Gas/indigestion: Sharp, shifting pain linked to diet or eating habits. …

Hormone changes before and during a period can slow bowel movement, alter fluid balance, and make gas more noticeable. Prostaglandins, the chemicals involved in menstrual cramps, can also affect the intestines and cause diarrhea, constipation, or cramping. ... - Hormone changes before and during a period can slow bowel movement, alter fluid balance, and make gas more noticeable. - Prostaglandins, the chemicals involved in menstrual cramps, can also affect the intestines and cause diarrhea, constipation, or cramping. - Food choices, swallowing air, stress, and pre-existing digestive conditions may intensify period-related gas. - Tracking symptoms across several cycles can help identify patterns and support a medical assessment if needed. - Severe pain, blood in the stool, ongoing bowel changes, fever, vomiting, or unexplained weight loss require medical advice. ... Gas, bloating, and changes in bowel habits are common around menstruation and are usually linked to normal shifts in hormones that affect the digestive tract. Symptoms that are severe, new, persistent, or accompanied by pelvic pain, bleeding changes, or weight loss should be assessed by a clinician. ... Many people notice more gas, abdominal fullness, burping, or bloating in the days before a period and during bleeding. In most cases, this is a harmless part of the menstrual cycle. The digestive system and reproductive organs sit close together in the pelvis, and hormonal changes can influence how quickly food moves through the intestines and how the abdomen feels. Symptoms may feel stronger even when the amount of intestinal gas has not changed greatly. Fluid retention, uterine cramping, constipation, and heightened sensitivity to pressure in the abdomen can make ordinary digestive activity more uncomfortable. These symptoms often improve after menstruation begins or ends, although the exact timing varies from person to person. Period-related gas is different from passing gas caused solely by a particular meal, but the two can overlap. A person may be more sensitive to foods or habits that usually cause mild gas during the premenstrual and menstrual phases of the cycle. ... Estrogen and progesterone rise and fall throughout the menstrual cycle. In the days before a period, higher progesterone levels may slow intestinal movement in some people. When stool moves more slowly, constipation can develop, and bacteria in the bowel have more time to produce gas. This can contribute to a feeling of pressure, swelling, or incomplete bowel emptying. As menstruation starts, progesterone levels fall. At the same time, the body produces prostaglandins, substances that help the uterus contract and shed its lining. Prostaglandins can also affect nearby intestinal muscles. This may lead to looser stools, more frequent bowel movements, intestinal cramping, or urgency in addition to gas. These normal cycle-related effects explain why some people alternate between constipation before a period and diarrhea during it. They can also explain why abdominal symptoms appear reliably at the same point in each cycle. However, symptoms should not automatically be attributed to hormones if they are severe or interfere with daily life. ... Hormones are only one part of the picture. Diet and daily habits can make gas more noticeable around a period. Carbonated drinks, chewing gum, eating quickly, drinking through a straw, and smoking can increase swallowed air. Foods that are more likely to ferment in the bowel, such as beans, certain vegetables, dairy products for people with lactose intolerance, and some high-fiber foods, may also contribute. Saltier foods may increase fluid retention and worsen the sensation of bloating. Changes in appetite, sleep, activity, and stress around menstruation can affect digestion as well. For example, reduced physical activity may worsen constipation, while anxiety can alter gut movement and make abdominal sensations feel more intense. Some people have an underlying digestive condition that becomes more apparent during menstruation. Irritable bowel syndrome can cause recurrent abdominal pain with constipation, diarrhea, or both, and symptoms may fluctuate with the menstrual cycle. Food intolerances, celiac disease, inflammatory bowel disease, and medication side effects are other possible contributors that a clinician may consider based on the overall symptom pattern. ... Most menstrual gas is not a sign of a serious condition. Still, digestive symptoms that consistently occur with significant pelvic pain or unusually heavy periods may deserve evaluation. Conditions affecting the pelvis can produce symptoms that overlap with bowel disorders because the uterus, ovaries, bladder, and intestines are located close together. ... , endometriosis may cause painful periods, pain during or after sex, pain with bowel movements, fatigue, and digestive symptoms that worsen around menstruation. Fibroids can also contribute to heavy bleeding, pelvic pressure, constipation, or a ... Gentle measures are often enough for mild, predictable symptoms. Regular meals, adequate fluids, light movement such as walking, and allowing time for bowel movements can support digestion. A warm compress or heating pad may ease menstrual cramping and abdominal discomfort for some people. It may help to reduce carbonated drinks and foods that repeatedly trigger symptoms during the days when gas is most troublesome. This does not mean that everyone needs to avoid fiber. Fiber is important for bowel health, but increasing it gradually and drinking enough water may reduce the chance of extra gas. If constipation is common, a clinician or pharmacist can advise on safe options tailored to the individual. ... Medical review is advisable when gas or bloating is new, severe, persistent outside the menstrual period, or increasingly disruptive. An appointment should also be arranged for very painful periods, heavy or irregular bleeding, pain during sex, persistent constipation or diarrhea, or symptoms that do not improve with simple measures. Prompt medical care is important for severe or worsening abdominal pain, fever, repeated vomiting, fainting, a swollen abdomen that does not settle, blood in the stool, black stools, or unexplained weight loss. These symptoms may have causes unrelated to menstruation and should not be managed by self-care alone. ... Yes. Gas and bloating are common menstrual symptoms and often result from hormonal changes that affect bowel movement and fluid retention. They usually improve as the cycle progresses, but severe or persistent symptoms should be discussed with a clinician. ... Progesterone can slow digestion before menstruation, which may lead to constipation and gas. During a period, prostaglandins can stimulate the intestines as well as the uterus, contributing to looser or more frequent stools. ... Gas can cause cramping, pressure, and discomfort in the lower abdomen. However, severe pain, pain that limits normal activities, or pain accompanied by heavy bleeding or bowel symptoms should be medically assessed. ... Triggers differ between individuals, but carbonated drinks, very salty foods, large meals, and foods that commonly produce gas may worsen symptoms. Keeping a brief food and symptom diary can help identify personal triggers without unnecessary dietary restriction. ... Endometriosis can be associated with digestive symptoms that become worse around menstruation, including bloating, altered bowel habits, and pain with bowel movements. Gas alone does not diagnose endometriosis, so evaluation is important when symptoms occur with significant pelvic pain, heavy bleeding, or fertility concerns. ... A doctor should assess symptoms that are severe, new, getting worse, present throughout the month, or affecting quality of life. Urgent care is needed for severe abdominal pain, fever, vomiting, blood in the stool, black stools, fainting, or unexplained weight loss.

