Pelvic pain causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pain in the pelvis can be described as acute or chronic. Urologic, gastrointestinal and gynaecologic problems can all be possible.

Causes

Causes in Alphabetical Order

Acute (<6 months)

• Abdominal aortic aneurysm
• Cervicitis
• Diverticulitis
• Ectopic pregnancy
• Endometriosis
• Incomplete abortion
• Intra-uterine device
• Irritable bowel syndrome
• Midcycle ovulation
• Mesenteric ischemia/infarction
• Nephrolithiasis
• Ovarian cyst
• Ovarian torsion
• Pelvic inflammatory disease
• Pelvic neoplasm
• Pelvic floor prolapse
• Primary dysmenorrhea
• Ruptured corpus luteal cyst
• Septic abortion
• Sexual abuse/trauma
• Threatened abortion
• Tubo-ovarian abscess
• Urinary tract infection
• Uterine fibroids
• Vaginitis

Chronic (>6 months)

• Adenomyosis
• Depression
• Diverticulosis
• Diverticular abscess
• Hernia
• IBD
• IBS
• Interstitial Cystitis
• Leiomyoma
• Lymphoma
• Pelvic adhesions

Diagnosis

History and Symptoms

• Nature
• Sensitivity
• Onset
• Pain occurrence

• Intercourse
• Menstrual
• Chronic vs. acute

• Risk of pregnancy
• Associated symptoms:

• Fever
• Nausea
• Vomiting
• Dysuria
• Vaginal bleeding
• Vaginal discharge
• Abdominal pain or back pain

Physical Examination

Abdomen

• Full abdominal and pelvic exam - speculum, bimanual, rectal

Other

• Examine for signs of physical abuse

Laboratory Findings

• Labs include:

• Urine pregnancy test
• Urinalysis
• Gram stain and culture
• STD tests
• Vaginal smear wet mount

Ultrasound

• Ultrasound for ovarian cyst, mass, ectopic pregnancy vs. intrauterine pregnancy

Treatment

Medical Therapy

Acute Pharmacotherapies

• Endometriosis

• Oral contraceptives 3-4 months
• Provera 39mg QD/2 months
• Danazol 200-800mg QD/6 month
• GnRH agonist

• Primary dysmenorrhea

• Oral contraceptives

• Treat STD's accordingly

References

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