Differential Diagnosis for Crampy Pain in the Suprapubic Region in an 84-Year-Old

Single Most Likely Diagnosis

• Urinary Tract Infection (UTI): Given the age and symptoms, a UTI is a common cause of suprapubic pain, especially in the elderly. The crampy nature of the pain could be indicative of the infection causing irritation to the bladder.

Other Likely Diagnoses

• Overactive Bladder: This condition can cause crampy suprapubic pain due to the sudden, uncontrollable contractions of the bladder muscle.
• Benign Prostatic Hyperplasia (BPH): In men, an enlarged prostate can cause urinary retention, leading to crampy suprapubic pain.
• Constipation: Severe constipation can cause abdominal and suprapubic discomfort or pain due to the pressure exerted by the impacted stool on surrounding structures.
• Diverticulitis: Inflammation of a diverticulum in the colon can cause crampy pain, typically on the left side but can sometimes be felt in the suprapubic area.

Do Not Miss Diagnoses

• Appendicitis: Although less common in the elderly and the location might not be typical (usually starts around the navel and then moves to the lower right abdomen), an appendicitis can sometimes present with suprapubic pain, especially if the appendix is located in a retrocecal position.
• Ovarian Torsion: In women, this is a surgical emergency that can cause severe, sudden pain, often in the lower abdomen, which might radiate to the suprapubic area.
• Ruptured Abdominal Aortic Aneurysm (AAA): A life-threatening condition that can cause severe abdominal pain, which might be felt in the suprapubic region, especially if the rupture involves the lower part of the aorta.
• Ectopic Pregnancy: Though less likely in an 84-year-old, it's not impossible, especially with the increased use of fertility treatments. This condition is a medical emergency.

Rare Diagnoses

• Bladder Cancer: Can cause a variety of symptoms including pain, but it's less likely to present as crampy suprapubic pain initially.
• Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which could be perceived as crampy suprapubic pain.
• Endometriosis: Though rare in postmenopausal women, endometriosis can cause chronic pelvic pain, including suprapubic pain, especially if there are endometrial implants on the bladder.