Little is known as to the extent gastrointestinal (GI) complaints are reported by women around menses. We aimed to describe GI symptoms that occurred premenstrually and during menses in healthy women, and to specifically assess the relationship of emotional symptoms to GI symptoms around menses. ... We recruited healthy, premenopausal adult women with no indication of GI, gynecologic, or psychiatric disease who were attending an outpatient gynecology clinic for well-woman care. They completed a survey that queried menstrual histories and the presence of GI and emotional symptoms. We compared the prevalence of primary GI symptoms (abdominal pain, diarrhea, constipation, nausea, vomiting), as well as pelvic pain and bloating, in the 5 days preceding menses and during menses, and assessed whether emotional symptoms or other factors were associated with the occurrence of GI symptoms. ... Of 156 respondents, 73% experienced at least one of the primary GI symptoms either pre- or during menses, with abdominal pain (58% pre; 55% during) and diarrhea (24% pre; 28% during) being the most common. Those experiencing any emotional symptoms versus those without were more likely to report multiple (2 or more) primary GI symptoms, both premenstrually (depressed p = 0.006; anxiety p = 0.014) and during menses (depressed p < 0.001; anxiety p = 0.008). Fatigue was also very common (53% pre; 49% during), and was significantly associated with multiple GI symptoms in both menstrual cycle phases (pre p < 0.001; during p = 0.01). ... With regard to the prevalence of GI symptoms, nearly three-quarters of the sample (73%, n = 107) reported experiencing at least one of the primary GI symptoms premenstrually, and about two-thirds (69%, n = 107) reported at least one GI symptom during menses (Table 2). Thirty-one percent had multiple primary GI symptoms, either premenstrually or during menses. The prevalence of each GI symptom was similar across the two phases, with abdominal pain and diarrhea being the most common primary symptoms, and the secondary GI symptom of bloating being experienced most frequently overall. Depressive symptoms were the most common emotional symptoms reported in both the premenstrual and menses phases. A significantly higher proportion reported depressive symptoms premenstrually (32%) than during menses (21%, P = 0.028). Fatigue was fairly pronounced, with about half endorsing that symptom in either phase (53% premenstrual; 49% during menses). ... Tables 3, 4, 5 and 6 detail the frequency of GI symptoms in relation to emotional symptoms (Tables 3 and 4) and fatigue (Tables 5 and 6), separately considering the premenstrual and menstrual phases. Women experiencing depressive symptoms were significantly more likely to also report diarrhea, both before (36% vs 19%, p = 0.028) and during menses (50% vs 23%, p = 0.004). Those with anxiety symptoms were significantly more likely to report nausea both before (38% vs 13%, p = 0.006) and during menses (44% vs 11%, p = 0.002). Overall, individuals with emotional symptoms of either depression or anxiety, or those reporting fatigue were significantly more likely to experience multiple primary GI symptoms, both prior to the onset of menses and during menses (p < 0.02 for all comparisons). ... Participants who had a history of painful menses in general were also significantly more likely to experience primary GI symptoms. In the premenstrual phase, those with a history of painful menses were more likely to report abdominal pain (73% v 42%, p = 0.0001), diarrhea (32% v 16%, p = 0.04), and nausea (27% v 5%, p = 0.0005) than those without painful menses. In the menstrual phase, those with a history of painful menses were more likely to report abdominal pain (73% v 34%, p < 0.0001) and nausea (24% v 3%, p = 0.0001), compared to those not reporting painful menses (data not shown). ... In this study, we found the experience of one or more GI symptoms was very common for healthy women both before and during menses. Not surprisingly, abdominal pain was quite frequent, but around one-quarter of the women also experienced bowel habit disturbance in the form of diarrhea. GI symptoms occurred at a similar rate in both the premenstrual phase and during menses. However, there was a higher prevalence of depressed mood and fatigue premenstrually, compared to during menses. As well, GI symptoms occurred disproportionately more frequently with depressive or anxious emotional symptoms than when those were not present, both prior to and during menses. This significant co-occurrence was also observed for fatigue. ... did not find any significant relationship [1]. In that study, women who reported their GI symptoms were exacerbated during their menses did not differ in their psychological profiles from women who did not report these symptoms [1]. Keisner and ... Depression, pain, and gut motility may share similar pathophysiological mechanisms including serotonin as an important neurotransmitter mediating those symptoms [1]. A study that found women in the late luteal phase experienced reduced pain tolerance, using a cold pressor test, provides some evidence for somatic neural changes related to the timing within the cycle [18]. There has also been consideration of the effect of hormonal activity in local tissue, with a recent study suggesting that physical symptoms, including GI symptoms, may indicate sensitivity to reproductive steroids, and that concurrent psychological symptoms may reflect neurological sensitivity to these steroids, at a peak point in the menstrual cycle [19]. Prostaglandins may provide another pathophysiological link to understand the overlap between menstrual pain and gastrointestinal symptoms. Premenstrually, uterine prostaglandin production may mediate an inflammatory response characterized by pain, and during menses abnormally high levels of prostaglandins in menstrual fluid may induce abnormal uterine contractions and pain [17, 20]. In the gut, prostaglandins can cause smooth muscle contractions, as well as reduced absorption and induced secretion of electrolytes in the small bowel, all of which may enhance gastrointestinal pain and diarrhea [21]. It is not known whether uterine prostaglandins are transported to the gut, or whether parallel changes in uterine and GI smooth muscle prostaglandin levels occur during menses [17]. Further study will be necessary to determine pathophysiological mechanisms for mood changes within the cycle as well and the direction of the relationship of these changes between brain and GI function. While these findings are preliminary, they suggest that clinicians should be aware of the heightened potential for co-occurring gastrointestinal and emotional symptoms perimenstrually, and could consider providing information to their patients to help normalize the experience. If the GI symptoms become troubling or problematic, it may be useful to consider prophylactic steps to alleviate the symptoms through use of medication or behavioral approaches, parallel to the approach used to manage gynecological symptoms during menses (e.g., analgesic medication for dysmenorrhea). ... In conclusion, the occurrence of GI symptoms in conjunction with the premenstrual and menses phases is fairly common, and is disproportionately more likely if there are also accompanying emotional symptoms. These co-occurring experiences may reflect underlying common mechanisms which can provide direction for symptom relief. Given the exploratory nature of the study, prospective work tracking GI and emotional symptom severity in the context of the menses phases will be important as a next step. It will be useful to discern whether GI symptoms contribute to the mood disorder that affects many women prior to and during menses or alternatively, whether depressive and anxiety symptoms are predominately impacting on GI symptoms, as these relationships may have implications for managing the symptoms therapeutically.

Daily stress (*P*= 0.0018), BSFS score (*P*= 0.0493), stool frequency (*P*= 0.0241), abdominal pain (*P*< 0.0001), diarrhea (*P*= 0.0022), constipation (*P*= 0.0446), reflux (*P*= 0.0193), and indigestion (*P*< 0.0001) all varied significantly by the day of the menstrual cycle. Dunnett’s post hoc tests showed that scores (mean ± SEM) on the first day of bleeding (day 1) for daily abdominal pain (2.6 ± 0.2), diarrhea (1.7 ± 0.1), and indigestion (2.1 ± 0.2) symptoms were higher than scores on all other days of the menstrual cycle (*P*< 0.05) with scores not on day 1 falling under 1.5, or between no discomfort at all and slight discomfort. Reflux, stool frequency, BSFS, self-reported stress, and constipation were higher on day 1 (*P*< 0.05) than on 12, 8, 6, 4, and 2 other days of the menstrual cycle, respectively. The median (IQR) GSRS score was higher during the week of menstruation than the week prior to menstruation for diarrhea [1.50 (1.00–2.33) vs 1.33 (1.00–2.00),*P*= 0.002] and abdominal pain [2.00 (1.33–2.67) vs 1.67 (1.33–2.33),*P*= 0.011] syndrome scores. ... . These hormones are known to slow GI motility [16–18], often resulting in constipation that is commonly experienced during pregnancy [19]. At menstruation, there is a sudden drop in these hormones and a simultaneous spike in prostaglandins, which contract local smooth muscle tissue during menstruation [20]. Because of the close proximity of the uterus to the intestinal tract, it has been hypothesized that these endogenous compounds result in constipation during the days leading up to menstruation (due to progesterone) and diarrhea or loose stools during the first few days of menstruation (due to prostaglandins) [21]. This process is altered by the use of oral contraceptives (OC). Combination OC contain a synthetic estrogen and a progestin that work synergistically to suppress ovulation, thin the endometrium, and reduce natural cycle hormonal fluctuations of ovarian estrogen and progesterone. Typically, a pack of OC contains 21 days of hormone pills followed by 7 days of inert placebo pills that result in a withdrawal bleed. The thin endometrium results in reduced production of prostaglandins; however, prostaglandin fluctuations still occur to some degree, and also play a role in menstruation in women taking OC [22]. ... Stool frequency (*P*= 0.0241), BSFS (*P*= 0.0493), and self-reported stress (*P*= 0.0018) all differed by day and peaked on day 1 (Fig.2). When daily GSRS items were analyzed by day, abdominal pain (*P*< 0.0001), diarrhea (*P*= 0.0022), constipation (*P*= 0.0446), indigestion (*P*< 0.0001), and reflux (*P*= 0.0193) symptoms all differed by day and peaked on day 1 except for constipation, which peaked on day 3 (Fig.3). For GSRS data that were measured at the two time points, the median (IQR) GSRS score was higher during the week of menstruation than during the pre-menstrual week for total [27 (22–36) vs 26 (20–33),*P*= 0.002], diarrhea [1.50 (1.00–2.33) vs 1.33 (1.00–2.00),*P*= 0.002], and abdominal pain [2.00 (1.33–2.67) vs 1.67 (1.33–2.33),*P*= 0.011] syndrome scores. Reflux, constipation, and indigestion syndrome scores were not different between time points. ... In the current study, stool frequency, BSFS score, self-reported stress, and all symptoms measured with a modified daily version of the GSRS except for constipation were higher on day 1 than on many other days of the menstrual cycle. Although previous studies did not use validated tools to measure similar outcomes, these findings support previous reports that women who take oral contraceptives experience looser stools [24] and more severe GI symptoms during menses [23]. Overall, the modified GSRS scores were of physiological significance in that participants moved from no discomfort to slight/mild discomfort from GI symptoms. The day-to-day change in these symptoms, as well as stool frequency and BSFS score, in relation to the menstrual cycle may reflect the cyclic changes in reproductive hormones and/or prostaglandins, whether endogenous or synthetic. It was anticipated that there would be a slowing of intestinal transit before menstruation due to progesterone, as OCs are progesterone dominant, and a speeding of transit and induction of GI muscle contraction during menstruation due to prostaglandins released from the endometrium. Accordingly, BSFS scores were lowest on day − 2, indicating that intestinal transit time was slowest in the days prior to menstruation. This is in accordance with a previous study that demonstrated the colonic transit time is significantly longer during the luteal phase than during the follicular phase; however, transit time was averaged over phases rather than days of the menstrual cycle [17]. Additionally, it is unknown if this population was on OC or not [17]. Constipation scores measured by the modified GSRS were not the highest on this day as would be expected, indicating that these objective and subjective measures of bowel function are not perfectly correlated. Finally, self-reported stress was the highest on day 1 of menstruation, indicating that quality of life, while not measured in this study, may also be negatively affected during menstruation. The increase in stress could be due to the inconveniences and/or mood changes [25,38] experienced by women while menstruating and/or to the GI disturbances that were demonstrated in this study, which is likely as stress and GI symptoms are closely related [34]. As with any observational study, only associations have been presented here, and cause and effect thus cannot be established. ... Because of the observational nature of the study, confounding is a possible limitation with such factors as stress, fibre intake, medication use, physical activity, or other lifestyle factors. Stress and fibre were expected to potentially influence the outcomes of this study and were thus measured in an attempt to control for them; however, fibre was only measured once at the beginning of the study and could not be analyzed with the outcomes on a daily or weekly basis. Medication use, such as nonsteroidal anti-inflammatory drugs, may impact gastrointestinal symptoms, including indigestion [41]. This information was not recorded. Participants also self-enrolled and were entrusted to read the inclusion criteria carefully before consenting to participate. OC vary widely in application and mechanism, and the dose, formulation, and regimen of OC were not assessed in this study. Days in which the active pills were consumed were also not recorded. It is unlikely that use of OC would increase GI symptoms as these side effects are rare and are typically found in women over 35 years old [42] and this age group was excluded from the study. Use of OC may actually alleviate the severity of GI symptoms, as they are known to control abdominal cramping due to decreased prostaglandin production by the endometrium [43,44]. In this present study, significant abdominal pain was still observed and could perhaps be more severe in women not taking OC, although this has yet to be measured. Abdominal pain due to menstrual cramps and abdominal pain due to gastrointestinal symptoms during the time of bleeding may also be difficult to differentiate. ... Bowel habits appear to differ between phases of the menstrual cycle and suggest more discomfort on day 1 of menstruation in healthy women taking OC. Future studies should assess whether these GI changes occur in women not taking OC and whether they negatively affect quality of life using validated digestion-associated quality of life tools. The positive results from this study indicate the need to further investigate mechanisms behind these findings, and, accordingly, dietary,lifestyle, and/or extended cycle pill interventions may subsequently be identified to reduce burdens imposed by menstruation-associated GI changes.

