Duration Health

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 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.

When To Worry

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

Quick Guide

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

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

If neither trimethoprim-sulfamethoxazole or nitrofuraintoin are available, or if an allergy is present, ciprofloxacin may be considered as an alternative.

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.

If you have

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

You may have

vaginal yeast infection

Consider

check a pregnancy test first

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

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 are an amazing and inexpensive diagnostic tool. They can be used to detect urinary tract infections, dehydration, diabetes, and blood in the urine. A urine test showing positive leukocytes or nitrites may indicate a urinary tract infection. A high specific gravity or ketones in the urine may indicate dehyration. Glucose in the urine is a sign of uncontrolled diabetes.

GeneralDisposable

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.

InfectionMedication

Trimethoprim-sulfamethoxazole (TMP-SMX, generic for Bactrim) is an antibiotic. It can be used to treat urinary tract infections and skin infections.

InfectionMedication

Pregnancy test is to check pregnancy status.

GeneralDisposable

Nitrofurantoin (generic for Macrobid) is an antibiotic used specifically to treat urinary tract infections.

InfectionMedication

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