Differential Diagnosis for Hematuria and Intermittent Pelvic Pain
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI) or Pyelonephritis: This is a common cause of hematuria and pelvic pain, especially in women. The intermittent nature of the pain could be related to the fluctuating severity of the infection.
Other Likely Diagnoses
- Kidney Stones: Kidney stones can cause severe, intermittent pain (renal colic) and hematuria. The pain often radiates from the flank to the groin.
- Bladder Stones: Similar to kidney stones, bladder stones can cause pelvic pain and hematuria, especially if they are large enough to obstruct urine flow.
- Overactive Bladder: While less likely to cause hematuria, an overactive bladder can lead to frequent urination and pelvic discomfort, and in some cases, may be associated with microscopic hematuria.
Do Not Miss Diagnoses
- Ovarian Torsion: Although more commonly associated with sudden, severe pain, ovarian torsion can present with intermittent pain if the torsion is partial or if the ovary intermittently untwists and then retwists. Hematuria is not a typical symptom but could occur if there's associated urinary tract injury.
- Ectopic Pregnancy: This is a life-threatening condition that can cause pelvic pain and, less commonly, hematuria if there's rupture and internal bleeding affecting the urinary tract.
- Appendicitis: While appendicitis typically presents with right lower quadrant pain, it can sometimes cause pelvic pain if the appendix is located in a retrocecal position. Hematuria is not a common symptom but could occur if the inflamed appendix irritates the urinary tract.
Rare Diagnoses
- Genitourinary Tuberculosis: This can cause chronic pelvic pain and hematuria, among other symptoms like frequent urination and dysuria. It's rare in many parts of the world but should be considered in endemic areas or in individuals with a history of exposure.
- Bladder or Renal Cancer: These are less common causes of hematuria and pelvic pain but are critical to diagnose early due to their potential for severe outcomes if left untreated.
- Endometriosis: While primarily known for causing dysmenorrhea and dyspareunia, endometriosis can also lead to pelvic pain and, in rare cases, hematuria if endometrial implants involve the urinary tract.