Menstrual and digestive discomfort often coincide, and a researcher who has been looking in to it for a decade tells us what she learned ... Every period, right on schedule: the cramps arrive, and right behind them, the urgent need to poop. If this is your experience, you’re in good company: in one study, 73% of healthy premenopausal women reported at least one significant gastrointestinal symptom in the days before or during their period. Abdominal pain and diarrhea were the most common complaints, but women reported nausea and constipation too. Menstrual and digestive discomfort often coincide: “If you ask women about ‘period poops’ they’ll tell you they’re having menstrual cramps and those GI cramps at the same time,” said Taylor Judkins, a nutrition researcher at the University of Florida who has spent more than a decade studying the phenomenon. ... It all starts with the uterus. As your period approaches, levels of estrogen and progesterone fall sharply. That’s the signal for

No significant differences were found between menstrual cycle group and PROMIS-GI scores. Higher GI-symptom and pain levels were found as health anxiety increased. Pain in the hypogastric region of the abdomen was significantly higher during the Menses phase when compared to Early-Luteal and Premenstrual phases. A subset of participants with DGBI diagnoses demonstrated significantly higher GI-symptom severity on several PROMIS-GI scales when compared to matched controls who did not have those diagnoses. In addition, participants with DGBI diagnoses reported significantly greater pain across multiple abdominal regions than their non-diagnosed counterparts. ... The relationship between specific GI symptoms and the menstrual cycle has been studied to some extent. A study on women with inflammatory bowel disease (IBD) found that perimenstrual GI symptoms were common in both healthy women and women with IBD, indicating that symptoms vary with menstrual cycle phase regardless of diagnosis [10]. However, the same authors found evidence to the contrary in another study [11]. Menstrual cycle phase was found to influence stool consistency in women. Those with dysmenorrhea reported significantly more nausea and decreased food intake than nondysmenorrheic individuals [12]. In women with IBS, symptomatology including rectal sensitivity was considerably exacerbated during menses [13]. In a sample of healthy women taking oral contraceptives, stool consistency and frequency, abdominal pain, reflux, and indigestion showed significant variations based on menstrual cycle timepoint [14]. Overall, the association between GI disorders and the menstrual cycle have been studied in the context of bowel-related disorders and dysmenorrhea. More research is needed to identify a comprehensive and standardized list of GI symptoms across the phases of the menstrual cycle and to clarify the relationship between the two at the community level. Ultimately, assessment of DGBI may be more accurate with consideration of the menstrual cycle and other hormonal influences on GI functioning. ... Fluctuations of pain, cognitive, affective, and physical symptoms according to the phases of the menstrual cycle have been described across studies [9, 19, 20]. However, findings regarding the specific patterns of symptom changes through the phases of the menstrual cycle are inconclusive. In general, the premenstrual phase is associated with increased somatic symptoms, fluid retention, negative affect, weight gain, depression, painful breasts, and lower overall health. During menses, somatic symptoms, pain, autonomic reaction, and fluid retention increase significantly [19, 20, 21]. Furthermore, the follicular phase is associated with lower pain [9]. ... An initial MANCOVA was conducted on the seven PROMIS-GI scales with menstrual group as the independent variable and health anxiety score as a covariate. No significant main effect for menstrual group was obtained, indicating that the PROMIS-GI measures did not significantly differ between the four menstrual groups. A significant main effect was obtained for health anxiety, F(7, 591) = 22.73, p < 0.001, η p 2 = 0.21. Health anxiety scores had a significant effect on each PROMIS-GI score including belly pain, constipation, diarrhea, gas, nausea, swallowing, and reflux. There was no significant interaction between menstrual group and health anxiety ratings. An additional MANCOVA examined the nine areas of the Pain Map across the four menstrual groups while controlling for health anxiety. A significant multivariate effect was obtained for SHAI score, F(9, 589) = 6.84, p < 0.001, η p 2 = 0.10, indicating a significant relationship between health anxiety and the nine reported pain areas across all menstrual groups. Region H (Hypogastric Region) on the Pain Map significantly differed between menstrual groups, F(3, 48.29) = 5.36, p < 0.001, η p 2 = 0.03. The Menses group (M = 4.37, SD = 3.14) reported more pain in Region H (Hypogastric Region) than did the Early-Luteal group (M = 2.91, SD = 3.03) and the Premenstrual group (M = 3.08, SD = 3.15). Ultimately, pain ratings in this region did not significantly differ between the Follicular phase and any other phase of the menstrual cycle. Early-Luteal and Premenstrual groups also did not significantly differ in Region H (Hypogastric Region) pain ratings. ... Overall, results indicated negligible variability in GI symptoms across the menstrual cycle. However, significant differences were observed regarding abdominal pain in the hypogastric area of the abdomen. Specifically, the Menses group reported higher levels of abdominal pain in the hypogastric region (Region H) compared to the Early-Luteal and Premenstrual groups. The hypogastric region is associated with the female reproductive organs that are most often implicated in menstrual pain. Taken together, the group difference in pain ratings of the hypogastric abdominal region is likely to originate from menses rather than GI symptoms due to its location and periodicity. ... The PROMIS-GI scale was effective in discerning participants with formal medical DGBI diagnoses and those without formal medical DGBI diagnoses. The DGBI group reported significantly higher belly pain, constipation, gas, and reflux than the non-diagnosed DGBI group. In addition, participants in the DGBI group had significantly higher rating of pain in Quadrants B (Epigastric Region), E (Umbilical Region), G (Right Iliac Region), H (Hypogastric Region), and I (Left Iliac Region) of the Pain Map. Thus, the Pain Map facilitated assessment of menstrual cycle pain and DGBI pain. ... limitation was the assumption of a 28–35-day menstrual cycle. Women who reported a period length greater than 35 days were excluded from the study. Thus, findings from this study may only be generalized to women who report a regular 28–35-day cycle. Since irregular period may be an indicator of other health abnormalities, including but not limited to GI diseases [33, 51], future studies should include women who do not report a regular menstrual cycle length. Those with irregular menstrual cycles may present differently than what we found in this study. Furthermore, we did not exclude females with other menstrual cycle irregularities such as anovulation. It has been established that college-aged females are at an increased risk of stress and disordered eating that can lead to menstrual irregularities, and future studies should aim to control for these factors. This study employed a cross-sectional design. Indeed, longitudinal studies will be essential to examine the long-term relationship between menstrual cycle phases and GI symptom patterns at the population level. Overcoming challenges such as individual variation in menstrual cycle timing and ensuring a sufficiently large sample size will be ... Menstrual cycle phase was not associated with differences in GI symptom severity on the PROMIS-GI scales, however we did find a characteristic difference in abdominal pain for women in the Menses phase. While our findings are most likely consistent with the everyday practice and observations of experienced clinicians, this study provides the first investigation into using standardized measures to quantify a full range of GI symptoms across the phases of the menstrual cycle. GI symptoms during all phases were highly impacted by health anxiety, which could possibly explain the observed sex-based differences in GI pain. Results from this study provide a simple approach to distinguish between GI- and menstrual-related abdominal pain and highlight the importance of routinely using tools such as a visual pain map during assessment and diagnosis. Based on our findings, a case can be made to collect PROMIS-GI measures, pain maps, and questions about the menstrual cycle in patient care settings, not only to facilitate GI symptom tracking, but also to differentiate features of the menstrual cycle from potential DGBI.

