Pelvic pain

Elvis is in paaaiiiiiiinnn!

Definition

Pain in the lower abdomen/pelvis area.

Epidemiology

Differential Diagnosis

It's also worth taking a look at abdominal pain. This where I got most of the differentials from.

Gynaecological

• Dysmenorrhoea
• Ectopic pregnancy
• Miscarriage
• STI
• Salpingitis
• PID

Dyspareunia

Pain during or after intercourse

• Superficial dyspareunia - pain of the external genitalia. Causes: genital infection, Bartholin's cyst, surgery
• Deep dyspareunia - chronic PID, endometriosis, retroverted uterus, IBD, IBS, chronic constipation, pelvic mass, vaginismus.

Non-gynae

• Abdominal abscess
• Renal stones
• Mesenteric adenitis
• Meckel's diverticulum
• Crohn's
• Bowel perforation
• Appendicitis
• Strangulated inguinal hernia

Clinical and Associated Features

Medical Emergencies - these conditions are medical emergencies presenting with abdominal pain. Scary stuff. Remember - acute abdominal pain is surgical until proven otherwise.

• Appendicitis - central abdominal pain moving to the right iliac fossa, fever, rebound tenderness (pain on removing pressure of palpation), tenesmus (feeling of needing to poo), nausea, vomiting, pressure in left IF (iliac fossa) makes pain worse in RIF. Untreated, has a very high mortality as it leads to peritonitis.
• Ectopic pregnancy - give a pregnancy test to any woman with acute abdominal pain. Usually presents as for a normal pregnancy. Pain in the lower abdomen, fever. If they start going into shock or becoming very unwell, this may be a sign of rupture.
• Irreducible inguinal hernia - it can develop gangrene and ischaemia with fatal consequences. Fatality is generally to be avoided in medicine.

Not-so-emergency

• Dysmenorrhoea - Crampy pain in lower abdomen during period. May be accompanied by menorrhagia.
• Perforation - pain (associated with where perforation is), tenderness, peritonitis, shock
• Renal stones - loin-to-groin pain, pain at the tip of the penis/in labia majorum, can lead to shock and peritonitis if infection develops, flank pain
• PID - usually asymptomatic. Otherwise, subfertility, menorrhagia, lower abdominal pain, deep dyspareunia.
• IBD - alternating diarrhoea and constipation, weight loss, blood in stools, tiredness