History of Present Illness (HPI)
The patient is a 38-year-old female presenting with a one-month history of intermittent, sharp lower pelvic pressure that radiates to the anus. The pain is exacerbated by physical activity and has been progressively worsening. She reports irregular menstrual cycles and underwent tubal ligation in July 2017. The patient denies fever, vaginal discharge, or urinary symptoms but experiences occasional urinary urgency and mild stress incontinence. She notes leaking small amounts of urine when coughing, laughing, or during physical activity. The patient also reports a history of being stomped on the chest by a horse, which has led to increased gas and heartburn, and a recent change in stool within the last month.
Differential Diagnosis
- Single Most Likely Diagnosis
- Pelvic Floor Dysfunction: This diagnosis is likely due to the patient's symptoms of pelvic pressure, urinary urgency, and stress incontinence, which are all related to the pelvic floor muscles. The recent change in stool and increased gas and heartburn may also be contributing factors.
- Other Likely Diagnoses
- Irritable Bowel Syndrome (IBS): The patient's recent change in stool and increased gas and heartburn could be indicative of IBS, which may be contributing to her pelvic pressure and discomfort.
- Urinary Tract Dysfunction: The patient's symptoms of urinary urgency and stress incontinence suggest a possible urinary tract dysfunction, which could be related to her pelvic floor muscles or other underlying conditions.
- Gastroesophageal Reflux Disease (GERD): The patient's increased gas and heartburn may be indicative of GERD, which could be contributing to her discomfort and pelvic pressure.
- Do Not Miss Diagnoses
- Ovarian Torsion: Although unlikely, ovarian torsion is a life-threatening condition that requires immediate attention. The patient's history of tubal ligation and irregular menstrual cycles increases her risk for ovarian torsion.
- Appendicitis: The patient's symptoms of pelvic pressure and discomfort could be indicative of appendicitis, which is a medical emergency.
- Diverticulitis: The patient's recent change in stool and increased gas and heartburn could be indicative of diverticulitis, which requires prompt medical attention.
- Rare Diagnoses
- Endometriosis: Although the patient's symptoms are not typical of endometriosis, it is a possible diagnosis that should be considered, especially given her history of irregular menstrual cycles and pelvic pain.
- Interstitial Cystitis: The patient's symptoms of urinary urgency and frequency could be indicative of interstitial cystitis, a rare condition that affects the bladder.
- Pudendal Neuralgia: The patient's symptoms of pelvic pressure and discomfort could be indicative of pudendal neuralgia, a rare condition that affects the pudendal nerve.