Friday, September 28, 2012

Bothersome Pelvic Pain

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

I am a 69 year old very healthy woman - never had surgery.  I am post-menopausal for 15 - 18 years.  I take no hormones.  Have never had any post-menopausal bleeding.  I have been  celibate for the past 5 yr. About 2 weeks ago I noticed an uncomfortable, crampy feeling in my very low abdomen - like the menstrual cramps of years ago - and also low back discomfort.  No discharge or bleeding.  Bowels fine.  No stomach discomfort or nausea.  Eating normally.  I do not feel bloated.  My last Pap test was 2 yr. ago. What do you think?


Gender: Female
How tall are you (feet and inches)?: 5 ft 5 in.
What is your weight in pounds?: 169
How old are you?: 69
How long has this been going on?: A week or two

Check all symptoms you are currently experiencing:
Abdominal Pain

What have you done so far to remedy this condition? Please include tests and relevant studies here.

I have appt. with my GP tomorrow - plan to ask for referral to gynocologist.  I had my yearly physical 6 mo, ago and all labs were good.

Please list any chronic medical problems and also list any prior surgery  Hypertension (controlled)
Occasional atrial fib - none for 3 months (on med)
Check all conditions present in your immediate family... :
Asthma / Lung Problems
Cancer
Cardiac Disease
History of Back Pain
Hypertension
Stroke

Please list any medications you are currently taking (and dosage if known) Norvasc 5 mg qd
Amiodarone 100 mg qd
Prilosec 10 mg qd
Asa 61 mg qd

When was your last menstrual cycle?: I no longer have a menstrual cycle

Are you currently using or do you have a history of tobacco use?: No

Are you currently using or do you have a history of illegal drug use?: No

Please describe your alcohol consumption :: Weekly

I would like to know how I should proceed, after I see my GP tomorrow.  Should I request a CT, ultrasound, or MRI?

_____________________________________



Great question. The list of possible problems is great but abdominal pain such as you are experiencing and at your age needs to be taken seriously indeed. To get to you most important question at the bottom here, it's going to be your GP's call. But before you get to the CT v MRI v US it's time for another pelvic exam and pap smear. This may give your GP a good clue as to the best imaging test to order. As a rule the CT of the abdomen and pelvis is easy to get, quick, and very sensitive for most problems that occur in the abdomen up to and including various cancers. Deep breath, I am not suggesting this is the answer, I am merely pointing out that the CT is the best exam to get quickly to see everything between the diaphragms to the pelvic floor. An MRI is typically better for detail of soft tissue, but we are getting ahead of ourselves. An ultrasound is best to look at the ovaries and uterus but otherwise probably won't have much utility in your case. Expect your GP to do a pelvic exam and to check your stool for blood. Expect some labs to be drawn along with a urine sample. And then ask your doctor, who knows you well, what the top three things he is concerned about are. I will tell you that when you look at it this way, in terms of BAD diagnoses, that cancer does appear on the list. Cancer of the bowel, uterus, ovary, or bladder. But against these possibilities is the fact that these symptoms have been apparent for two weeks and happened rather acutely and seem to be accompanied by no other symptoms other than pain. Not a worrisome story for cancer, more likely pointing to a more benign cause. Constipation? Bladder infection? Hernia? I hope this has been helpful. Please feel free to comment or ask more questions below. Please check back in and let us know the result. God Bless.

1 comment:

space doc said...

I agree with all that MDSTAT DOC 1 has said. After the pelvic exam and repeat pap it is a tossup whether an ultrasound or a C-T scan would be the next step.

If the uterus and ovaries are o.k. it may be necessary to look for intestinal problems (polyps etc. in the colon; irritable bowel syndrome).

Occasionally a gynecologist may be needed to do a biopsy of the uterine lining.

You are certainly on the right track and very wise not to ignore the symptoms.

Good Luck! Would love to hear the follow up.

Space Doc.rmrpon