Groin pain in women is one of the most common symptoms. Deterioration in well-being is observed in both young girls and older women. Most patients cope with this problem by taking painkillers. It is worth visiting a gynecologist as soon as possible and conducting examinations to find out the cause of the ailment. Pain varies in intensity, nature and frequency. It can be cutting, stabbing, dull and aching. In any case, this symptom is a signal of a dysfunction of certain organs in the female body.
Aching pain in the groin in women indicates pathological processes, so consult a specialist. At the KDS Clinic, diagnostics are carried out only with the help of modern equipment. The disease will be detected even at the earliest stage.
Why does it hurt in the pubic area in women?
Traumatic injuries
The cause of sudden pain can be bruises of the pubic symphysis and fractures of the anterior pelvis.
With bruises, the pain syndrome develops after a blow or fall, is moderate, can be accompanied by local swelling, and sometimes bruising. The range of motion is preserved completely or almost completely, the support function is not impaired. All symptoms disappear within 1-2 weeks. With fractures, there are limitations in movement, impaired support of varying degrees, and the inability to raise the straight leg on the side of the injury from a lying position. In women with damage to the superior branch of the pubic bone and the anterior pelvic semi-ring, the pain increases with palpation, compression, and movements of the lower limb on the affected side. In case of ruptures of the symphysis pubis, the patient takes a forced position with the limbs slightly bent and brought together. The pain increases sharply when you try to spread your legs.
Osteomyelitis
Inflammation of the pubic bone occurs due to infection due to surgical interventions, deep wounds in the pubic area, purulent processes in the surrounding tissues. The pain quickly intensifies against the background of increasing swelling, redness of the skin, and deterioration of the general condition. The amount of discharge increases, it becomes purulent in nature. With osteomyelitis, a woman complains of tugging, tearing, throbbing pain in the pubic area. Fever and signs of severe intoxication are detected.
New growths of the pubic bone
The pelvic bones are a common location for benign and malignant tumors. With chondroblastomas, osteomas and osteochondromas, the pain is not intense, slowly increasing over a long time. Chondrosarcomas and metastatic neoplasia are characterized by rapid progression of pain. Initially, the woman complains of minor aching or nagging pain in the pubic area. After a few months, the pain becomes severe, constant, unbearable, and can only be eliminated with narcotic analgesics.
Pregnancy period
Minor pain in the pubic area can normally be observed in the 2nd and 3rd trimesters of pregnancy. It is caused by an increase in the size of the fetus, preparing the body for the birth of a child. If the pain intensifies at night, during sexual intercourse, walking up stairs, spreading the legs and putting pressure on the pubic area, symphysitis should be suspected. Intense pain, inability to stand, walk and lift legs indicate the development of symphiolysis - damage to the ligaments and separation of the pubic bones.
Pelvic fractures in pregnant women develop as a result of trauma in half of the cases. In other women, they become a consequence of systemic diseases (osteoporosis, osteodystrophy) or local processes (tuberculosis, osteomyelitis). In the absence of provoking pathologies, spontaneous damage occurs extremely rarely. The classic clinical picture of a fracture is observed: intense pain in the projection of the pubis or other areas of the pelvis, forced position, limited function of the limbs.
Pain in the pubic area
Gynecological diseases
Pain in the pubis and suprapubic region is mainly noted when the uterus is affected, which, like the symphysis pubis, is located in the midline. Determined for the following pathologies:
- Acute endometritis.
The pain syndrome occurs acutely simultaneously with the appearance of leucorrhoea with an unpleasant odor, chills, general hyperthermia, tachycardia, and pain when urinating. It is especially difficult in the presence of an intrauterine device. - Chronic endometritis.
The pain is not intense, aching. Often combined with dyspareunia. They are supplemented by uterine bleeding, menstrual disorders, bloody or serous-purulent discharge from the genital tract. - Postpartum endometritis.
In mild cases it develops within 5-10 days. Low-grade fever, pain above the womb, slight tachycardia, moderate lochia mixed with blood are noted. In severe cases, it manifests itself within 2-3 days. Chills, fever, severe pain above the pubis, profuse bloody-purulent cloudy lochia with a fishy odor are detected. - Endometriosis.
Painful sensations are found in 15-25% of women and can be localized only above the pubis or be diffuse. They are permanent or worsen in the premenstrual period. Other possible symptoms are dysmenorrhea, menorrhagia, pain during sexual intercourse, urination and defecation.
