Differential Diagnosis for a 28-year-old Female with Suprapubic Pain
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): Given the location of the pain (suprapubic), the most common cause is a UTI, especially cystitis, which is an infection of the bladder. This condition is prevalent in women due to their shorter urethra, making it easier for bacteria to reach the bladder.
Other Likely Diagnoses
- Interstititial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can be similar to those of a UTI but without the presence of an infection.
- Ovarian Cysts: These can cause pelvic pain that might be perceived as suprapubic, especially if the cysts are large or if there is a rupture.
- Endometriosis: Although more commonly associated with cyclic pelvic pain, endometriosis can cause chronic pain that might be felt in the suprapubic area.
- Constipation: Severe constipation can lead to suprapubic discomfort or pain due to the proximity of the rectum to the suprapubic area.
Do Not Miss Diagnoses
- Ectopic Pregnancy: Although less likely in a patient without a reported missed period or positive pregnancy test, ectopic pregnancy is a life-threatening condition that must be considered, especially if there's any chance the patient could be pregnant.
- Appendicitis: While the pain typically starts near the navel and then moves to the lower right abdomen, atypical presentations can occur, and appendicitis is a surgical emergency.
- Kidney Stones: If a stone is obstructing the ureter, it can cause severe pain that might be referred to the suprapubic area, along with other symptoms like nausea, vomiting, and possibly blood in the urine (though not present in this case).
- Diverticulitis: Inflammation of a diverticulum in the intestine can cause severe pain, usually in the lower left abdomen, but can occasionally present with suprapubic pain if the involved segment is near the bladder.
Rare Diagnoses
- Bladder Cancer: Although extremely rare in a young woman, any persistent or unexplained bladder symptoms warrant further investigation to rule out malignancy.
- Schistosomiasis (Bilharzia): A parasitic infection that can cause bladder symptoms, including pain and hematuria (though not present in this case), more commonly seen in travelers to or immigrants from endemic areas.
- Tuberculosis of the Urinary Tract: Can cause chronic symptoms including pain, frequency, and possibly hematuria, though it's relatively rare in immunocompetent individuals in non-endemic areas.