Overview Pelvic pain of sudden onset. Of women of reproductive age it is a ectopic pregnancy until proven otherwise. Refer immediately to gynaecology all patients with a pelvic mass, abnormal cervix, or persistent bleeding
Definition Chronic pelvic pain (CPP): refers to pain of at least six months' duration that occurs below the umbilicus and is severe enough to cause functional disability or require treatment. Acute pelvic pain: generally defined as pain in the lower abdomen or pelvis lasting less than three months. In women, it can pose a challenging clinical scenario in which history and physical examination findings are often nonspecific, and the clinical presentation of each condition can vary widely. |
Differential Diagnosis
Acute pelvic pain - Gyaenacological
Acute Pelvic Pain - Non-Gyaenacological
Remember In a pregnant woman these differential will be different as the pain might be due to the obstetric complications |
Side note In Adolescents don't forget transverse vaginal septum and imperforate hymen |
Think In postmenopausal women who present with acute pelvice pain, ectopic pregngnacy and ovarian torsion is unlikely |
Chronic Pelvic Pain will be discussed elsewhere
More info on Chronic Pelvic Pain
DIFFERENTIAL DIAGNOSIS OF ACUTE PELVIC PAIN | ||
Condition | History | Examination |
Ectopic Pregnancy | Nausea, vaginal bleeding | Adnexal mass, hypotension |
Miscarriage | vaginal bleeding | |
Ovarian torsion | Nausea, vomiting, radiation of pain to groin, right sided or left sided pelvic pain | |
Ovarian cyst | Dyspareunia, left sided pelvic pain, Hypotension (ruptured left cyst) | Adnexal mass |
Endometriosis/endometritis | Dysmenorrhoea, Dyspareunia | Adnexal mass |
Pelvic inflammatory disease | Bilateral pelvic pain, Dysuria, Vaginal Discharge | Adnexal mass, bilateral adominal examination, cervical motion, uterine or adnexal tenderness, Fever, vaginal discharge |
Appendicits | Nausea, vomiting, pain migration from periumbilical to RLQ of abdomen | Fever, RLQ pain |
Urinary tract infection | Dysuria, Gross haematuria, Urinary Frequency | Fever |
Urinary stones | left sided pelvic pain, Gross haematuria, radiation of pain to groin |
Think Life threatening causes of pelvic pain are ectopic pregnancy, ruptured ovarian cyst, ovarian torsion, appendicits and PID |
Evaluation and Approach
Remember β-hCG to rule out pregnancy |