Duration Health — Field Guide: Pelvic & Urinary

Pelvic and Urinary

Introduction

Pelvic or lower abdominal pain can be caused by a number of different things, including pregnancy, infections like urinary tract infection, yeast infection, and sexually transmitted infections, as well as more serious conditions like appendicitis that require surgical treatment. Urinary tract infections usually cause mild lower abdominal/pelvic pain or cramping, pain or burning with urination, or sensation of feeling like you have to urinate more frequently or urgently. Yeast infections can cause itching of the vaginal area and a thick white vaginal discharge. Sexually transmitted infections may cause some pelvic discomfort and white, yellow or green vaginal discharge. If you have severe or persistent lower abdominal/pelvic pain or the pain is associated with fever, seek help immediately, as this could indicate a more severe infection of the uterus or fallopian tubes, appendicitis (especially if pain is in the right lower abdomen), or a condition called ovarian torsion, where the blood supply to the ovaries is blocked which can result in losing an ovary.

Treatment

If you are having pelvic pain, first check if you could be pregnant using the pregnancy test. If you are pregnant, seek immediate medical attention, as pelvic pain in pregnancy is a medical emergency until proven otherwise. Do not take any medications listed in this guide if you are pregnant until you consult with your obstetrician.

Urinary tract infections may be treated with an antibiotic called nitrofurantoin (generic for Macrobid®). Yeast infections may be treated with fluconazole. Consider using the urine test strips to test for the presence of leukocytes and nitrites, either of which suggest the presence of a urinary tract infection.

Emergency Contraception

Levonorgestrel (generic for Plan B) is an emergency contraceptive. Take one tablet as soon as possible within 72 hours of unprotected sex to prevent pregnancy if primary birth control methods fail. Do not take if already pregnant. Levonorgestrel does not protect against sexually transmitted infections.

When To Worry

Seek immediate medical care if you have any of the following:

  • severe or persistent pelvic pain
  • fever associated with pelvic pain
  • you are pregnant and have pelvic pain

Pediatrics

Quick Guide

If you have

  • unprotected sex within the past 72 hours and desire to PREVENT pregnancy
  • failure of primary birth control (for example, broken condom)
  • have a NEGATIVE pregnancy test (are NOT pregnant)
  • are NOT experiencing pain

You may need

emergency contraception

Consider

check a pregnancy test first

levonorgestrel (generic for Plan B®) 1.5 mg once

If you have

  • pain or burning with urination
  • increased frequency of urination
  • feeling like you have urinate urgently
  • mild lower abdominal discomfort
  • no fever
  • urinalysis test showing nitrites or leukocyte esterase (see: urine test strips)

You may have

urinary tract infection (UTI)

Consider

check a pregnancy test first, if female

nitrofurantoin (generic for Macrobid®) 100 mg twice a day for 5 days

OR

cephalexin (generic for Keflex®) 500 mg twice a day for 7 days

OR

trimethoprim-sulfamethoxazole (generic for Bactrim®) 1 tab by mouth twice a day for 5 days

If none of the above are available, or if an allergy is present, ciprofloxacin may be considered as an alternative.

OR

Pediatrics

For children age 17 and under

trimethoprim-sulfamethoxazole, cephalexin, and amoxicillin-clavulanate may all be used for UTI – see dosing in Pediatrics

ciprofloxacin should not used in children

If you have

  • fever
  • back pain
  • pain or burning with urination
  • increased frequency of urination
  • feeling like you have urinate urgently
  • mild lower abdominal discomfort
  • urinalysis test showing nitrites or leukocyte esterase (see: urine test strips)

You may have

pyelonephritis

Consider

check a pregnancy test first, if female

trimethoprim-sulfamethoxazole (generic for Bactrim®) 1 tab by mouth twice a day for 7 days

and seek emergency medical care

If trimethoprim-sulfamethoxazole is unavailable, or if an allergy to sulfa drugs is present, ciprofloxacin may be considered as an alternative.

OR

Pediatrics

For children age 17 and under

trimethoprim-sulfamethoxazole, cephalexin, and amoxicillin-clavulanate may all be used for UTI – see dosing in Pediatrics

ciprofloxacin should not used in children

If you have

  • vaginal burning or itching
  • mild lower abdominal/pelvic discomfort
  • thick, white, “cottage cheese”-like vaginal discharge
  • no fever
  • no foul-smelling discharge

You may have

vaginal yeast infection

Consider

check a pregnancy test first

clotrimazole cream 1-2 topical applications per day for 7 days

OR

fluconazole 150 mg once. You may take a second dose of 150 mg in 7 days if symptoms persist.

