Pelvic pain | Dr Shamim Y. Patel MD
Pelvic pain is a common gynecological issue. This pelvic pain is something that so many women suffer with on a regular basis. Pelvic pain can have a large differential diagnosis and even the severity of pelvic pain can range in a large way. In other words the pelvic pain can be anywhere from a small twinge to debilitating pain that requires hospital admission. So any degree of pelvic pain should be determined as the patient deserves to know what is the issue and what is going on so that things do not worsen. As a gynecologist I treat pelvic pain every time I’m in clinic because this is such a common reason for referrals to my office and it is also a reason why patients seek Gyn care. Pelvic pain includes pain from the pelvic bones to the muscles to the ligaments to medical conditions like endometriosis to endometritis to pelvic inflammatory or infections to pelvic trauma to uterine prolapse to any type of even pelvic floor muscle weakness to ovarian masses or ovarian torsion to fibroids. The initial step in evaluating pelvic pain is to start with the basic is the history and physical exam. This history should include the exact location of the pelvic pain and also if it travels, what does it feel like, is it achy is it stabbing is it pulling, ect. How long has the pelvic pain been going for? Clearly the history is important to pin down what this differential diagnosis may be since the differential is so long, as a physician you want to clearly order the needed tests but not so many extra tests. With the rising cost of healthcare and the need to pick the right tests, it is very important to be efficient. It is very expensive for patients to get any tests especially even basic lab tests can cost excessive amounts of money. So let’s start with the history and then decide what tests are likely to be involved. Next is the crucial physical exam. Remember this patient has pain so as a gynecologist I am always gentle, especially careful in the physical exam for a woman in pelvic pain. I do a complete exam including a speculum exam and I include cultures to check for infections if there is any concern. The physical exam often tells me what the problem is. If it’s pelvic inflammatory disease (pid) then I can tell the patient has cervical motion tenderness. If it’s endometriosis I have palpated tenderness in the cul de sac on exam. The exam should not be dismissed. This exam just include an abdominal exam too. This included palpating gently the abdomen and making sure the pelvic pain is not liked to something unrelated to gynecological issues. Remember the bowels are in close proximity to the female pelvis and something like diverticulitis can cause pelvic pain but this patient will be referred to a gastroenterologist. Next I order the labs- if the patient has an infection I obtain that cbc with differential to check the white blood cells. If the patient has fibroids I want to look for anemia or low blood cell count. The labs are tailored to the suspected diagnosis. Next I find the pelvic ultrasound so important for pelvic pain. Remember it’s just sound waves and a simple limited scan can find so much. Often I want a complete scan including the abdomen. After the scan, now it’s time to get back those labs and start unraveling that diagnosis. This is where I spent the time with each patient of mine and tailor the treatment options to each patient. Pelvic pain is a significant problem in our society but luckily the treatment options are there. As a physician I find the crucial step is making the right diagnosis and then going on with treatment options. This should lead to the remedy of the pelvic pain. Each of the diagnoses has a long pathway of treatment options and monitoring so let’s continue this discussion in the near future.