Considering the number of anatomic structures, there are many disease processes that cause pelvic and rectal pain. In some patients, no actual disease process can be identified. Table 39-2 describes a classification system that provides the clinician with a systematic approach to the diagnosis and management of pelvic pain syndromes. Organic: Inflammatory Diseases That Affect the Pelvis and Anorectum
Common anorectal disorders that present as perineal or pelvic pain readily lend themselves to diagnosis; these include abscesses (cryptoglandular, intramuscular), fistulas, Crohn's disease, and ulcerative proctitis. These conditions must be excluded as the source of pelvic pain.
In the male patient, chronic or acute prostatitis may present as rectal or pelvic pain. Urinary symptoms are often present and should be elicited in questioning. Digital rectal examination in men should always include careful prostatic palpation to exclude these conditions. Transrectal ultrasound may be helpful to diagnose pelvic pain, revealing pathology of the male reproductive organs. In women, tubo-ovarian infections, ectopic pregnancy, endometritis, and endometriosis are potential sources of pelvic pain. Bimanual pelvic examination with speculum visualization of the cervix will usually suffice to eliminate these concerns. Occasionally, ultrasonography or CT of the pelvic viscera is necessary to complete the evaluation.
Occasionally, complicated diverticular disease of the sigmoid colon or a pelvic appendicitis may present as pelvic pain. The history will generally direct the clinician to a more specific gastrointestinal work-up. Contrast radiography, CT, and ultrasonography may assist in this determination.
Was this article helpful?