Acute Pelvic Pain
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.
Acute pelvic pain – Gyaenacological
- Ectopic pregnancy
- Miscarriage
- Ovarian cyst rupture
- Ovarian torsion
- Ovarian haemorrhage
- Fallopian torsion
- Endometritis
- Pelvic Inflammatory Disease
- Mittelschmerz
Acute Pelvic Pain – Non-Gyaenacological
- Appendicitis
- Urinary stones
- Urinary Tract infection
In a pregnant woman these differential will be different as the pain might be due to the obstetric complications.
In Adolescents don’t forget transverse vaginal septum and imperforate hymen.
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 | |
Life threatening causes of pelvic pain are ectopic pregnancy, ruptured ovarian cyst, ovarian torsion, appendicits and PID.
Evaluation and Approach
- History
- Examination
- Psychological Assessment
- Investigations
β-hCG to rule out pregnancy.
Discussion