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
ACOG Practice Bulletin Summary 218: Chronic Pelvic Pain
Chronic Pelvic Pain (Obstetrics & Gynecology, 2014)
RCOG Green-top Guideline 41: Chronic Pelvic Pain, Initial Management (reviewed 2017)
Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome (Journal of Clinical Medicine, 2017)
AGA: Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation
Abdominal migraine in the differential diagnosis of acute abdominal pain (American Journal of Emergency Medicine, 2015)
Evidence-Based Medicine Approach to Abdominal Pain (Emergency Medicine Clinics of North America, 2016)
AAFP: Abdominal Aortic Aneurysm
GeneReviews: Acute Intermittent Porphyria
GHR: Familial Mediterranean Fever
GeneReviews: Familial Mediterranean Fever
Emerging Therapies in Hereditary Angioedema (Immunology and Allergy Clinics of North America, 2017)
Hereditary and acquired C1-inhibitor-dependent angioedema: from pathophysiology to treatment (Annals of Medicine, 2016)
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