Patient Information: Abdominal Pain with Negative UTI and Pregnancy Tests
You should schedule a gynecology follow-up appointment within 1-2 weeks and return to the emergency department immediately if you develop severe pain, fever, vomiting, or vaginal bleeding. 1
What Your Test Results Mean
- Your negative pregnancy test effectively rules out pregnancy-related causes of your pain, including ectopic pregnancy. 1, 2
- Your negative urinary tract infection test makes a bladder infection unlikely as the cause of your pain. 3
- Your non-tender abdominal exam is reassuring and suggests you do not have an urgent surgical emergency at this time. 1
Why You Need Gynecology Follow-Up
Your symptoms require further evaluation by a gynecologist because many gynecologic conditions cannot be diagnosed by physical examination alone and need specialized imaging. 1
Possible Gynecologic Causes That Need Evaluation
- Ovarian cysts or masses – These are common in reproductive-age women and can cause intermittent or persistent abdominal pain. 4
- Pelvic inflammatory disease (PID) – This infection of the reproductive organs can present with mild, nonspecific symptoms and may not cause obvious tenderness on initial examination. 1
- Endometriosis – This condition causes tissue similar to the uterine lining to grow outside the uterus and can cause chronic or cyclic pain. 4
- Ovarian torsion – Though less common, this is a twisting of the ovary that requires urgent treatment. 1
What to Expect at Your Gynecology Appointment
Your gynecologist will likely order a pelvic ultrasound (both transvaginal and transabdominal) as the first imaging test, which is the most accurate way to evaluate gynecologic causes of abdominal pain without radiation exposure. 5, 1
- Pelvic ultrasound is 93% sensitive and 98% specific for detecting tubo-ovarian abscesses. 1
- It can also identify ovarian cysts, masses, and signs of endometriosis with high accuracy. 1, 4
Pain Management at Home
You may take ibuprofen 400 mg every 4-6 hours as needed for pain relief. 6
- Take ibuprofen with food or milk to reduce stomach upset. 6
- Do not exceed 3,200 mg (eight 400 mg tablets) in 24 hours. 6
- If ibuprofen is not effective or you cannot take it, discuss alternative pain medications with your provider.
Warning Signs: Return to the Emergency Department Immediately If You Experience
- Severe or worsening abdominal pain – This could indicate a complication requiring urgent imaging or surgery. 2, 4
- Fever (temperature >100.4°F or 38°C) – This suggests possible infection requiring immediate treatment. 1
- Persistent vomiting – This could indicate bowel obstruction or other serious conditions. 4
- Vaginal bleeding – New bleeding could indicate a gynecologic emergency. 1
- Dizziness, fainting, or rapid heartbeat – These symptoms could indicate internal bleeding. 1
- Pain with urination or blood in urine – Your UTI test could have been falsely negative, particularly if symptoms develop. 7, 3
Important Considerations
- False negative pregnancy tests can occur in up to 1.6% of cases, and are more common (3.6%) in women with abdominal pain. If your period is late or you develop vaginal bleeding, return for repeat pregnancy testing. 7
- If your pain becomes generalized, severe, or you cannot keep down food/fluids before your gynecology appointment, go to the emergency department for a CT scan with IV contrast, which is the most accurate test for non-gynecologic causes of abdominal pain. 5, 2, 4
- Do not ignore persistent or worsening symptoms – Many serious gynecologic conditions present with mild initial symptoms that progressively worsen. 1
Timeline for Follow-Up
- Schedule your gynecology appointment within 1-2 weeks if your pain is mild and stable. 1
- Call for an urgent appointment (within 24-48 hours) if your pain is moderate, interfering with daily activities, or associated with abnormal vaginal discharge. 1
- Go to the emergency department immediately if you experience any of the warning signs listed above. 1, 2