link between low back pain and rheumatoid arthritis. Functional capacity is significantly reduced, and patients are at a greater risk of depression.

Pregnancy 

Pregnant ladies are at a greater risk of developing low back pain. The additional weight of the fetus puts extra pressure on the lumbar spine. Paired with the physiological changes in the pelvis structures to accommodate the baby, this accounts for the back pain’s propensity.

The prevalence of low back pain and pelvic pain in pregnant ladies can be as high as 72%, indicating it to be a significant pregnancy-related issue.

Pelvic pain in expecting mothers is termed pregnancy-related pelvic girdle pain (PGP). Studies suggest that PGP can be managed using pelvic belts, postpartum exercises, and patient education.

Vitamin Deficiency

Vitamin D deficiency can also induce chronic low back pain in patients. Research is ongoing to establish a link between vitamin D deficiency and LBP.

Vitamin D3 supplementation has improved back pain symptoms in some individuals, indicating the prohormone's role in keeping backache at bay.

Symptoms of Low Back Pain

Low back and pelvic pain differ in nature and in intensity. For some individuals, it is mild discomfort, while for others, it is excruciating, gnawing pain.

Whenever the sciatic nerve is involved, the low back pain is of radiating nature and usually travels from the lower back to the buttocks or even down to the toes.

Sciatica may be accompanied by numbness, tingling, or burning sensations. Disc herniation patients often complain of feeling alternative sessions of pain and numbness.

Pelvic Congestion Syndrome

Pelvic Congestion Syndrome is a vascular disorder affecting the veins of the pelvic region because there is not proper drainage of blood out of the region. It is most common in women who have more than one childbirth.

The main sign of Pelvic Congestion Syndrome is how long the pressure lasts, pain while intercourse, and after intercourse, and high degree of discomfort during menstruation.

Treatment of Pelvic Congestion Syndrome 

Conservative management includes the use of compression devices such as medical-grade compression pantyhose or compression shorts

With the advent of advanced technology, patients can be treated using a minimally invasive procedure. The benefits of these procedures are:

• No hospital stays and usually can go home the same day.
• Small incisions and less blood loss.
• Less pain and no open surgeries.
• Minimal scarring and lower rates of complication.
• Treatment options may also include embolization of the ovarian vein(s) and peri uterine veins.  Risks during these procedures are minimal with a high success rate.

Outcomes of treatment allow patients to regain quality of life and may prevent the need for more invasive surgical treatment such as hysterectomy. 

Other Treatment Options

Managing pelvic or low back pain is difficult as it relies on treating the underlying cause. In most cases, the most effective non-surgical treatment modality for pelvic and low back pain is physical therapy.

Due to its efficacy, physiotherapy is the first-line treatment modality for low back pain. Physical therapy and manual chiropractic sessions can also reduce the frequency of back pain recurrence.

Old individuals suffer from weakness of muscles (abdominal and back muscles). Such patients are advised to carry out pelvic muscle (pelvic floor training) and back muscle strengthening exercises. Strong muscles allow the alleviation of symptoms.

Patients can also use over-the-counter painkillers such as ibuprofen, naproxen and drugs for neuropathic pain, e.g., pregabalin and gabapentin. Vitamin D supplementation is also beneficial for those facing backache due to vitamin deficiency.

Surgery is reserved for patients who do not respond to non-surgical interventions for low back and pelvic pain. A vascular surgeon would perform a minimally-invasive procedure to open the vein in the pelvic region. 

Schedule a consultation or a telehealth consultation to find out if the Center for Vascular Medicine can help with your condition.