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. May occur during pregnancy. They are sharp, blunt, strong, non-intense, permanent or intermittent. With the involvement of solid structures, they increase or decrease with a change in body position. The nature of the pathology is determined on the basis of a conversation, a general and gynecological examination, and the results of hardware and laboratory techniques. Therapeutic tactics depend on the cause of the pain syndrome, it can be conservative (medications, physiotherapy) or operational.
Why does it hurt in the pubic area in women
Traumatic injuries
The cause of sudden pain can be bruises of the pubic symphysis and fractures of the anterior pelvis. With bruises, the pain syndrome develops after a blow or fall, is moderately expressed, may be accompanied by local swelling, sometimes bruising. The range of motion is completely or almost completely preserved, the support function is not disturbed. All symptoms disappear within 1-2 weeks.
With fractures, there are restrictions on movement, violation of the support of varying severity, inability to raise the straight leg on the side of the injury from the prone position. In women with damage to the upper branch of the pubic bone and the anterior pelvic half ring, the pain increases with palpation, compression, and movements of the lower limb on the side of the lesion. With ruptures of the pubic joint, the patient takes a forced position with the limbs slightly bent and brought together. The pain increases sharply when you try 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 quickly increases 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 jerking, 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 osteochondromas, the pain is not intense, slowly increasing for a long time. Chondrosarcomas and metastatic neoplasias are characterized by rapid progression of the pain syndrome. At first, a woman complains of slight aching or pulling pain in the pubic area. After a few months, the pain becomes severe, constant, unbearable, and is eliminated only by narcotic analgesics.
Pregnancy period
Slight soreness in the pubic area can normally be observed in the 2nd and 3rd trimesters of pregnancy. It is due to an increase in the size of the fetus, the preparation of the body for the birth of a child. If the pain intensifies at night, during sexual intercourse, walking up stairs, spreading the legs and pressure on the pubic area, it is worth suspecting symphysitis. Intense pain, inability to stand, walk and raise legs indicate the development of symphiolysis - damage to the ligaments and divergence of the pubic bones.
Pelvic fractures in pregnant women in half of the cases develop as a result of injuries. In other women, they become 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 with damage to the uterus, which, like the pubic joint, is located in the midline. It is determined in the following pathologies:
- Acute endometritis. Pain syndrome occurs acutely simultaneously with the appearance of leucorrhoea with an unpleasant odor, chills, general hyperthermia, tachycardia, pain during urination. It is especially difficult in the presence of an intrauterine device.
- Chronic endometritis. The pains are not intense, aching. Often associated with dyspareunia. Complemented by uterine bleeding, menstrual disorders, bloody or serous-purulent discharge from the genital tract.
- Postpartum endometritis. In mild cases, it develops for 5-1 days. Subfebrile temperature, pain over the womb, slight tachycardia, moderate lochia mixed with blood are noted. In severe cases, it manifests for 2-3 days. Chills, fever, severe pain above the pubis, abundant bloody-purulent turbid lochia with a fishy smell come to light.
- Endometriosis. Painful sensations are found in 15-25% of women, they can be localized only above the pubis or be spilled. Have a permanent character or increase in the premenstrual period. Other possible symptoms are dysmenorrhea, menorrhagia, pain during intercourse, urination, and defecation.
Patients with adnexitis, salpingitis and ovarian cysts often complain of pain in the right or left iliac zone. Irradiation to the womb and suprapubic region is possible. In women with cysts, the pain syndrome increases with internal bleeding, suppuration, rupture of the membrane or torsion of the cystic pedicle.
Drawing pains in the suprapubic region during delayed menstruation and breast engorgement may indicate an ectopic pregnancy with the attachment of a fetal egg in the uterine part of the fallopian tube, the rudimentary horn of the uterus or the abdominal cavity. When the fetal egg ruptures, the pain increases sharply, radiates to the lower back, legs and anus, accompanied by bleeding or spotting, weakness, tachycardia, loss of consciousness.
With cancer and sarcoma of the uterus in the early stages, bleeding, menstrual irregularities are observed. Subsequently, there are paroxysmal cramping pains over the bosom, followed by discharge of the pathological discharge from the vagina. In the later stages, the pain becomes intense, constant. There are violations of the functions of neighboring organs, cancer cachexia.
Pathologies of the urinary system
Pain above the pubis is typical for diseases of the bladder. They are observed in diseases such as:
- Acute cystitis. Cutting and aching pains appear suddenly. Increased urges, soreness, cramps and burning during urination, sometimes an admixture of blood in the urine, back pain, fever to subfebrile numbers are detected.
- Chronic cystitis. Diagnosed with 3 or more exacerbations in a year or 2 or more exacerbations in six months. 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 pubis, 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, constant.
- Tuberculosis of the bladder. It develops against the background of tuberculosis of the kidneys. It is manifested by constant aching pain in the suprapubic area, 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, and weight loss.
- Bladder stones. Pain in the lower abdomen and above the pubis at rest are minor. They increase sharply with a change in body position, during urination, which is associated with the movement of the calculus and traumatization of the mucosa. Irradiation to the perineum, labia, upper thighs is possible.