Patients with adnexitis, salpingitis and ovarian cysts more often complain of pain in the right or left iliac zone. Possible irradiation into the womb and suprapubic region. In women with cysts, pain increases with internal bleeding, suppuration, rupture of the membrane or torsion of the leg of the cystic formation.
Nagging pain in the suprapubic region with delayed menstruation and engorgement of the mammary glands may indicate an ectopic pregnancy with the attachment of the fertilized egg in the uterine part of the fallopian tube, the rudimentary horn of the uterus or the abdominal cavity. When the ovum ruptures, the pain increases sharply, radiates to the lower back, legs and anus, and is accompanied by bleeding or spotting, weakness, tachycardia, and loss of consciousness.
With cancer and sarcoma of the uterus in the early stages, bleeding and menstrual irregularities are observed. Subsequently, paroxysmal cramping pain occurs over the womb, followed by the discharge of pathological discharge from the vagina. In the later stages, the pain becomes intense and constant. There are dysfunctions of neighboring organs and cancer cachexia.
Pathologies of the urinary system
Pain above the pubis is typical for bladder diseases. Observed in diseases such as:
- Acute cystitis.
Cutting and aching pains appear suddenly. An increased frequency of urges, pain, pain and burning during urination, sometimes blood in the urine, lower back pain, and an increase in temperature to subfebrile levels are detected. - Chronic cystitis.
Diagnosed with 3 or more exacerbations in a year or 2 or more exacerbations in six months. It is accompanied by the same symptoms as acute cystitis, but the manifestations persist longer and often have a wave-like character. - Bladder cancer.
Dysuria, pain in the pubic area, groin and sacrum is preceded by hematuria. The pain syndrome is initially insignificant or moderate, observed only when the detrusor is filled, and subsequently becomes intense, painful, and constant. - Bladder tuberculosis.
Develops against the background of kidney tuberculosis. It manifests itself as constant aching pain in the suprapubic area, frequent painful urination with a feeling of incomplete emptying of the bladder, imperative urges, periodic blood in the urine, malaise, increased fatigue, low-grade fever, and loss of body weight. - Bladder stones.
Pain in the lower abdomen and above the pubis is minor at rest. They increase sharply when changing body position, during urination, which is associated with the movement of stones and traumatization of the mucous membrane. Possible irradiation to the perineum, labia, upper thighs.
Complications.
Because sexual intercourse is intensely painful, vulvodynia can cause associated emotional problems. For example, fear of sexual intercourse can cause spasm of the vaginal muscles (vaginismus).
Other known complications may include:
- anxiety,
- depression,
- sleep disturbance,
- sexual dysfunction,
- individual psychological problems and difficulties in relationships with a partner,
- decreased quality of life.
Diagnostics
Women with suspected injuries and diseases of the musculoskeletal system are examined by an orthopedic traumatologist. Patients with signs of gynecological pathologies require consultation with a gynecologist. If there are symptoms of damage to the urinary system, an examination by a urologist is necessary. At the initial stage, the specialist establishes the circumstances of the appearance, the nature and duration of the pain syndrome, its connection with various factors, and the presence of other manifestations. The diagnostic program may include the following procedures:
- Visual inspection.
Allows you to localize the source of pain (bones, internal organs). During the physical examination, the doctor identifies redness, swelling, wounds, purulent foci, bone deformities, space-occupying formations, and detects symptoms that are pathognomonic for certain pathological conditions. - Gynecological examination.
Makes it possible to determine the presence and nature of discharge, the size and tone of the uterus, and the condition of the appendages. It is used in assessing the duration and course of pregnancy, during the primary diagnosis of endometritis, endometriosis, adnexitis, ovarian cysts, and other gynecological pathologies. - X-ray of the pelvis.
In case of fractures, survey photographs are recommended to study all the pelvic bones and fully visualize possible severe and complex injuries. For osteomyelitis, tuberculosis, and tumors, radiographs of the symphysis and pubic bones are taken. For women with symphysitis, the technique is prescribed in the postpartum period. - Ultrasonography.
In case of symphysitis, an ultrasound of the symphysis pubis is performed to assess the severity of the pathology and select the method of delivery. For gynecological diseases, ultrasound of the pelvic organs is performed. The best option in most cases is the method with the simultaneous use of vaginal and abdominal sensors. For detrusor lesions, an ultrasound of the bladder is performed. Some women are advised to have a kidney ultrasound. - Other imaging methods.