Gastroenteritis is inflammation of the lining of the stomach and small and large intestines. Most cases are infectious, although gastroenteritis may occur after ingestion of drugs, medications, and chemical toxins (eg, metals, plant substances). Acquisition may be foodborne, waterborne, person-to-person spread, or occasionally through zoonotic spread. Symptoms include anorexia, nausea, vomiting, diarrhea, and abdominal discomfort. Diagnosis is clinical, by stool culture, polymerase chain reaction testing, or immunoassays. Treatment is supportive and directed at symptoms, but some parasitic and some bacterial infections require specific anti-infective therapy. ... udation of fluid and electrolytes ... resulting from mal ... in the affected ... subsequently worsen symptoms by causing osmotic diarrhea. Diarrhea is watery. Inflammatory diarrhea ... Several other bacteria cause gastroenteritis, but most are uncommon in the United States. Yersinia enterocolitica can cause gastroenteritis or a syndrome that mimics appendicitis because patients may have pain in the right lower quadrant. It is transmitted by undercooked pork, unpasteurized milk, or contaminated water. Several Vibrio species (eg, V. parahaemolyticus) cause diarrhea after ingestion of undercooked seafood. V. cholerae sometimes causes severe dehydrating diarrhea in regions where people lack access to clean drinking water and sanitary disposal of human waste and is a particular concern after natural disasters or in refugee camps. Listeria can rarely cause foodborne gastroenteritis but more often causes bloodstream infection or meningitis in pregnant women, neonates (see Neonatal Listeriosis), or older adults. Aeromonas is acquired from swimming in or drinking contaminated fresh or brackish water. Plesiomonas shigelloides can cause diarrhea in patients who have eaten raw shellfish or traveled to tropical Southeast Asia and Africa (10). ... Certain intestinal parasites, notably Giardia intestinalis (G. lamblia), adhere to the intestinal mucosa, causing nausea, vomiting, diarrhea, and general malaise. Giardiasis occurs in every region of the United States and throughout the world. The infection can become chronic and may cause a malabsorption syndrome. It is usually acquired via person-to-person transmission (often in day care centers) or from ingestion of cysts in contaminated water or food (11). Cryptosporidium parvum causes watery diarrhea and can ... be accompanied by abdominal cramps, nausea, and vomiting. In ... people, the illness is self- ... , lasting about 2 weeks. In patients with immunocompromise, illness may be severe and prolonged, causing substantial electrolyte and fluid loss. Cryptosporidium is usually acquired ... contaminated water. It is not easily killed by chlorine and is the most common cause of recreational waterborne ... , accounting for about three-fourths of outbreaks. ... Generally, onset is sudden, with anorexia, nausea, vomiting, abdominal cramps, and diarrhea (with or without blood and mucus). Malaise and myalgias may occur. The abdomen may be distended and mildly tender; in severe cases, muscle guarding may be present. Gas-distended intestinal loops may be palpable. Hyperactive bowel sounds are present on auscultation even without diarrhea (an important differential feature from paralytic ileus, in which bowel sounds are absent or decreased). Persistent vomiting and diarrhea can result in intravascular fluid depletion with hypotension and tachycardia. Hypovolemic shock with vascular collapse and oliguric acute kidney injury or kidney failure may occur in severe cases. ... The hallmark of adenovirus gastroenteritis is diarrhea lasting 1 to 2 weeks. Affected infants and children may have mild vomiting that typically starts 1 to 2 days after the onset of diarrhea. Low-grade fever occurs in many patients. Respiratory symptoms may be present. Symptoms are generally mild but can last longer than with other viral causes of gastroenteritis (1). ... Bacteria that cause invasive disease (eg, Shigella, Salmonella) are more likely to result in fever, prostration, and bloody diarrhea. E. coli O157:H7 infection usually begins with severe abdominal cramps and watery diarrhea for 1 to 2 days, followed by bloody diarrhea. Fever is absent or low grade. The spectrum of illness with C. difficile infection ranges from mild abdominal cramps and mucus-filled diarrhea to severe hemorrhagic colitis and shock. Bacteria that produce an enterotoxin (eg, S. aureus, B. cereus, C. perfringens) usually cause watery diarrhea. S. aureus and some strains of B. cereus predominantly cause vomiting. ... Supportive treatment is all that is needed for most patients. Bed rest with convenient access to a toilet or bedpan is desirable. Rehydration is critical for treatment of dehydration and to prevent unnecessary hospitalization. Antidiarrheal, antiemetic, and probiotic agents may be useful. Antimicrobial agents are used in select cases in which bacterial infection is suspected or documented. ... Antidiarrheal (antimotility) agents are not recommended in children < 18 years of age with acute diarrhea). Use of antidiarrheal agents is contraindicated in children < 2 years of age. These agents are generally safe for adult patients with watery diarrhea (as shown by heme-negative stool). However, antidiarrheals may cause deterioration of patients with C. difficile or E. coli O157:H7 infection and thus should not be given to any patient with recent antibiotic use, heme-positive or bloody stool, or diarrhea with fever, pending specific diagnosis (1). ... If vomiting is severe and a surgical condition (eg, small-bowel obstruction) has been excluded, an antiemetic may be beneficial. Medications useful in adults include ondansetron, prochlorperazine, and promethazine. In children, ondansetron has been shown to reduce the need for intravenous rehydration and to prevent hospitalizations ( ... - Do not use antidiarrheal (antimotility) agents in adults with suspected C. difficile or E. coli O157:H7 infection (eg, with recent antibiotic use, bloody diarrhea, heme-positive stool, or diarrhea with fever) or in children. ... Even patients with vomiting should take frequent small sips of such fluids in between episodes of emesis; vomiting may abate with volume replacement. For patients with E. coli O157:H7 infection, rehydration with isotonic IV fluids may attenuate the severity of any renal injury kidney dysfunction should hemolytic-uremic syndrome develop. Children may become dehydrated more quickly and should be given an appropriate rehydration solution (several are available commercially—see Oral Rehydration). If vomiting is protracted, severe dehydration is present, or oral rehydration is not tolerated, IV replacement of volume and electrolytes is necessary (see Intravenous Fluid Resuscitation).

Gastroenteritis is inflammation that spreads from your stomach into your intestines, causing pain, vomiting and diarrhea. When it feels like it’s “coming out both ends,” you’ve usually ingested a virus, bacteria or chemical by mistake. Most of the time, it goes away by itself. ... Gastroenteritis means inflammation in your stomach and intestine. Inflammation makes these organs feel swollen and sore. It causes symptoms of illness, like nausea, vomiting, abdominal pain and diarrhea. ... Gastroenteritis affects your stomach and intestines, causing symptoms like nausea, vomiting and diarrhea. ... Symptoms involving your intestines (diarrhea, cramps), together with symptoms involving your stomach (nausea, vomiting) are the hallmarks of gastroenteritis. You’ll know it if it’s “coming out both ends.” ... - Diarrhea. - Nausea and vomiting. - Loss of appetite. - Abdominal pain and cramping. - Fever. - Chills. - Fatigue. - Body aches. ... Gastroenteritis symptoms often come on suddenly. Gastrointestinal symptoms appear first. You might have diarrhea, stomach pain or cramps, nausea and/or vomiting many times in a short period. As the day goes on, you may or may not begin to experience what are called “systemic symptoms” — symptoms that affect the rest of your body. These may include fever, chills and body aches. ... of the time ... this is the case, the primary ... dehydration. This is more of a risk for children and senior citizens ... In most cases, gastroenteritis goes away by itself. The best way to help your body recover is to give it lots of rest and fluids. You might want to stick with bland, easy-to-digest foods for a few days. ... - IV fluids to prevent or correct dehydration and electrolyte imbalances. - Parenteral nutrition to give your body energy without using your stressed digestive system. - Medications to treat symptoms like nausea and diarrhea, in certain cases. ... - Inability to keep fluids down, signs of dehydration. - Symptoms last longer than five days. - Fever lasts more than three days or is higher than 104 degrees Fahrenheit (40 degrees Celsius). - Severe abdominal pain or a rigid, distended abdomen. - Abnormal heartbeat or abnormal breathing. - Blood in your poop. - Green vomit. - Altered mental status. ... Gastritis causes stomach symptoms, like stomach pain, nausea and vomiting. Inflammation in your intestines affects your poop, causing diarrhea. ... It can be ... and vomiting. It ... something is really wrong. But those ... body is already taking care of it.

