Pelvic pain

Question 1

what are some acute causes of pelvic pain?

Answer 1

• ectopic pain
• UTI
• appendicitis
• PID
• ovarian torsion
• miscarriage

Question 1

what is the most common cause of pelvic pain?

Answer 1

primary dysmenorrhoea

• transient pain in middle of cycle secondary to ovulation (Mittelshmertz)

Question 2

what are some chronic causes of pelvic pain?

Answer 2

endometriosis
IBS
ovarian cyst
urogenital prolapse

Question 3

what are common causes of pelvic pain in older women?

Answer 3

• cystitis
• constipation
• pelvic organ prolapse
• reproductive tract cancers

Question 4

what features would you focus on in someone with pelvic pain?

Answer 4

history + associated sx
vaginal bleeding or discharge, dyspenunia, fever, haemodynamic instability
signs of pregnancy
infection signs
GI pain
urinary sx
PMH for obs, gynae hx
surgical hx
gynae hx: gravidity, parity, menstrual history, sexual history, history of sexually transmitted infections, infertility, ectopic pregnancy, PID

Question 5

how might you examine in pelvic pain?

Answer 5

• abdomen palpated for tenderness, masses
• rectal exam for blood, masses
• cervix abnormalities
• bimanual exam cervical motion tenderness, adnexal masses or tenderness, and uterine enlargement or tenderness
• do not apply pressure to mass, is ectopic suspected

Question 6

what are some red flag sx of pelvic pain?

Answer 6

• Syncope or hemorrhagic shock (eg, tachycardia, hypotension)
• Peritoneal signs (rebound, rigidity, guarding)
• Postmenopausal vaginal bleeding
• Fever or chills
• Sudden severe pain with nausea, vomiting, or diaphoresis

Question 7

how do you assess for cervical motion tenderness?

Answer 7

elicited bymoving the cervix side to side between the index and middle fingers– If positive, it will be exquisitely painful and can often make the patient jump in response

Question 8

how is pelvic pain investigated?

Answer 8

• pregnancy test
• urinalysis
• USS for ectopic
• if a mass is suspected, pelvic ultrasonography

Question 9

how is pelvic pain managed?

Answer 9

• laparoscopy or laparotomy in case of emergency
• Pelvic pain in nonpregnant - oral nonsteroidal anti-inflammatory drugs
• Pain related to the menstrual cycle (eg, dysmenorrhea, endometriosis) - hormonal contraceptives
• Musculoskeletal or myofascial pain requires rest, heat, physical therapy, analgesics or other drugs
• hysterectomy may be offered as a last option