Differential Diagnosis for Perineal Pain with Hematuria
- Single most likely diagnosis
- Urinary Tract Infection (UTI): This is a common condition that can cause both perineal pain and hematuria, especially in women. The proximity of the urinary tract to the perineal area and the potential for infection to cause irritation and bleeding make UTI a plausible explanation.
- Other Likely diagnoses
- Kidney Stones: The movement of kidney stones through the urinary tract can cause severe pain, including perineal pain, and may lead to hematuria due to the stone's abrasive action on the urinary tract lining.
- Prostatitis: In men, prostatitis (inflammation of the prostate) can cause perineal pain and may be associated with hematuria, especially if the inflammation affects the prostate's surrounding tissues or the urinary tract.
- Trauma: Physical trauma to the perineal area or the urinary tract can result in both pain and bleeding, making it a likely consideration in the appropriate clinical context.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Testicular Torsion: Although more commonly associated with testicular pain, testicular torsion can sometimes present with perineal pain and, in rare cases, hematuria if there's associated urinary tract involvement or severe systemic response.
- Ruptured Ectopic Pregnancy: In women of childbearing age, a ruptured ectopic pregnancy can cause severe perineal and abdominal pain, and while hematuria is not a primary symptom, it could occur due to the proximity of the ectopic pregnancy to the urinary tract or as part of a broader hemorrhagic event.
- Cancer (e.g., bladder, prostate, or urethral cancer): Various cancers in the pelvic area can cause both perineal pain and hematuria. Early detection is crucial for effective treatment, making these conditions critical not to miss.
- Rare diagnoses
- Schistosomiasis: A parasitic infection that can cause urinary symptoms, including hematuria, and potentially perineal pain if the infection involves the lower urinary tract or surrounding tissues.
- Tuberculosis of the Urinary Tract: Although rare in many parts of the world, urinary tract tuberculosis can cause a wide range of symptoms, including perineal pain and hematuria, due to the infection's chronic and destructive nature.