This study evaluated the effects of a simulated football match on gastrointestinal (GI) symptoms, damage and indirect markers of gut barrier integrity, and investigated whether GI responses are modulated by menstrual cycle (MC) phase. Twelve eumenorrheic females completed two 45-min bouts of an intermittent treadmill protocol, replicating the activity profile of a football match, during Phase 1 (P1, days 1–5) and Phase 4 (P4, 6–8 days following a positive ovulation test) of their MC. Global GI discomfort was recorded every 15 min during exercise, and specific GI symptoms were assessed at rest, half-time (HT), full-time (FT) and 60 min post-exercise (POST-60). Blood samples were collected at rest, FT and POST-60 to assess intestinal fatty-acid binding protein (I-FABP), lipopolysaccharide binding protein (LBP), soluble cluster of differentiation 14 (sCD14) and claudin-3 (CLDN-3). I-FABP increased by 51% from rest to FT (p = 0.007), but there was no effect of exercise on LBP, CLDN-3 or sCD14. Global GI discomfort was 65% greater in P1, than P4 (p = 0.006) and total GI symptom score was greater in P1 than P4 at rest (p = 0.011) and FT (p = 0.021). CLDN-3 concentrations were greater in P1 than P4 at rest (p = 0.02) and POST-60 (p = 0.03). There were no differences between MC phase for I-FABP, LBP or sCD14. Participants experienced increased GI discomfort during P1 compared to P4 of the MC, at rest and during exercise. However, exercise-induced GI symptoms and damage occurred at a similar rate in both MC phases. ... Exercise-induced gastrointestinal (GI) symptoms, such as nausea, abdominal cramps, diarrhoea and vomiting, have been reported to affect 30%–90% of athletes and can have a detrimental effect on exercise performance (de Oliveira and Burini 2009). Recent evidence from applied and survey-based studies suggests that the prevalence and severity of GI symptoms may be greater in female compared with male team sport athletes (Wilson et al. 2023; Chantler et al. 2024). Female team sport athletes reported higher GI symptom scores at rest, during training and in competition than males, and 37.5% of females reported that their performance had been negatively impacted by GI symptoms, compared to 13.9% of males (Wilson et al. 2023). Female rugby players have also reported greater frequency and severity of GI symptoms than their male counterparts at rest and around training and competition (Chantler et al. 2024). ... The high prevalence of GI symptoms in female athletes might be influenced by the menstrual cycle (MC). The MC can be categorised into four distinct phases, based on ovarian hormone profiles: Phase 1 (P1), lowest concentrations of oestrogen and progesterone; Phase 2, highest oestrogen and low progesterone concentrations; Phase 3, medium oestrogen and low progesterone concentrations and Phase 4 (P4), high oestrogen and highest progesterone concentrations (Elliott-Sale et al. 2021). At rest, females experience a higher incidence and severity of GI symptoms during P1 of their MC compared to all other MC phases (Pugh et al. 2022), with symptoms such as bloating, diarrhoea, and nausea commonly reported (Bruinvels et al. 2021; McNulty et al. 2023). Symptoms of diarrhoea and abdominal pain, in addition to other MC symptoms, may contribute to perceived reductions in exercise performance and an increased likelihood of missing or adapting training or competition (Armour et al. 2020; Bruinvels et al. 2021; Parker et al. 2022). In contrast to other elite female sports where 47%–50% of players report hormonal contraceptive use (Martin et al. 2018; Larsen et al. 2020), Parker et al. (2022) found that 72% of Women's Super League football players do not use hormonal contraceptives. Therefore, research into the effect of the MC and associated symptomology in non-hormonal contraceptive users is particularly important in female football players. ... Participants rated the severity of specific GI symptoms on a 10-point scale, with 0 indicating an absence of symptoms, 1–4 indicating mild symptoms, 5–8 indicating severe symptoms, and 9–10 indicating extremely severe symptoms (Gaskell et al. 2019). The presence of either regurgitation, projectile vomiting or defaecation were rated as either 0 (not present) or 10 (extremely severe). All symptom scores were summed to generate a total GI symptom score at each time-point, and symptoms associated with the upper and lower GI tract were separated to determine regional symptom scores. The maximum possible score was 180 for total GI symptoms, 70 for upper GI tract symptoms and 80 for lower GI tract symptoms. ... The most commonly reported GI symptoms across both P1 and P4 were bloating, flatulence, lower abdominal bloating and stomach pain (Figure 4A) and participants reported the greatest incidence of GI symptoms at FT. In P1, the most commonly reported GI symptoms were bloating, flatulence, lower abdominal bloating and stomach pain, experienced by eight (67%) participants at FT. In P4, stomach pain and lower abdominal bloating were the highest reported symptoms, reported by seven (58%) participants. Whereas similar GI symptoms were reported in both MC phases, they were found to have the greatest incidence (Figure 4A) and severity (Figure 4B) during P1. ... The aims of this study were to assess the effects of a simulated football match on GI symptoms, damage and indirect markers of gut barrier integrity and determine whether these GI responses are modulated by MC phase. In response to exercise, participants reported increased levels of GI discomfort, with the greatest incidence and severity of GI symptoms reported immediately post-exercise. Bloating, flatulence, lower abdominal bloating and stomach pain were the most commonly reported GI symptoms across both MC phases. Following the simulated football match, there was an increase in the gut damage marker, I-FABP, compared to rest but there were no changes in indirect markers of gut barrier integrity (CLDN-3, LBP and sCD14) in response to exercise. The primary finding of this study was that GI symptoms experienced pre-, during and post-a simulated football match were greater during P1 compared to P4 of the MC. We did not observe any effect of MC phase on I-FABP, LBP or sCD14 concentrations, but CLDN-3 concentrations were greater in P1 than P4 at both rest and POST-60. ... resting GI symptoms during P1 of the MC (Bruinvels et al. 2021; McNulty et al. 2023). At rest, there was no difference in ... The cause of elevated levels of resting GI symptoms in P1 is likely multi-factorial. For example, fluctuations in oestrogen and progesterone throughout the MC may affect the occurrence of GI symptoms due to changes in visceral sensitivity and GI motility (Meleine and Matricon 2014). Additionally, during P1, there is a rise in prostaglandins, in particular PGF 2α, which stimulate uterine contractions to facilitate menstrual shedding (Judkins et al. 2020). Because of the proximity between the uterus and GI tract, this may also increase smooth muscle contractions in the intestines, contributing to cramping and diarrhoea-type symptoms. Oestrogen has also been reported to have anti-inflammatory and antioxidant properties (Whitcomb et al. 2014), and changes in inflammatory responses across the MC may also impact exercise associated GI symptoms (Lambert 2009). ... To conclude, GI symptoms experienced both at rest, and during a simulated football match were greater in P1 compared with P4 of the MC. This research also highlights the importance of controlling for MC phase in studies investigating GI symptoms in female athletes. There does not appear to be an association between indirect markers of gut barrier integrity and MC phase-related changes in GI symptoms. Thus, the mechanisms contributing to elevated GI symptoms in P1 require further investigation. Future studies should also assess potential nutritional strategies to alleviate GI symptoms at rest and during exercise in P1.

Little is known as to the extent gastrointestinal (GI) complaints are reported by women around menses. We aimed to describe GI symptoms that occurred premenstrually and during menses in healthy women, and to specifically assess the relationship of emotional symptoms to GI symptoms around menses. ... We recruited healthy, premenopausal adult women with no indication of GI, gynecologic, or psychiatric disease who were attending an outpatient gynecology clinic for well-woman care. They completed a survey that queried menstrual histories and the presence of GI and emotional symptoms. We compared the prevalence of primary GI symptoms (abdominal pain, diarrhea, constipation, nausea, vomiting), as well as pelvic pain and bloating, in the 5 days preceding menses and during menses, and assessed whether emotional symptoms or other factors were associated with the occurrence of GI symptoms. ... Of 156 respondents, 73% experienced at least one of the primary GI symptoms either pre- or during menses, with abdominal pain (58% pre; 55% during) and diarrhea (24% pre; 28% during) being the most common. Those experiencing any emotional symptoms versus those without were more likely to report multiple (2 or more) primary GI symptoms, both premenstrually (depressed p = 0.006; anxiety p = 0.014) and during menses (depressed p < 0.001; anxiety p = 0.008). Fatigue was also very common (53% pre; 49% during), and was significantly associated with multiple GI symptoms in both menstrual cycle phases (pre p < 0.001; during p = 0.01). ... A questionnaire was developed to assess the range of physical and emotional symptoms that might occur specifically in conjunction with the premenstrual and menses phases. As there were no validated measures that served that purpose, items were identified based on patient reports, literature review, and expert consensus from a team of gastroenterologists, gynecologists, and clinical psychologists. Items were included that briefly queried (a) menstrual history, including age at menarche, duration of menstrual cycle, history of painful periods, and use of medicinal contraception; (b) the presence of seven common GI symptoms, of which five - abdominal pain, constipation, diarrhea, nausea, and vomiting - were classified as primary GI symptoms. The remaining two - bloating and pelvic pain – were considered to be possibly gynecologic in origin in the context of the perimenstrual period, and thus classified as secondary GI symptoms; and (c) the presence of emotional symptoms (depressive symptoms, anxiety, ‘other’ emotional symptoms), and fatigue. The questionnaire was piloted with 20 women to assess clarity of the questions and completion time, and adjustments were made as needed based on feedback. ... With regard to the prevalence of GI symptoms, nearly three-quarters of the sample (73%, n = 107) reported experiencing at least one of the primary GI symptoms premenstrually, and about two-thirds (69%, n = 107) reported at least one GI symptom during menses (Table 2). Thirty-one percent had multiple primary GI symptoms, either premenstrually or during menses. The prevalence of each GI symptom was similar across the two phases, with abdominal pain and diarrhea being the most common primary symptoms, and the secondary GI symptom of bloating being experienced most frequently overall. Depressive symptoms were the most common emotional symptoms reported in both the premenstrual and menses phases. A significantly higher proportion reported depressive symptoms premenstrually (32%) than during menses (21%, P = 0.028). Fatigue was fairly pronounced, with about half endorsing that symptom in either phase (53% premenstrual; 49% during menses). ... Tables 3, 4, 5 and 6 detail the frequency of GI symptoms in relation to emotional symptoms (Tables 3 and 4) and fatigue (Tables 5 and 6), separately considering the premenstrual and menstrual phases. Women experiencing depressive symptoms were significantly more likely to also report diarrhea, both before (36% vs 19%, p = 0.028) and during menses (50% vs 23%, p = 0.004). Those with anxiety symptoms were significantly more likely to report nausea both before (38% vs 13%, p = 0.006) and during menses (44% vs 11%, p = 0.002). Overall, individuals with emotional symptoms of either depression or anxiety, or those reporting fatigue were significantly more likely to experience multiple primary GI symptoms, both prior to the onset of menses and during menses (p < 0.02 for all comparisons). ... Participants who had a history of painful menses in general were also significantly more likely to experience primary GI symptoms. In the premenstrual phase, those with a history of painful menses were more likely to report abdominal pain (73% v 42%, p = 0.0001), diarrhea (32% v 16%, p = 0.04), and nausea (27% v 5%, p = 0.0005) than those without painful menses. In the menstrual phase, those with a history of painful menses were more likely to report abdominal pain (73% v 34%, p < 0.0001) and nausea (24% v 3%, p = 0.0001), compared to those not reporting painful menses (data not shown). ... In this study, we found the experience of one or more GI symptoms was very common for healthy women both before and during menses. Not surprisingly, abdominal pain was quite frequent, but around one-quarter of the women also experienced bowel habit disturbance in the form of diarrhea. GI symptoms occurred at a similar rate in both the premenstrual phase and during menses. However, there was a higher prevalence of depressed mood and fatigue premenstrually, compared to during menses. As well, GI symptoms occurred disproportionately more frequently with depressive or anxious emotional symptoms than when those were not present, both prior to and during menses. This significant co-occurrence was also observed for fatigue. ... Depression, pain, and gut motility may share similar pathophysiological mechanisms including serotonin as an important neurotransmitter mediating those symptoms [1]. A study that found women in the late luteal phase experienced reduced pain tolerance, using a cold pressor test, provides some evidence for somatic neural changes related to the timing within the cycle [18]. There has also been consideration of the effect of hormonal activity in local tissue, with a recent study suggesting that physical symptoms, including GI symptoms, may indicate sensitivity to reproductive steroids, and that concurrent psychological symptoms may reflect neurological sensitivity to these steroids, at a peak point in the menstrual cycle [19]. Prostaglandins may provide another pathophysiological link to understand the overlap between menstrual pain and gastrointestinal symptoms. Premenstrually, uterine prostaglandin production may mediate an inflammatory response characterized by pain, and during menses abnormally high levels of prostaglandins in menstrual fluid may induce abnormal uterine contractions and pain [17, 20]. In the gut, prostaglandins can cause smooth muscle contractions, as well as reduced absorption and induced secretion of electrolytes in the small bowel, all of which may enhance gastrointestinal pain and diarrhea [21]. It is not known whether uterine prostaglandins are transported to the gut, or whether parallel changes in uterine and GI smooth muscle prostaglandin levels occur during menses [17]. Further study will be necessary to determine pathophysiological mechanisms for mood changes within the cycle as well and the direction of the relationship of these changes between brain and GI function. ... . Given the exploratory nature of the study, prospective work tracking GI and emotional symptom severity in the context of the menses phases will be important as a next step. It will be useful to discern whether GI symptoms contribute to the mood disorder that affects many women prior to and during menses or alternatively, whether depressive and anxiety symptoms are predominately impacting on GI symptoms, as these relationships may have

