Differential Diagnosis for Pelvic Pressure and Sensitivity

The patient's symptoms of pelvic pressure and sensitivity, along with difficulty urinating and a normal urinalysis (UA), suggest a range of possible diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Urinary Tract Infection (UTI) or Interstitial Cystitis: Despite a normal UA, some UTIs, especially those caused by certain bacteria or interstitial cystitis, might not show typical findings like leukocyte esterase or nitrites. The symptoms of pelvic pressure, sensitivity, and difficulty urinating are consistent with these conditions, especially if the patient has been experiencing them for a few weeks.

• Other Likely Diagnoses

  • Ovarian Cyst: Ovarian cysts can cause pelvic pressure and sensitivity. They are common in women of reproductive age and can sometimes cause urinary symptoms if they are large enough to press on the bladder.
  • Endometriosis: This condition, where tissue similar to the lining inside the uterus grows outside of it, can cause pelvic pain, pressure, and sensitivity, especially during menstruation. However, it might also cause symptoms at other times, including difficulty urinating if the endometrial implants are near the bladder or ureters.
  • Pelvic Inflammatory Disease (PID): PID can cause pelvic pain and pressure, and while it often presents with abnormal vaginal discharge and fever, some cases might be more subtle, especially in the early stages.

• Do Not Miss Diagnoses

  • Ectopic Pregnancy: Although less likely if the patient is not pregnant, an ectopic pregnancy can present with pelvic pain and pressure. It's a medical emergency that requires immediate attention.
  • Appendicitis: While appendicitis typically presents with right lower quadrant pain, it can sometimes cause pelvic pressure and sensitivity, especially if the appendix is located near the bladder or ureters. It's a surgical emergency.
  • Ovarian Torsion: This is a condition where the ovary twists around its ligaments, cutting off blood supply. It's extremely painful and requires immediate surgical intervention.

• Rare Diagnoses

  • Bladder Cancer: Although rare, especially in younger women, bladder cancer can cause pelvic pressure, sensitivity, and difficulty urinating. It would be unusual for it to present without hematuria (blood in the urine), but it's a possibility, especially if the cancer is obstructing the ureters.
  • Pelvic Neurogenic Tumors: Tumors affecting the nerves in the pelvic region can cause a variety of symptoms, including pelvic pressure and sensitivity. These are relatively rare and might require specialized imaging for diagnosis.