Pain in the pubic area in women
Pain in the pubic area in women is provoked by traumatic injuries and diseases of the cartilage of the symphysis zone and adjacent bones, some gynecological and urological pathologies. They may occur during pregnancy. They can be acute, blunt, strong, non-intensive, permanent or periodic. With the involvement of solid structures, they strengthen or weaken when the body position changes. Determination of the nature of pathology is carried out on the basis of conversation, general and gynecological examination, the results of hardware and laboratory techniques. Therapeutic tactics depend on the cause of the pain syndrome, can be conservative (medications, physiotherapy) or operative.
Why does it hurt in the pubic area in women
Traumatic injuries
Osteomyelitis
Neoplasms of the pubic bone
Pregnancy period
Gynecological diseases
Pathologies of the urinary system
Diagnostics
Treatment
Assistance at the pre-hospital stage
Conservative therapy
Surgical treatment
Prices for treatment
Why does it hurt in the pubic area in women
Traumatic injuries
The cause of sudden pain may be bruises of the pubic symphysis and fractures of the anterior parts of the pelvis. With bruises, the pain syndrome develops after a blow or fall, is moderately pronounced, may be accompanied by local swelling, sometimes bruising. The volume of movements is preserved completely or almost completely, the supporting function is not violated. All symptoms disappear within 1-2 weeks.
With fractures, there are restrictions of movement, violation of the support of varying degrees of severity, inability to lift a straight leg on the side of the injury from a prone position. In women with damage to the upper branch of the pubic bone and the anterior pelvic semicircle, pain increases with palpation, compression, movements of the lower limb on the side of the lesion. With ruptures of the pubic articulation, the patient assumes a forced position with slightly bent and brought together limbs. The pain increases sharply when trying to spread your legs.
Osteomyelitis
Inflammation of the pubic bone occurs due to infection due to surgical interventions, deep wounds in the pubic area, purulent processes in the surrounding tissues. Soreness increases rapidly against the background of increasing swelling, redness of the skin, deterioration of the general condition. The amount of discharge increases, it becomes purulent. With osteomyelitis, a woman complains of twitching, tearing, throbbing pain in the pubic area. Fever, signs of severe intoxication are detected.
Neoplasms of the pubic bone
Pelvic bones are a frequent localization of benign and malignant tumors. With chondroblastomas, osteomas and osteochondromes, the pain is not intense, slowly increasing over a long time. Chondrosarcomas and metastatic neoplasia are characterized by rapid progression of pain syndrome. At first, the woman complains of minor aching or pulling pain in the pubic area. After a few months, the pain becomes severe, constant, unbearable, eliminated only by narcotic analgesics.
Pregnancy period
Minor soreness in the pubic area can normally be observed in the 2nd and 3rd trimesters of pregnancy. It is caused by an increase in the size of the fetus, the preparation of the body for the birth of a child. If the pain worsens at night, during sexual acts, walking on the steps, diluting the legs and pressure on the pubic area, it is worth suspecting symphysitis. Intense pain, inability to stand, walk and lift your legs indicate the development of symbiolysis – ligament damage and divergence of the pubic bones.
Pelvic fractures in pregnant women in half of cases develop as a result of injuries. In other women, they are the result of systemic diseases (osteoporosis, osteodystrophy) or local processes (tuberculosis, osteomyelitis). In the absence of provoking pathologies, spontaneous injuries occur extremely rarely. There is a classic fracture clinic: intense pain in the projection of the pubis or other areas of the pelvis, forced position, limitation of limb function.
Pain in the pubic area
Gynecological diseases
Pain in the pubis and suprapubic region is mainly noted when the uterus is affected, which, like the pubic joint, is located along the midline. It is determined in the following pathologies:
Acute endometritis. Pain syndrome occurs acutely simultaneously with the appearance of whites with an unpleasant odor, chills, general hyperthermia, tachycardia, soreness during urination. It is especially difficult in the presence of an intrauterine device.
Chronic endometritis. The pain is not intense, aching. Often combined with dyspareunia. They are supplemented by uterine bleeding, menstrual cycle disorders, bloody or serous-purulent discharge from the genital tract.
Postpartum endometritis. In mild cases, it develops for 5-10 days. There is a subfebrile temperature, pain over the womb, slight tachycardia, moderate lochia with an admixture of blood. In severe cases, it manifests on 2-3 days. Chills, fever, severe pain over the pubis, abundant bloody-purulent cloudy lochia with a fishy smell are detected.
