History
- History of reproductive, colon, or breast cancer
- History of dysmenorrhea, ovarian cysts, pelvic inflammatory disease, sexually transmitted disease
- Endometriosis
- Chronic bladder of urinary tract infections
- Chronic irritable bowel syndrome
- Previous history of pelvic/bladder surgeries, especially hysterectomy
- Resent abortion or miscarriage
- History of assault, incest, or trauma
- History of prolonged labor; use of forceps or vacuum extraction during delivery
- History of multiple births
- Chronic yeast/vaginal infections
- History of varicose veins in the lower extremities (risk factor for pelvic congestion syndrome)
Risk factors
- Recent intrauterine contraceptive device (rejection) or long term use, especially without medical follow-up (scar tissue)
- Perimenopause, menopause (vaginitis)
- Sexual activity without use of a condom
- Multiple sexual partners
- Childbirth, recent abortion, multiple abortions
Clinical Presentation
- Poorly localized, diffuse; client unable to point to one spot
- Aggravated by increased intra-abdominal pressure (e.g. standing, walking, sexual intercourse, coughing, constipation, Valsalva's maneuver)
- Pelvic pain is not affected by specific movements but gets worse toward the end of the day or after standing for a long time
- May be temporarily relieved by position change (e.g. getting off feet, resting or elevating the legs, putting the feet up)
- Pelvic pain is not reduced or eliminated by by scar or soft tissue mobilization or by trigger point release of myofascial structures in the pelvic cavity
- Positive McBurney's, Blumberg's, or iliopsoas/obturator sign
Associated signs and symptoms
- Discharge from vagina or penis
- Urologic signs and symptoms
- Unreported abdominal pain
- Dyspareunia
- Constitutional symptoms
- Missed menses or unexplained/unexpected spotting (e.g. ectopic pregnancy) ask about shoulder pain
- Headache, fatigue, irritability
References
Goodman CCM, PT Snyder, T.K. MN, RN, OCN. Differential Diagnosis for Physical Therapists: Screening for referral 4ed: Saunders Elsevier; 2007.