If you have

  • a chance you may be pregnant
  • a POSITIVE pregnancy test
  • pelvic pain
  • vaginal bleeding

You may have

ectopic pregnancy (tubal pregnancy)

You should

seek emergency medical care

If you have

  • severe pelvic pain, especially one sided
  • fever 100.4°F or higher
  • pus-like discharge
  • nausea/vomiting
  • severe abdominal or back pain

You may have

ovarian torsion, pelvic inflammatory disease (PID), tubo-ovarian abscess, pyelonephritis

You should

seek emergency medical care

Reference

Urine test strips

Urine test strips are used to test for urinary tract infection (UTI). We offer urine test strips that check for the presence of leukocytes (white blood cells) and nitrites. A urine test showing positive leukocytes or nitrites may indicate a urinary tract infection. Brand, color, or style may vary based on available inventory.

GeneralDisposable

levonorgestrel

Levonorgestrel (generic for Plan B) is an emergency contraceptive. Take one tablet as soon as possible within 72 hours of unprotected sex to prevent pregnancy if primary birth control methods fail. Available for prescription to FEMALES ONLY.

Prescription only

GeneralMedication

fluconazole

Fluconazole is an antifungal. It can be used to treat fungal infections like a vaginal yeast infection or fungal skin infection. Consider using fluconazole to treat copious white vaginal discharge or a blotchy red rash in the groin or skin folds, both of which may indicate a fungal infection.

Prescription only

InfectionMedication

trimethoprim-sulfamethoxazole

Trimethoprim-sulfamethoxazole (TMP-SMX, generic for Bactrim, and also abbreviated SMZ-TMP) is an antibiotic. It can be used to treat urinary tract infections and skin infections, and can be used to treat infections caused by MRSA (Methicillin-resistant S. aureus) bacteria.

Prescription only

InfectionMedication

pregnancy test

Pregnancy test is to check pregnancy status.

GeneralDisposable

nitrofurantoin

Nitrofurantoin (generic for Macrobid) is an antibiotic used specifically to treat urinary tract infections. While nitrofurantoin does not treat many types of infections, it tends to work exceptionally well for simple urinary tract infections, and is often used for this purpose.

Prescription only

InfectionMedication

trimethoprim-sulfamethoxazole pediatric

Trimethoprim-sulfamethoxazole (TMP-SMX, generic for Bactrim, and also abbreviated SMZ-TMP) is an antibiotic. It may be used to treat urinary tract or ear infections in pediatric patients. Other antibiotics are usually preferred as first-line treatment options. The suspension form of this medication contains sulfamethoxazole (SMX) 200 mg and trimethoprim (TMP) 40 mg together in each 5 mL liquid. Dosing is based on the trimethoprim (TMP) component.

Prescription only

PediatricsMedication

cephalexin

Cephalexin (generic for Keflex) is an antibiotic. It is used to treat respiratory infections, ear infections, skin infections, and urinary tract infections. It is in the cephalosporin category of antibiotics.

Prescription only

InfectionMedication

cephalexin pediatric

Cephalexin (generic for Keflex) is an antibiotic. It is used to treat respiratory infections, ear infections, skin infections, and urinary tract infections. It is in the cephalosporin category of antibiotics.

Prescription only

InfectionMedication

clotrimazole

Clotrimazole is an antifungal cream. It is used to treat fungal infections of the skin. Clinical improvement, with relief of itching, usually occurs within the first week of treatment.

InfectionMedication

cefdinir

Cefdinir is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

cefdinir suspension

Cefdinir is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

cefpodoxime

Cefpodoxime is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

cefuroxime

Cefuroxime is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is also sometimes used to treat the STD gonorrhea. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

phenazopyridine

Phenazopyridine (generic for Pyridium) is a pain reliever that is specific for the urinary tract and the bladder. It can be used to treat the symptoms of a urinary tract infection (UTI). Phenazopyridine causes the urine to turn red/orange, this is normal and not harmful.

Prescription only

GeneralMedication

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