For stones, urography is informative. Patients with neoplasms can undergo cystography, pelvic venography, and lymphadenography. Women with urolithiasis are prescribed a CT scan of the kidneys, ureters and bladder. Victims with traumatic injuries with insufficient radiographic information require a CT scan of the pelvis. - Endoscopic studies.
They are an important part of tumor diagnosis. For malignant neoplasia of the uterus, hysteroscopy is performed, and for neoplasms of the bladder, cystoscopy is performed. They provide detailed visualization of space-occupying formations and provide for the collection of biopsy samples for subsequent histological analysis. - Lab tests.
Leukocytosis and increased ESR in the CBC indicate the presence of inflammation. Urine, discharge from wounds and genitals are examined by culture to identify the causative agent of infection. With symphysitis, a decrease in the amount of calcium and magnesium in the LHC is determined. To confirm an ectopic pregnancy, the level of human chorionic gonadotropin is examined. As part of the morphological analysis of biopsy specimens, the type and degree of malignancy of tumors is clarified.
Ultrasound of the bladder
Causes of vulvodynia.
To date, the causes of vulvodynia remain unknown. However, the most likely contributing factors include:
- damage or irritation to the nerves surrounding the vulva area,
- past vaginal infections,
- tendency to allergies or increased sensitivity of the skin and mucous membranes,
- hormonal changes,
- muscle hypertonicity or, conversely, weakness of the pelvic floor muscles that support the uterus, bladder and intestines.
Treatment
Pre-hospital assistance
A woman with a suspected pelvic fracture should be placed on a backboard with her legs bent and a pillow placed under them. The pelvic bones should be secured by wrapping a scarf or sheet. To prevent traumatic shock, it is recommended to warm up with a blanket, drink plenty of warm drinks, and take an anesthetic. Fractures and suspicion of an interrupted tubal pregnancy are indications for immediately calling an ambulance.
Conservative therapy
Therapeutic tactics are determined by the cause of the development of pain in the pubis:
- Injuries.
Upon admission, intrapelvic anesthesia is administered; in the case of isolated pubic bone fractures, local anesthetic administration is possible. The fixation option is chosen taking into account the type of injury; a shield or a hammock is used, or in severe cases, skeletal traction. Painkillers are used, and antibiotics are prescribed for open injuries. During the rehabilitation period, patients are referred to exercise therapy, massage and physiotherapy. - Osteomyelitis.
The basis of therapy is antibiotics, which are selected taking into account the sensitivity of the pathogen and administered intramuscularly or intravenously. Analgesics are used. In case of severe intoxication, infusion therapy is carried out. Dressings are carried out, the wound is washed and drained. - Symphysitis.
To eliminate hypocalcemia, calcium supplements are prescribed, and vitamin D and magnesium supplements are used to improve the absorption of the microelement. To eliminate aseptic inflammation, NSAIDs are recommended. Non-drug methods include magnetic therapy, wearing a bandage, and special exercise therapy complexes. An adequate choice of obstetric care tactics is required, taking into account the severity of the pathology. - Endometritis.
The first priority is to fight the infection with antibacterial agents. In case of severe intoxication, protein and saline solutions are administered intravenously. Immunomodulators, antihistamines, and multivitamin complexes are prescribed. To eliminate bleeding and reduce pain in the acute period, cold and hormonal drugs are used. After the condition improves, medicinal electrophoresis, UHF, magnetic therapy, and ultrasound therapy are useful. - Endometriosis.
Conservative treatment is carried out in case of asymptomatic or mild symptoms during premenopause, if it is necessary to restore or preserve reproductive function. Hormone therapy is carried out with combined estrogen-progestogen agents, gestagens, antigonadotropic drugs, gonadotropic releasing hormone agonists. - Cystitis.
The treatment regimen includes antibiotics from the groups of fluoroquinolones, nitrofurans, macrolides, cephalosporins and non-fluorinated quinolones. Uroseptics, NSAIDs, and combined herbal remedies are used. Intravesical instillations are performed. Inductothermy, UHF, and iontophoresis are performed. - Detrusor tuberculosis.
Treatment is carried out with anti-tuberculosis drugs and fluoroquinolones. Additionally, NSAIDs and angioprotectors are prescribed to reduce the severity of inflammation and prevent cicatricial changes in the urinary tract.