Women experience more severe gastrointestinal (GI) symptoms compared to men. The onset of puberty and the menstrual cycle may influence these differences. Additionally, health anxiety is an important construct that has been shown to play a role in increased symptomatology across many medical conditions. Using standardized clinical measures often employed to assess disorders of gut-brain interaction (DGBI) we aimed to identify differences of GI functioning across menstrual cycle phases and to evaluate the role of health anxiety in this relationship. ... No significant differences were found between menstrual cycle group and PROMIS-GI scores. Higher GI-symptom and pain levels were found as health anxiety increased. Pain in the hypogastric region of the abdomen was significantly higher during the Menses phase when compared to Early-Luteal and Premenstrual phases. A subset of participants with DGBI diagnoses demonstrated significantly higher GI-symptom severity on several PROMIS-GI scales when compared to matched controls who did not have those diagnoses. In addition, participants with DGBI diagnoses reported significantly greater pain across multiple abdominal regions than their non-diagnosed counterparts. ... The relationship between specific GI symptoms and the menstrual cycle has been studied to some extent. A study on women with inflammatory bowel disease (IBD) found that perimenstrual GI symptoms were common in both healthy women and women with IBD, indicating that symptoms vary with menstrual cycle phase regardless of diagnosis [10]. However, the same authors found evidence to the contrary in another study [11]. Menstrual cycle phase was found to influence stool consistency in women. Those with dysmenorrhea reported significantly more nausea and decreased food intake than nondysmenorrheic individuals [12]. In women with IBS, symptomatology including rectal sensitivity was considerably exacerbated during menses [13]. In a sample of healthy women taking oral contraceptives, stool consistency and frequency, abdominal pain, reflux, and indigestion showed significant variations based on menstrual cycle timepoint [14]. Overall, the association between GI disorders and the menstrual cycle have been studied in the context of bowel-related disorders and dysmenorrhea. More research is needed to identify a comprehensive and standardized list of GI symptoms across the phases of the menstrual cycle and to clarify the relationship between the two at the community level. Ultimately, assessment of DGBI may be more accurate with consideration of the menstrual cycle and other hormonal influences on GI functioning. ... There is a need to more precisely characterize abdominal pain related to GI and menstrual symptoms. To achieve this, we utilized an abdominal pain map, illustrated in Fig. 1. We hypothesized that pain reported during the menses and luteal phases would be higher in the lower abdominal region, where the female reproductive organs are located, and in line with literature on gynecologic disorders [34, 35, 36]. ... The NIH PROMIS-GI symptom scales. The National Institutes of Health (NIH) developed the Patient Reported Outcomes Measurement Information System (PROMIS®) Gastrointestinal Symptom Scales (PROMIS-GI) in 2014. The PROMIS-GI scales have been validated as effective measures of a broad range of GI symptoms within the general and clinical populations and may be effective in identifying clinical thresholds for action [32, 39]. The PROMIS-GI scales have good psychometric properties and construct validity [32]. The PROMIS-GI version 1 scales evaluate eight GI symptom domains: Abdominal Pain (6 items), Gas/bloating (v1.1; 12 items), Diarrhea (5 items), Constipation (9 items), Bowel Incontinence (4 items), Gastroesophageal Reflux (13 items), Disrupted Swallowing (8 items), and Nausea/vomiting (4 items). All items ask participants to recall symptoms that occurred within the past 7 days. Scores were calculated using the PROMIS website (www.healthmeasures.net) and provided as a standardized T-score with a mean of 50 and a SD of 10. Higher T-scores indicate more severe symptoms compared to the national normative sample described in Spiegel et al. [32]. T-scores were converted into GI symptom severity levels using the suggested PROMIS T-Score range of mild (T-scores between 55 and 60), moderate (T-scores between 60 and 70), and severe (T-scores above 70). ... COVA was conducted on the seven PROMIS-GI scales with menstrual group as the independent variable and health anxiety score as a covariate. No significant main effect for menstrual group was obtained, indicating that the PROMIS-GI measures did not significantly differ between the four menstrual groups. A significant main effect was obtained for health anxiety, F(7, 591) = 22.73, p < 0.001, η p 2 = 0.21. Health anxiety scores had a significant effect on each PROMIS-GI score including belly pain, constipation, diarrhea, gas, ... Overall, results indicated negligible variability in GI symptoms across the menstrual cycle. However, significant differences were observed regarding abdominal pain in the hypogastric area of the abdomen. Specifically, the Menses group reported higher levels of abdominal pain in the hypogastric region (Region H) compared to the Early-Luteal and Premenstrual groups. The hypogastric region is associated with the female reproductive organs that are most often implicated in menstrual pain. Taken together, the group difference in pain ratings of the hypogastric abdominal region is likely to originate from menses rather than GI symptoms due to its location and periodicity. ... Dysmenorrhea is a condition thought to affect between 45 and 90% of menstruating women and is characterized by painful menstruation accompanied by symptoms including nausea, diarrhea, vomiting, lower back pain, fatigue, and headache [46]. The rate of GI symptoms in our menses group is lower relative to studies that have focused on dysmenorrhea. Furthermore, only two women in our sample reported receiving a formal medical diagnosis of dysmenorrhea. Chen and colleagues [47, 48] categorized women with dysmenorrhea into 3 distinct latent classes and found that an estimated 19–25% of women with self-reported dysmenorrhea experienced “multiple severe symptoms,” which included GI symptoms along with abdominal cramps, abdominal pain, lower back pain, and headaches. Given this information, it is possible that the participants in our menses group predominantly fall outside of the identified “multiple severe symptoms” phenotype. This could account for the heightened pain localized to the hypogastric region, without the parallel increase in GI symptoms one might expect. This underscores the heterogeneous nature of dysmenorrhea experiences and emphasizes the necessity for continued research in this population. ... Menstrual cycle phase was not associated with differences in GI symptom severity on the PROMIS-GI scales, however we did find a characteristic difference in abdominal pain for women in the Menses phase. While our findings are most likely consistent with the everyday practice and observations of experienced clinicians, this study provides the first investigation into using standardized measures to quantify a full range of GI symptoms across the phases of the menstrual cycle. GI symptoms during all phases were highly impacted by health anxiety, which could possibly explain the observed sex-based differences in GI pain. Results from this study provide a simple approach to distinguish between GI- and menstrual-related abdominal pain and highlight the importance of routinely using tools such as a visual pain map during assessment and diagnosis. Based on our findings, a case can be made to collect PROMIS-GI measures, pain maps, and questions about the menstrual cycle in patient care settings, not only to facilitate GI symptom tracking, but also to differentiate features of the menstrual cycle from potential DGBI.

Menstrual cramps are pains in the lowest part of the abdomen (pelvis), a few days before, during, or after a menstrual period. The pain tends to be most intense about 24 hours after periods begin and to subside after 2 to 3 days. The pain is often crampy or a dull, constant ache, but it may be sharp or throbbing and may come and go. It sometimes extends to the lower back or legs. ... Experts think that primary dysmenorrhea may be caused by release of substances called prostaglandins into the blood or tissues during menstruation. Prostaglandin levels are high in women with primary dysmenorrhea. Prostaglandins may cause the uterus to contract (as occurs during labor), reducing blood flow to the uterus. These contractions can cause pain and discomfort. Prostaglandins also make nerve endings in the uterus more sensitive to pain. ... - Endometriosis: Tissue that normally occurs only in the lining of the uterus (endometrial tissue) appears outside the uterus. Endometriosis is the most common cause of secondary dysmenorrhea. - Adenomyosis: Endometrial tissue grows into the wall of the uterus, causing it to enlarge and swell during menstrual periods. - Fibroids: These noncancerous tumors are composed of muscle and fibrous tissue and grow in the uterus. - Cervical stenosis: The passageway through the cervix (from the vagina to the main body of the uterus) is narrow or completely closed. ... Doctors usually diagnose dysmenorrhea when a woman reports that she regularly has bothersome pain during menstrual periods. They then determine whether dysmenorrhea is primary or secondary. ... | Adenomyosis (growth of tissue that normally lines the uterus—called endometrial tissue—into the wall of the uterus) | Heavy, painful periods, vaginal bleeding between periods, pain in the lowest part of the abdomen (pelvis), and a feeling of pressure on the bladder and rectum Sometimes pain during sexual intercourse | Ultrasound or MRI of the pelvis In women with abnormal vaginal bleeding, sometimes a biopsy to rule out other causes of bleeding | ... | Endometriosis (patches of endometrial tissue that are abnormally located outside the uterus) | Dull or crampy pain that occurs before and during the first days of menstrual periods Infertility Often pain during sexual intercourse, bowel movements, or urination | Ultrasound of the pelvis Sometimes laparoscopy (insertion of a viewing tube through a small incision just below the navel) | ... - Dysmenorrhea is pelvic cramps or pain during menses. - Usually, menstrual cramps have no identifiable cause (called primary dysmenorrhea). - Pain is often crampy or a dull, constant ache but may be or sharp or throbbing and usually starts a few days before a menstrual period, and subsides after 2 or 3 days.