Endometriosis. Painful sensations are found in 15-25% of women, can be localized only over the pubis or be spilled. They have a permanent character or are intensified in the premenstrual period. Other possible symptoms are dysmenorrhea, menorrhagia, soreness during sexual intercourse, urination and defecation.
Patients with adnexitis, salpingitis and ovarian cysts are more likely to complain of pain in the right or left iliac zone. Irradiation into the womb and suprapubic region is possible. In women with cysts, the pain syndrome increases with internal bleeding, suppuration, rupture of the shell or twisting of the leg of the cystic formation.
Pulling pains in the supral region with delayed menstruation and breast enlargement may indicate an ectopic pregnancy with the attachment of a fetal egg in the uterine part of the fallopian tube, rudimentary uterine horn or abdominal cavity. With the rupture of the fetal egg, the pain increases sharply, gives to the lower back, legs and anus, accompanied by bleeding or bloody discharge, weakness, tachycardia, loss of consciousness.
With cancer and uterine sarcoma, bleeding and menstrual cycle disorders are observed in the early stages. Subsequently, paroxysmal cramping pains occur over the womb, followed by the departure of the pathological discharge from the vagina. In the later stages, the painful sensations become intense, permanent. There are violations of the functions of neighboring organs, cancerous cachexia.
Pathologies of the urinary system
Pain over the pubis is typical for diseases of the bladder. They are observed in diseases such as:
Acute cystitis. Cutting and aching pains appear suddenly. There is an increase in urge, soreness, pain and burning when urinating, sometimes an admixture of blood in the urine, lower back pain, fever to subfebrile figures.
Chronic cystitis. It is diagnosed with 3 or more exacerbations in a year or 2 or more exacerbations in six months. It is accompanied by the same symptoms as acute cystitis, but the manifestations persist longer, often have a wave-like character.
Bladder cancer. Dysuria, pain in the pubic area, groin and sacrum is preceded by hematuria. The pain syndrome is initially insignificant or moderate, it is noted only when the detrusor is filled, later it becomes intense, painful, permanent.
Tuberculosis of the bladder. Develops against the background of kidney tuberculosis. It is manifested by constant aching pain in the suprapubic zone, frequent painful urination with a feeling of incomplete emptying of the bladder, imperative urges, periodic impurities of blood in the urine, malaise, increased fatigue, subfebrile temperature, weight loss.
Bladder stones. Pain in the lower abdomen and above the pubis at rest is insignificant. They increase sharply when changing the position of the body, during urination, which is associated with the movement of the concretion and traumatization of the mucosa. Possible irradiation to the perineum, labia, upper thighs.
Diagnostics
Women with suspected injuries and diseases of the musculoskeletal system are examined by an orthopedic traumatologist. Patients with signs of gynecological pathologies need to consult a gynecologist. In case of symptoms of damage to the urinary system, an examination by a urologist is necessary. At the initial stage, the specialist determines the circumstances of the appearance, the nature and duration of the pain syndrome, its connection with various factors, the presence of other manifestations. The diagnostic program may include the following procedures:
External inspection. Allows you to localize the source of pain (bones, internal organs). During the physical examination, the doctor detects redness, swelling, wounds, purulent foci, bone deformities, bulky formations, detects symptoms pathognomonic for certain pathological conditions.
Gynecological examination. It makes it possible to determine the presence and nature of secretions, the size and tone of the uterus, the condition of the appendages. It is used to assess the duration and course of pregnancy, during the primary diagnosis of endometritis, endometriosis, adnexitis, ovarian cysts, and other gynecological pathologies.
Radiography of the pelvis. In case of fractures, survey images are recommended to study all pelvic bones, complete visualization of possible severe and complex injuries. In osteomyelitis, tuberculosis, tumors, radiographs of the symphysis and pubic bones are performed. For women with symphysitis, the technique is prescribed in the postpartum period.
Ultrasonography. With symphysitis, ultrasound of the pubic articulation is performed to assess the severity of the pathology and choose the method of delivery. In gynecological diseases, ultrasound of the pelvic organs is performed. The best option in most cases is a method with simultaneous use of vaginal and abdominal sensors. With detrusor lesions, ultrasound of the bladder is performed. Some women are shown ultrasound of the kidneys.
Other visualization methods. With stones, urography is informative. Patients with neoplasms can undergo cystography, pelvic venography, lymphadenography. Women with urolithiasis are prescribed CT of the kidneys, ureters and bladder. Victims with traumatic injuries with insufficient informative radiography require a CT scan of the pelvis.