For adnexitis and salpingitis, antibiotics, anti-inflammatory drugs, and physiotherapy are used. For oncological lesions alone or as part of combination therapy, including radiation therapy and chemotherapy in the pre- and postoperative period.
How is it arranged?
The pubic bone is considered the part of the skeleton that forms the pelvic bone. In women and men, the pubis consists of a body and 2 branches, thus forming a closed opening with a membrane located there.
Women with a normal build have a roll-shaped bone, the thickness of which is equal to the thumb on the hand. It is curved and is called the pubic eminence. Like an arch, it hangs over the genital organ in women, merging with the pelvic bones.
The distance between these pubic bones should normally be no more than 5 mm. During pregnancy, this indicator increases by 3 mm.
Possible consequences
If the patient does not receive the necessary treatment or delays contacting a specialist for help, then the discrepancy of the pubic bones can provoke severe pain, which will appear even with the slightest movement. Sometimes this causes complete loss of mobility.
The most severe complication is rupture of the symphysis. In most cases, this is observed in the last week of pregnancy, when the baby’s head enters directly into the pelvis and puts pressure on weak and inflamed ligaments. In the event of such a rupture, the woman begins to experience severe pain shock.
If the discrepancy of the pubic bones is more than 2 cm, then therapy should be carried out only by surgical method. In the future, a long recovery will be required, as well as the help of rehabilitation specialists. As a rule, pregnancy is not recommended for women after this, otherwise a relapse may develop.
How to get rid of pain?
If the bones diverge naturally during pregnancy, then therapy is not carried out. As a rule, after childbirth the ligaments return to their original position. During this period, a specialist may recommend that a woman take medications, for example, No-shpu or Menovazin. When a woman is in a hospital under the supervision of doctors in the last two weeks of pregnancy, pain can be controlled with the help of anti-inflammatory non-steroidal drugs. For this, patients are prescribed the drug Paracetamol or Ibuprofen. When pain appears at 32 weeks of pregnancy, as well as after the birth of the baby, the woman is prescribed the use of antibiotics, as well as ultraviolet irradiation, to avoid the formation of an inflammatory process.
Gels and ointments are of great importance in therapy, since after application to the skin they do not enter the systemic bloodstream. If the pain syndrome is the most severe, then after childbirth the specialist may prescribe opioid painkillers to the patient, which should include Fentanyl. Epidural anesthesia can also be used for these purposes.
Therapy methods
Treatment of pain is carried out taking into account the reasons that caused it. When diseases of an inflammatory-infectious nature develop, antibiotics are prescribed. You need to drink them in a course, taking into account the results of the antibiogram. When pain and spasms develop, analgesics and antispasmodics are prescribed.
Treatment of many gynecological diseases is carried out using hormonal agents. They eliminate imbalances in a woman’s body, which leads to her recovery. If conservative therapy is ineffective, surgery is performed: removal of the cyst or foci of endometriosis.
Treatment of gastrointestinal diseases is carried out with mandatory adherence to a diet. Additionally, medications are prescribed to eliminate flatulence, vomiting, diarrhea and other disorders. To normalize intestinal function, probiotics are used, and enterosorbents are used to eliminate toxins. Appendicitis is treated surgically.
Treatment of diseases of the urinary system occurs with the use of antibiotics, diuretics, and anti-inflammatory drugs. If there are stones, they are crushed.
Exercises
At any stage of discrepancy of the pubic bones, the specialist recommends performing some gymnastic exercises. They are necessary to strengthen the pelvic muscles, but they are very simple. Let's consider what movements to do if you have a discrepancy in the pubic bones, which causes severe pain in this area:
- First of all, you need to lie on your back, bend your knees, and pull your heels towards your buttocks. After this, spread your knees in different directions, slowly, fix in this position for 20 seconds and return to the starting position.
- Lie on your back on a hard surface, raise your pelvis to a height of approximately 5 cm from the floor. It is necessary to stay in this position for 10-20 seconds. During this exercise, the heels should be located 30 cm from the body.
- Next you need to perform an exercise called “Cat”. To do this, the woman gets on all fours, her back straight. Then the back slowly arches and the head rises. This exercise works the abdominal muscles.
It is important to note that when performing such gymnastics, you should definitely monitor your sensations. If pain occurs, all exercises must be stopped immediately.