Mittelschmerz—or ovulation pain, as it is commonly known today—is a benign preovulatory lower abdominal pain that occurs midcycle (between days 7 and 24) in women. Mittelschmerz may affect over 40% of women of reproductive age, and it occurs almost every month in these patients. It generally does not begin until a few years following menarche, when the true ovulatory cycles become established. Pain varies in severity from a mild ache to agonizing pain and is generally felt near the ovaries on the same side as the developing follicle. Mittelschmerz has been found to coincide with the peak in plasma luteinizing hormone (LH) levels when the follicle is enlarging and has not yet ruptured; however, mittelschmerz is unlikely due to follicular distention. Rather, the LH rise increases ovarian perifollicular smooth muscle contractility via a prostaglandin-mediated pathway, potentially producing pain.[1][2][3][4] ... Mittelschmerz most often presents as an acute lower quadrant (usually right-sided) pain ranging from a mild ache to intense pain. Along with several other gynecologic pathologies, mittelschmerz may present similarly to acute appendicitis, leading to misdiagnosis and unnecessary surgery. Mittelschmerz merits consideration before diagnosing appendicitis in young women of reproductive age. Mittelschmerz should also be given adequate attention from all medical providers so that it can be easily recognized and diagnosed. Interprofessional communication and awareness can help improve patient outcomes and reduce patient harm.[5][6][7] ... Women who experience mittelschmerz may not experience it every month, and they may not recognize that it is related to their ovulatory cycles. Mittelschmerz can present as pain in either iliac fossa, and it will generally be on the same side as the developing follicle.[8] The pain usually ceases within three to twelve hours, although patients who have undergone ovarian surgery may experience mittelschmerz that persists until the onset of menstruation. The patient may also report mild backache.[5] Mittelschmerz may improve with oral contraceptive use.[9][10] The knowledge that mittelschmerz coincides with peak luteinizing hormone (LH) levels may be useful in identifying the most fertile days of the ovulatory cycle and potentially aid in family planning.[3]

Mittelschmerz is one-sided, lower abdominal pain that affects some women. It occurs at or around the time when an egg is released from the ovaries (ovulation). ... One in five women have pain around the time of ovulation. This is called mittelschmerz. The pain may occur just before, during, or after ovulation. ... Mittelschmerz may be felt on one side of the body during one month and then switch to the other side during the next month. It may also occur on the same side for many months in a row. ... - Occurs only on one side. - Goes on for minutes to a few hours. It can last up to 24 to 48 hours. - Feels like a sharp, cramping pain unlike other pain. - Is severe (rare). - May switch sides from month to month. - Begins midway through the menstrual cycle.

Mittelschmerz—or ovulation pain, as it is commonly known today—is a benign preovulatory lower abdominal pain that occurs midcycle (between days 7 and 24) in women. Mittelschmerz may affect over 40% of women of reproductive age, and it occurs almost every month in these patients. It generally does not begin until a few years following menarche, when the true ovulatory cycles become established. Pain varies in severity from a mild ache to agonizing pain and is generally felt near the ovaries on the same side as the developing follicle. Mittelschmerz has been found to coincide with the peak in plasma luteinizing hormone (LH) levels when the follicle is enlarging and has not yet ruptured; however, mittelschmerz is unlikely due to follicular distention. Rather, the LH rise increases ovarian perifollicular smooth muscle contractility via a prostaglandin-mediated pathway, potentially producing pain.[1][2][3][4] ... Mittelschmerz most often presents as an acute lower quadrant (usually right-sided) pain ranging from a mild ache to intense pain. Along with several other gynecologic pathologies, mittelschmerz may present similarly to acute appendicitis, leading to misdiagnosis and unnecessary surgery. Mittelschmerz merits consideration before diagnosing appendicitis in young women of reproductive age. Mittelschmerz should also be given adequate attention from all medical providers so that it can be easily ... and diagnosed. Interprofessional communication and awareness can help improve patient outcomes and reduce patient harm ... 6][7] ... Women who experience mittelschmerz may not experience it every month, and they may not recognize that it is related to their ovulatory cycles. Mittelschmerz can present as pain in either iliac fossa, and it will generally be on the same side as the developing follicle.[8] The pain usually ceases within three to twelve hours, although patients who have undergone ovarian surgery may experience mittelschmerz that persists until the onset of menstruation. The patient may also report mild backache.[5] Mittelschmerz may improve with oral contraceptive use.[9][10] The knowledge that mittelschmerz coincides with peak luteinizing hormone (LH) levels may be useful in identifying the most fertile days of the ovulatory cycle and potentially aid in family planning.[3]

Some women feel pain in the abdomen or pelvis during ovulation, when an egg is released from the ovary. This usually happens midway between menstrual cycles. The medical term for this is mittelschmerz, which comes from the German words for "middle" and "pain." Some women don't feel anything when an egg is being released from an ovary. Other women may feel intermittent or constant discomfort or pain during ovulation. ... Ovulation usually occurs two weeks before the first day of each menstrual period, give or take a couple of days. During this time, you may feel pain in the pelvis that can range from a sense of discomfort or a mild twinge to severe pain that mimics appendicitis. It usually lasts a short period of time, from a few minutes to hours. It often is felt in the lower abdomen or pelvis, either in the middle or on one side. If the pain is severe, it may be accompanied by some mild nausea. ... Ovulatory pain usually lasts from a few moments to several hours. The longer episodes of pain may be due to lingering irritation from a small amount of bleeding, which sometimes happens when the egg is released. ... It usually is not necessary to prevent this mild, short-lived pain syndrome. Birth control pills prevent ovulation and can be used to prevent mid-cycle pain. ... Painful ovulation is generally brief, so using medication for pain relief usually is not necessary. Over-the-counter pain medicines, such as ibuprofen (Advil, Motrin and others), can be used as needed and are very effective at relieving mid-menstrual cycle pain. ... Call your doctor if you have fever, pain with urination, abnormal bleeding or vomiting, even if your pain happens exactly at time of ovulation. Let your doctor know if mid-cycle pain lasts longer than a day. You also should contact your doctor if you missed your last menstrual period.

Mittelschmerz is one-sided, lower abdominal pain that affects some women. It occurs at or around the time when an egg is released from the ovaries (ovulation). ... One in five women have pain around the time of ovulation. This is called mittelschmerz. The pain may occur just before, during, or after ovulation. This pain can be explained in several ways. Just before the ovulation, the growth of the follicle where the egg develops may stretch the surface of the ovary. This can cause pain. At the time of ovulation, fluid or blood is released from the ruptured egg follicle. This may irritate the lining of the abdomen. ... Mittelschmerz may be felt on one side of the body during one month and then switch to the other side during the next month. It may also occur on the same side for many months in a row. ... - Occurs only on one side. - Goes on for minutes to a few hours. It can last up to 24 to 48 hours. - Feels like a sharp, cramping pain unlike other pain. - Is severe (rare). - May switch sides from month to month. - Begins midway through the menstrual cycle. ... Most of the time, treatment is not needed. Pain relievers may be needed if the pain is intense or lasts a long time. In patients with Mittelschmerz-related symptoms that interfere with their normal activities, the use of an oral contraceptive may be used to control symptoms. ... Mittelschmerz can be painful, but it is not harmful. It is not a sign of disease. It may help women to be aware of the time in the menstrual cycle when the egg is released. It is important for you to discuss any pain you are having with your health care provider. There are other conditions that can cause similar pain that are much more serious and require treatment. ... - Ovulation pain seems to change. - Pain lasts longer than usual. - Pain occurs with vaginal bleeding. ... Ovulation pain; Midcycle pain

Mittelschmerz is one-sided lower belly pain. It occurs with ovulation. German for "middle pain," mittelschmerz occurs midway through a menstrual cycle. That's about 14 days before your next menstrual period. In most people, mittelschmerz doesn't require medical attention. For minor mittelschmerz discomfort, pain relievers you can buy without a prescription and home remedies are often effective. If the pain really bothers you, your healthcare professional may have you try birth control pills, also called oral contraceptives, to stop ovulation and prevent midcycle pain. ... Mittelschmerz often lasts a few minutes to a few hours, but sometimes it lasts for as long as a day or two. The pain of mittelschmerz may be: - On one side of the lower belly. - Dull and achy, like menstrual cramps. - Sharp and sudden. - Present with slight vaginal bleeding or discharge. - Severe, rarely. Mittelschmerz occurs on the same side of your body as the ovary that's releasing an egg during a process called ovulation. The pain may switch sides from month to month, or you may feel pain on the same side for a few months in a row. Keep track of your menstrual cycle for a few months and note when you feel lower belly pain. If it happens midcycle and goes away without treatment, it's most likely mittelschmerz. ... Mittelschmerz occurs during ovulation, when a follicle on the ovary ruptures and releases its egg. Some people have mittelschmerz every month; others have it only sometimes. ... Pain at any other point in the menstrual cycle isn't mittelschmerz. If pain occurs during your period, it may be typical menstrual cramping called dysmenorrhea. Other stomach or pelvic conditions also may cause pain. If you have bad pain, see a healthcare professional. ... Ovulation is the release of an egg from one of the ovaries. It often happens about midway through the menstrual cycle, although the exact timing may vary.