Endoscopic examinations. They are an important part of the diagnosis of tumors. With malignant neoplasia of the uterus, hysteroscopy is performed, with neoplasms of the bladder – cystoscopy. They provide detailed visualization of volumetric formations, provide for the collection of biopsies for subsequent histological analysis.
Laboratory tests. Leukocytosis and increased ESR in the UAC indicate the presence of inflammation. Urine, discharge from wounds and genitals are examined by seeding to identify the causative agent of infection. With symphysitis, a decrease in the amount of calcium and magnesium in the tank is determined. To confirm ectopic pregnancy, the level of chorionic gonadotropin is examined. As part of the morphological analysis of biopsies, the type and degree of malignancy of tumors are specified.
Ultrasound of the bladder
Ultrasound of the bladder
Treatment
Assistance at the pre-hospital stage
A woman with a suspected pelvic fracture should be placed on a shield, bending her legs and placing a pillow under them. The pelvic bones should be fixed by wrapping a handkerchief or a sheet. To prevent traumatic shock, it is recommended to warm up with a blanket, drink plenty of warm water, and take an anesthetic. Fractures and suspicion of an aborted tubal pregnancy are indications for the immediate call of an ambulance team.
Conservative therapy
Therapeutic tactics are determined by the cause of the development of pain in the pubis:
Injuries. Upon admission, intra-phase anesthesia is performed, in the case of isolated fractures of the pubic bone, local administration of an anesthetic is possible. The fixation option is chosen taking into account the type of damage, a shield or hammock is used, in severe cases – skeletal traction. Painkillers are used, antibiotics are prescribed for open injuries. During the rehabilitation period, patients are referred for physical therapy, massage and physiotherapy.
Osteomyelitis. The basis of therapy is antibiotics, which are selected taking into account the sensitivity of the pathogen, administered intramuscularly or intravenously. Analgesics are used. In case of severe intoxication, infusion therapy is performed. Bandages are carried out, the wound is washed and drained.
Symphysitis. To eliminate hypocalcemia, calcium preparations are prescribed, vitamin D and magnesium preparations are used to improve the absorption of the trace element. NSAIDs are recommended to eliminate aseptic inflammation. From non-drug methods, magnetotherapy, wearing a bandage, and special physical therapy complexes are effective. An adequate choice of delivery tactics is required, taking into account the severity of the pathology.
Endometritis. The primary task is to fight infection with the help of antibacterial agents. With severe intoxication, protein and salt solutions are administered intravenously. Immunomodulators, antihistamines, multivitamin complexes are prescribed. To eliminate bleeding and reduce pain in the acute period, cold, hormonal drugs are used. After the improvement of the condition, medicinal electrophoresis, UHF, magnetic therapy, ultrasound therapy are useful.
Endometriosis. Conservative treatment is carried out in case of asymptomatic course or insignificant severity of symptoms during premenopause, if necessary, restoration or preservation of reproductive function. Hormone therapy is carried out with combined estrogen-progestogenic agents, progestogens, antigonadotropic drugs, gonadotropin releasing hormone agonists.
Cystitis. The treatment regimen includes antibiotics from the groups of fluoroquinolones, nitrofurans, macrolides, cephalosporins and non-fluorinated quinolones. Uroseptics, NSAIDs, combined phytopreparations are used. Perform intravesical instillations. Inductothermy, UHF, and iontophoresis are performed.
Tuberculosis of detrusor. Anti-tuberculosis drugs and fluoroquinolones are being treated. Additionally, NSAIDs and angioprotectors are prescribed to reduce the severity of inflammation and prevent scarring of the urinary tract.
With adnexitis and salpingitis, antibiotics, anti-inflammatory drugs, physiotherapy are used. In case of oncological lesions, radiation therapy and chemotherapy are performed separately or as part of combination therapy, including in the pre– and postoperative period.
Surgical treatment
With pubic pain in women , the following surgical interventions may be indicated:
Fractures: osteosynthesis of the anterior pelvic semicircle.
Osteomyelitis: sequestrectomy.
Pelvic tumors: removal of benign neoplasms, ileo-abdominal resection, resection of pelvic bones or pubic bone.
Symphysitis: caesarean section with a significant divergence of the symphysis, a large fetus, a narrow pelvis, intense pain.
Endometriosis: laparotomy or laparoscopic excision of endometriosis foci, hysterectomy.
Ectopic pregnancy: tubotomy, tubectomy.
Malignant tumors of the uterus: hysterectomy or pangisterectomy, if necessary – in combination with lymphadenectomy.
Bladder concretions: cystolithotomy, cystolithotripsy, cystolithoextraction.
Neoplasia of the bladder: partial or radical cystectomy.