Diagnostics
Women with suspected injuries and diseases of the musculoskeletal system are examined by an orthopedic traumatologist. Patients with signs of gynecological pathologies require a consultation with a gynecologist. With symptoms of damage to the urinary system, an examination by a urologist is necessary. At the initial stage, the specialist establishes the circumstances of the appearance, the nature and duration of the pain syndrome, its relationship with various factors, the presence of other manifestations. The diagnostic program may include the following procedures:
- Visual inspection. Allows you to localize the source of pain (bones, internal organs). During the physical examination, the doctor reveals redness, swelling, wounds, purulent foci, bone deformities, volumetric formations, and detects symptoms that are pathognomonic for certain pathological conditions.
- Gynecological examination. It makes it possible to determine the presence and nature of discharge, the size and tone of the uterus, the condition of the appendages. It is used in assessing the duration and course of pregnancy, during the primary diagnosis of endometritis, endometriosis, adnexitis, ovarian cysts, and other gynecological pathologies.
- X-ray of the pelvis. In case of fractures, survey pictures are recommended to study all the pelvic bones, to fully visualize possible severe and complex injuries. With 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, an ultrasound of the pubic symphysis 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 the method with the simultaneous use of vaginal and abdominal sensors. With lesions of the detrusor, an 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. Patients with traumatic injuries with insufficient information content of radiography require a CT scan of the pelvis.
- Endoscopic studies. 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 a detailed visualization of volumetric formations, provide for the collection of biopsy specimens for subsequent histological analysis.
- Laboratory tests. Leukocytosis and an increase in ESR in the KLA indicate the presence of inflammation. Urine, discharge from wounds and genital organs are examined by culture to identify the causative agent of infection. With symphysitis, a decrease in the amount of calcium and magnesium in the LHC is determined. To confirm an ectopic pregnancy, the level of human chorionic gonadotropin is examined. As part of the morphological analysis of biopsy specimens, the type and degree of malignancy of tumors are specified.
bladder ultrasound
Treatment
Help at the prehospital stage
A woman with a suspected pelvic fracture must be laid on a shield, bending her legs and placing a pillow under them. The pelvic bones should be fixed by wrapping a scarf or 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 the suspicion of an interrupted tubal pregnancy are indications for the immediate call of an ambulance team.
Conservative therapy
Therapeutic tactics is determined by the cause of the development of pain in the pubis:
- Injuries. Upon admission, intrapelvic anesthesia is performed; in the case of isolated pubic bone fractures, local anesthetic administration is possible. The fixation option is chosen taking into account the type of damage, using a shield or a hammock, in severe cases - skeletal traction. Painkillers are used, and antibiotics are prescribed for open injuries. During the rehabilitation period, patients are referred to exercise therapy, massage and physiotherapy.
- Osteomyelitis. The basis of therapy are antibiotics, which are selected taking into account the sensitivity of the pathogen, administered intramuscularly or intravenously. Use analgesics. In case of severe intoxication, infusion therapy is carried out. Dressings are carried out, the wound is washed and drained.
- Symphysite. Calcium preparations are prescribed to eliminate hypocalcemia, vitamin D and magnesium preparations are used to improve the absorption of the microelement. NSAIDs are recommended to eliminate aseptic inflammation. Of the non-drug methods, magnetotherapy, wearing a bandage, and special exercise therapy complexes are effective. An adequate choice of obstetric tactics is required, taking into account the severity of the pathology.
- Endometritis. The first priority is to fight the infection with antibacterial agents. With severe intoxication, protein and saline solutions are administered intravenously. Assign immunomodulators, antihistamines, multivitamin complexes. Cold and hormonal preparations are used to eliminate bleeding and reduce pain in the acute period. After the condition improves, medicinal electrophoresis, UHF, magnetotherapy, and ultrasound therapy are useful.
- Endometriosis. Conservative treatment is carried out in case of an asymptomatic course or a slight severity of symptoms during the premenopausal period, if it is necessary to restore or preserve reproductive function. Hormone therapy is carried out with combined estrogen-gestagenic agents, gestagens, antigonadotropic drugs, agonists of gonadotropic releasing hormones.
- Cystitis. The treatment regimen includes antibiotics from the groups of fluoroquinolones, nitrofurans, macrolides, cephalosporins and non-fluorinated quinolones. Apply uroseptics, NSAIDs, combined herbal remedies. Perform intravesical instillations. Conduct inductothermy, UHF, iontophoresis.
- Detrusor tuberculosis. Produce therapy with anti-tuberculosis drugs and fluoroquinolones. Additionally, NSAIDs and angioprotectors are prescribed to reduce the severity of inflammation and prevent cicatricial changes in the urinary tract.
With adnexitis and salpingitis, antibiotics, anti-inflammatory drugs, and physiotherapy are used. In case of oncological lesions, either separately or as part of combination therapy, including pre- and postoperative periods, radiation therapy and chemotherapy are performed.
Surgery
For pain in the pubis in women, the following surgical interventions may be indicated:
- Fractures: osteosynthesis of the anterior pelvic half ring.
- Osteomyelitis: sequestrectomy.
- Tumors of the pelvis: removal of benign neoplasms, interilio-abdominal resection, resection of the 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 panhysterectomy, if necessary - in combination with lymphadenectomy.
- Bladder stones: cystolithotomy, cystolithotripsy, cystolithoextraction.
- Bladder neoplasia: partial or radical cystectomy.