Pelvic pain Flashcards
Probability diagnosis
Gynaecological disorders, for example:
- endometriosis
- dysmenorrhoea/mittelschmerz
- pelvic adhesions
- ovarian cyst – torsion, pressure or rupture
Musculoskeletal disorders
Irritable bowel syndrome
Referred spinal pain
Serious disorders not to be missed
Neoplasia/cancer:
- lower bowel
- cervix and uterus
- ovary
Vascular:
- internal iliac artery → claudication
Infection:
- osteomyelitis
- pelvic inflammatory disease
- pelvic abscess
Ectopic pregnancy
Strangulated hernia (femoral or inguinal)
Pitfalls (often missed)
- Endometriosis
- Constipation/faecal impaction
- Paget disease
- Stress fractures (incl. SCFE)
- Prostatitis/prostatodynia
- Misplaced IUCD
- Hernia in evolution (e.g. inguinal)
- Nerve entrapment
- Rectum: proctitis or prolapse
Masquerades checklist
Depression
Spinal dysfunction
UTI
Is the patient trying to tell me something?
Functional disorders possible.
Psychosexual dysfunction.
Pelvic congestion syndrome.
Key clinical features
As it is almost always seen in women rather than men
Focus will be taking a history of pain associated with periods, ovulation and sexual intercourse.
It is invariably linked at times with lower abdo pain
In men it is related to
- trauma
- sporting injuries
- prostatic disorders
- hernias.
Exam abdo and pelvis; rectal and vaginal
Key investigations
- FBE
- ESR/CRP
- urine MC ± chlamydia PCR
- STI tests
- pregnancy test
- plain X-ray
- vaginal or pelvic ultrasound
- colour Doppler US imaging
- colonoscopy/flexible sigmoidoscopy
- laparoscopy if appropriate.
- cutaneous pain mapping
Diagnostic tips
The incidence of chronic pelvic pain (CPP) is 15% in 18–50 year old women.
Endometriosis causes 33% and adhesions 24%.
CCP in women is the reason for 40% of gynaecological laproscopies and 15% of hysterectomies.
Pelvic congestion syndrome is regarded as a type of ovarian dysfunction causing;
- unilateral pain
- deep dyspareunia
- postcoital aching
