Hip, Pelvic, Rectal Pain

Hip Pain

Adult

• Anterior

  • Adult/Geriatric

    • Femoral neck stress fracture

    • Hip osteoarthritis +/- femoroacetabular impingement

    • Hip labral tear: Groin pain and catching/clicking sensation with activity. Positive FABER (~80%) and FADIR (~85%) tests. Obtain MRI.

    • Iliopsoas bursitis

    • Femoral hernia: Groin pain exacerbated by increased intraabdominal pressure with an upper thigh bulge on exam.

  • Hip osteonecrosis

  • Transient synovitis vs. septic arthritis

• Posterior

  • Piriformis syndrome

  • Sacroiliac joint dysfunction

• Lateral/Other

  • Trochanteric bursitis

  • Meralgia paresthetica

Pediatric

• Age 2-11 years

  • Most common: Transient synovitis vs. septic arthritis

  • Legg-Calve-Perthes (osteonecrosis)

• Age 11-16 years: Slipped capital femoral epiphysis (SCFE)

Pelvic Pain

Urgent/Emergent

• Cardiovascular: Ruptured abdominal aortic aneurysm

• GI: Appendicitis, diverticulitis, small bowel obstruction

• Urologic: Complicated urinary tract infection

• OBGYN: Pelvic inflammatory disease, ovarian torsion, ruptured ovarian cyst, tubo-ovarian abscess

Common

GI

• Gastroenteritis

• Irritable bowel syndrome

• Inflammatory bowel disease

• Appendicitis

• Diverticulitis

Urologic

• Nephrolithiasis

• Urinary tract infection

• Bladder pain syndrome

OBGYN

• Menses-dependent

  • Dysmenorrhea

  • Endometriosis

• Non-cyclic

  • Pregnancy

  • Dyspareunia

    • Vaginal atrophy/inadequate lubrication

    • Vaginitis/vulvovaginitis

    • Herpes simplex infection

  • Infectious

    • Dysuria

    • Pelvic inflammatory disease

• Neuropathic

  • Vulvodynia

  • Fibromyalgia

Rectal Pain

Visible Lesion

• Potentially Urgent/Emergent: Trauma +/- foreign body

• Hemorrhoid

• Anal fissure

  • Risk factors: Hard stool/straining, pregnancy, opiate analgesia

  • Anal spasm, tearing sensation with defecation, bright red blood on stool/toilet paper

  • Treatment

    • Topical 0.4% nitroglycerin ointment administered as 1 inch paste BID PRN x 3 weeks

    • Adjunctive therapy: Docusate sodium 100 mg daily, psyllium fiber (Metamucil) 2 teaspoons in 8 oz water daily, Sitz bath daily

• Perianal fistula, e.g. irritable bowel disease

Internal Pathology

• Rectoanal neoplasm

• Constipation/fecal impaction

• Females

  • Endometriosis

  • Pelvic inflammatory disease

• Males

  • Proctalgia fugax

  • Prostatitis