Pelvic pain

Pelvic pain – Differential Diagnosis

Common causes

• UTI
• Mittelschmerz
• Threatened miscarriage
• Ovarian cyst
• Endometriosis
• Chronic Pelvic Pain
• Irritable bowel syndrome
• Muscular strain
• IUCD
• Renal colic
• Psychiatric (functional)

Must Not Miss

• ‘Acute’ Abdomen
  • Ectopic pregnancy
  • Incarcerated hernia
  • Appendicitis
• Malignancy
  • Ovarian cancer
  • Endometrial cancer
  • Cervical cancer
  • Colorectal cancer
• Infection
  • Pelvic Inflammatory Disease
  • Pelvic abscess
  • Diverticulitis
• Acute urinary retention
• Ovarian Torsion

Easily missed

• Crohn’s dis/ Ulcerative colitis

Red flags

• Pregnant and severe pain
• Abdominal swelling/mass
• PMB/IMB/PCB
• Weight loss
• Rectal bleeding
• Persistent altered bowel habit: age > 50 years
• Systemic features (fever, night sweats, anorexia)

Investigations to consider

• FBC, CRP/ESR
• U&Es, LFTs
• Urinalysis/culture
• Pregnancy test
• Genito-urinary swabs
• AXR/ KUB
• US scan (Abdominal & Pelvis)
• Cervical smear/ Colposcopy
• Hysteroscopy
• Laparoscopy
• Colonoscopy
• CT scan