13 - Diagnosis and management of acute pelvic pain

Summary

Introduction

Acute pelvic pain is usually defined as pain of less than 2 weeks’ duration. While this chapter focuses on the common gynaecological conditions that cause acute pain, it should be borne in mind that a woman may suffer an acute exacerbation of a chronic condition that may or may not have been previously diagnosed. Therefore, in some women the cause of the acute pain will be a condition typically associated with chronic pelvic pain. This chapter primarily describes the clinical approach to the management of acute pelvic pain rather than providing detailed descriptions of separate pathological entities causing pain. The emphasis is on clinical presentation and differential diagnosis of pelvic pain, with plenty of practical advice.

History and clinical examination

Taking a detailed history is one of the most important elements of the clinical assessment of a woman presenting with acute pelvic pain. Even if you are not the first person to see the woman and her history has already been taken by a colleague, it is always worth hearing the woman describe the onset and character of the pain again in her own words. The uterus, cervix and adnexa share the same visceral innervation as the lower ileum, sigmoid colon and rectum. Afferent pain signals travel via the sympathetic nerves to spinal cord segments T10 to L1. Because of this shared pathway, distinguishing between pain of gynaecological origin and pain of gastrointestinal origin is often difficult.