209. Pelvic Pain

I am rarely comfortable with my diagnoses of pelvic pain.  Any age, any body type, any psych profile.  Pelvic pain can be constant, intermittent, sharply defined, or a vague ache. Ovaries, fallopian tubes, bowels, bladder, may share common nerve pathways, and to a lesser extent, muscles, ligaments and tendons. So a patient may be convinced that her ovary is the problem when it may be the bowels.  Sometimes an ultrasound or CT X-ray will point to the source: a tubal pregnancy, say, or a large, twisted ovarian cyst.  But sometimes, no test helps. So I may suggest a tentative diagnosis, but doubt often remains.

Consider Rachael, a 29 year old who presented with severe pelvic cramping, lasting for 45 minutes after awakening, usually from a sexual dram.  During past year, frequency has increased to once every few weeks.  She states that they do not feel like orgasms, which are not painful.  The symptoms are relieved within 10 minutes of having a bowel movement, though she does not feel the urge to relieve her bowels.  Otherwise, no problems with her gastrointestinal system.  Her only significant history are migraine headaches. 

I suggest to the family practice doctor who consulted me, to manage her as a patient with irritable bowel, and if this proved unhelpful to refer her to gynecology.  I've not heard back