When it comes to women’s health, pelvic pain is a serious condition that needs to be examined carefully and seriously. Pelvic pain is a common problem among women and in primary care office, and it is seen in approximately in one to two percentage of women (Dunphy et al., 2015). The nature and intensity of the pain may fluctuate, and its cause is often unclear. According to Dunphy et al., (2015) pelvic pain is characterized as acute, chronic or recurrent and reported in both pelvic or lower abdomen. Speer, Mushkbar, & Erbele (2016) define Chronic Pelvic Pain (CPP) as a persistent, noncyclic pain perceived to be in structures related to the pelvis, lasting more than six months, and does not show any signs of improvement with treatment. Due to the multiple possible causes to develop CPP, the diagnosis could be difficult and must be done with care. The cause of the pelvic pain might stem from genitourinary, gastrointestinal, musculoskeletal system disease or dysfunction which could cause sudden acute pain. (Dunphy et al., 2015). CPP is not a direct diagnosis, but rather a condition that is caused by numerous factors or another medical disease. The most prevalent and medically significant causes are cancers, sexually transmitted diseases (STDs), and general medical issues with the intestines and reproductive organs (Passavanti, Pota, & Sansone, 2017). Ovarian cancer, chlamydia, and ovarian cysts are all potential causes that could be extremely serious for the patient and could even be life threatening. On the other hand, it could be simple ache or pain caused by relatively benign reasons (Speer, Mushkbar, & Erbele, 2016). Chronic or recurrent pelvic pain is less urgent; and recurrent pain could be associated or not with menstruation (Dunphy et al., 2015). The origin of CPP could be related to benign or malignant neoplasms or characterized as psychogenic. (Dunphy et al., 2015).
Pain is a subjective symptom, and healthcare professionals cannot experience the pain that the patient is experiencing. However, there are procedures that can help with assessment and diagnosis. First, when assessing pelvic pain, a solid interview with the patient should be conducted, including the use of pain scales, questionnaires, and direct statements from the patient (Passavanti, Pota, & Sansone, 2017). Severe persisting pain that has been present for an extended period should be evaluated and taken as a potential cause for professional diagnosis. Due to the sheer amount of potential conditions that could cause pelvic pain, being able to narrow down possible causes is extremely important. Therefore, other factors must be put into consideration to make a good differential diagnosis. Lifford & Barbieri (2002) state that evaluating potential pre-existing conditions such as depression, narcotic dependency, and physical, sexual, or emotional abuse is crucial when diagnosing pelvic pain. In the case that patients state that the pain is unbearable and severely affects their everyday life, referral to emergency department must be recommended to get promptly treatment. Overall, the diagnosis and evaluation of pelvic pain cannot be taken lightly and should be done with caution to implement an adequate treatment with good health outcomes, which could give to the patient a better quality of life. The determination when and why one would refer a patient for diagnostics and second opinions is based upon by the physical exam and tests, treatments might include medicines, surgical procedures, physical therapy and pain management techniques.
There are many different causes of pelvic pain in women. Pelvic pain is defined as pain that is felt in the lower part of the abdomen or pelvis and can be caused from urinary, reproductive/sexual, musculoskeletal, or digestive issues (Mayo Clinic, 2018). One of the causes can be due to uterine fibroids. Uterine fibroids, also referred to as leiomyomas, are noncancerous growths in the uterus that can cause pain, abnormal bleeding, pelvic pressure, constipation, and back aches (Mayo Clinic, 2018). Uterine fibroids are most commonly seen in patients who are in child bearing years and they can vary in size, shape, and symptom severity. Fibroids do not generally interfere with conceiving; however, they can lead to placental abruption, preterm delivery, and fetal growth restriction if not managed properly. (Mayo Clinic, 2018).
This patient would be referred to a GYN specialist and surgeon, have a pelvic ultrasound obtained with results sent to both the primary and GYN. The GYN specialist, surgeon, and patient can discuss a treatment plan such as expectant management, laparoscopic myomectomy, or hysterectomy. (Mayo Clinic, 2018)
The steps to writing a referral involve the diagnosis and chief complaint, plan of care such as the ultrasound, and the NP should plan to see the patient in 2 weeks for ultrasound review and to discuss the patient’s plan going forward.