The differential diagnosis of pelvic/ lower abdominal pain is extensive. Sometimes, the diagnosis is clear, but patients may present with ongoing pain, lasting several months in duration. Of particular concern is when such pain leads to functional disability, need for medical care and incomplete relief with prior medical and surgical therapies. Below, we provide key points to consider when performing the work-up as well as where to look next when a clear answer from the common differential list is not apparent.
Note: Watch for ‘Red Flag’ signs and symptoms which require immediate evaluation/referral
General Musculoskeletal Exam
The following differential diagnosis list is not exhaustive, but represents disorders to consider in a woman with ongoing pain, a non-surgical abdomen, and negative pregnancy test
Endometriosis and/or Adenomyosis (see ‘Related ObG Topics’ below for clinical findings, evaluation and treatment of endometriosis)
Residual Ovary Syndrome (Trapped Ovary Syndrome)
Vaginal Apex Pain
Pelvic Floor Disorders
Irritable Bowel Syndrome (IBS)
Other GI Disorders to Consider
Below are a few genetic syndromes that could be placed on the differential
Note: Pain episodes can last hours to days, and vary in frequency
Note: Pain episodes can last for days but frequency and duration are variable
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