If you have ovulation pain, also called mittelschmerz, you may experience twinging or cramps during ovulation. Other ovulation pain symptoms include light vaginal bleeding and discharge. Most of the time, rest and over-the-counter medications help. For severe ovulation pain, talk to your provider about options such as birth control pills. ... Ovulation pain is pelvic pain that you may have during ovulation. Ovulation is the part of the menstrual cycle when your ovary releases an egg. Ovulation usually happens about halfway between your periods or around day 14 of a 28-day menstrual cycle. People who experience pain at ovulation often can tell based on the type of pain they feel and when it occurs. ... Ovulation pain is also called “mittelschmerz.” The term comes from the German words for “middle” and “pain.” Mittelschmerz is typically harmless and doesn’t require medical attention. Over-the-counter (OTC) pain relievers are effective in treating painful ovulation. If the pain becomes severe, a healthcare provider may prescribe oral contraceptives to stop ovulation from occurring. ... The pain may feel like a mild twinge, or you might have sudden, sharp pain. It usually hurts on just one side of your lower abdomen (the side that releases the egg). Some people feel pain for a few minutes, while others experience pain for the entire day. You may also experience: ... Ovulation pain may feel similar to period pain — like menstrual cramps (dysmenorrhea). But ovulation pain happens about two weeks before you get your period. ... Ovulation pain typically lasts a few hours. However, the pain can last up to 48 hours. ... Your healthcare provider might diagnose mittelschmerz based on the timing of the pain. Ovulation usually happens about two weeks into your menstrual cycle. You may have ovulation pain if you feel pain at this point in your cycle. Your provider may ask you to keep a record of your menstrual cycles. Note whenever you have pain and where you feel the pain. ... Your menstrual cycle length is the time from the first day of one period to the first day of the next period. For example, if you begin bleeding on March 1 and then again on March 30, your cycle length is 29 days. In this example, ovulation likely occurs around day 15. If your pain happens around day 15 of that cycle, it may be ovulation pain. ... Most people don’t need treatment for mittelschmerz. The pain typically goes away within a day. You can take medication available over the counter, such as nonsteroidal anti-inflammatory medications (ibuprofen or naproxen) or acetaminophen to help with the pain. ... For severe ovulation pain, talk to your healthcare provider about ... birth control pills. Hormonal birth control medications prevent ovulation. Without ovulating, you won’t have ovulation pain. ... Ovulation pain is normal. It’s one of the side effects of your period. It’s not dangerous or a sign of a serious health condition. Ovulation pain doesn’t affect fertility, and it can help you be more aware of when you ovulate. ... If you have ovulation pain, try at-home treatments, such as a warm bath, heating pad and over-the-counter (OTC) pain relief. For severe ovulation pain, talk to your healthcare provider about other treatment options. ... - Fever greater than 100.4 degrees Fahrenheit. - Pain while urinating. - Red or burning skin where the pain is located. - Severe nausea or vomiting. - Severe pain in the middle of your menstrual cycle that lasts longer than a day or occurs during most months. - Over-the-counter pain medication isn’t providing relief from the pain. - Heavy vaginal bleeding between periods. ... Ovulation pain, also called mittelschmerz, happens when people experience ovulation cramps or other pain when they ovulate. Ovulation pain isn’t harmful. Most of the time, you can treat it with pain relievers from the drug store, heating pads and warm baths. But talk to your healthcare provider if you have severe ovulation pain. Your healthcare provider may recommend birth control pills to prevent ovulation.

They sometimes affect the menstrual cycle, and very big cysts can be painful. ... Most women who have ovarian cysts don’t know that they have them. But some cysts cause dull pain in the lower abdomen (pelvic pain). Ovarian cysts can also lead to problems with the menstrual cycle, such as heavy or irregular periods, or spotting (abnormal vaginal bleeding between periods). Menstrual cycle problems occur if the cyst produces sex hormones that cause the lining of the womb to grow more. ... If a cyst ruptures (bursts), it can be felt as a sudden pain – but usually doesn’t cause any other problems. The weight of the cyst can sometimes pull on the ovary and cause it to become twisted. This leads to sudden, severe, cramping pain on the affected side of the lower abdomen, as well as nausea, vomiting and a high pulse rate. ... Complications are also rare. They may occur if the wall of the cyst ruptures (bursts) and the fluid leaks out into the space around it. Although ruptures can be painful, they are usually harmless. Only rarely do they lead to bleeding that needs to be stopped through surgery. A more serious complication may occur if the ovary becomes twisted around the tissue that supports it. Known as ovarian torsion, this mainly happens in women who have larger cysts – often after jerky movements, for instance when playing tennis. Ovarian torsion is very painful. It may also cut off the blood supply to the ovary. If that happens, surgery is needed as soon as possible to prevent the ovary from dying.

But sometimes ovarian cysts can become twisted or burst open (rupture). This can cause serious symptoms. To protect your health, get regular pelvic exams and know the symptoms that can signal what might be a serious problem. ... Most ovarian cysts cause no symptoms and go away on their own. But a large ovarian cyst can cause: - Pelvic pain that may come and go. You may feel a dull ache or a sharp pain in the area below your bellybutton toward one side. - Fullness, pressure or heaviness in your belly (abdomen). - Bloating. ... Most ovarian cysts form as a result of your menstrual cycle. These are called functional cysts. Other types of cysts are much less common. ... Your ovaries grow small cysts called follicles each month. Follicles produce the hormones estrogen and progesterone and break open to release an egg when you ovulate. ... - Follicular cyst. About halfway through your menstrual cycle, an egg bursts out of its follicle. The egg then travels down a fallopian tube. A follicular cyst begins when the follicle doesn't rupture. It doesn't release its egg and continues to grow. - Corpus luteum cyst. After a follicle releases its egg, it shrinks and begins producing estrogen and progesterone. These hormones are needed for conception. The follicle is now called the corpus luteum. Sometimes, the opening where the egg came from gets blocked. Fluid builds up inside the corpus luteum, causing a cyst. Functional cysts are usually harmless. They rarely cause pain and often disappear on their own within 2 to 3 menstrual cycles. ... Dermoid cysts and cystadenomas can become large and move the ovary out of position. This increases the chance of painful twisting of the ovary, called ovarian torsion. Ovarian torsion may reduce or stop blood flow to the ovary. ... - Ovarian torsion. Cysts that become large can cause the ovary to move. This increases the chance of painful twisting of the ovary (ovarian torsion). If this happens, you might have sudden, severe pelvic pain and nausea and vomiting. Ovarian torsion can also reduce or stop blood flow to the ovary. - Cyst rupture. A cyst that bursts open (ruptures) can cause severe pain and bleeding inside the pelvis. The larger the cyst, the greater the risk of rupture. Vigorous activity that affects the pelvis, such as vaginal sex, also increases the risk of rupture.

Ovarian cysts often cause no symptoms. An ovarian cyst is more likely to cause pain if it: - Becomes large - Bleeds - Breaks open - Interferes with the blood supply to the ovary - Is twisted or causes twisting (torsion) of the ovary ... - Bloating or swelling in the abdomen - Pain during bowel movements - Pain in the pelvis shortly before or after beginning a menstrual period - Pain with intercourse or pelvic pain during movement - Pelvic pain -- constant, dull aching - Sudden and severe pelvic pain, often with nausea and vomiting (may be a sign of torsion or twisting of the ovary on its blood supply, or rupture of a cyst with internal bleeding) ... Complications have to do with the condition causing the cysts. Complications can occur with cysts that: - Bleed. - Break open. - Show signs of changes that could be cancer. - Twist, depending on size of the cyst. Bigger cysts carry a higher risk.

Most ovarian cysts are functional cysts. They form as a result of natural changes during your menstrual cycle. Less commonly, a cyst forms on your ovary for other reasons. ... Small ovarian cysts may not cause symptoms. If you have symptoms, they could include pelvic pain, feeling bloated or painful periods. ... Some smaller cysts don ... not even know ... have one. Larger cysts may cause: - Pelvic pain or a dull ache in your back - A feeling of fullness in your lower belly (it may be focused on just one side) - Pain during sex - Painful periods and/or irregular periods - Trouble pooping or needing to pee frequently ... - No pain at all - Mild discomfort or a feeling of fullness - Pain that could be described as sharp or like a dull ache - Discomfort or pain that comes and goes without explanation - Pain during certain parts of your menstrual cycle ... - Cancer: Ovarian cysts that develop after menopause are more likely to be cancerous than cysts that form before menopause. - Ruptured ovarian cyst: Some cysts can break open. Many don’t cause symptoms, but a ruptured cyst can sometimes cause severe pain, dizziness or weakness. Larger cysts are more likely to break open. - Ovarian torsion: A large cyst can make an ovary twist. This can cut off blood flow to the ovary. Symptoms include sudden, severe pain, nausea and vomiting. Get medical care right away if you have symptoms of a ruptured ovarian cyst or ovarian torsion. ... Get help immediately if you notice signs of ovarian torsion or ovarian cyst rupture: - Severe abdominal pain that comes on suddenly, accompanied by vomiting or fever - Feeling light-headed or faint and breathing rapidly - Cold, clammy skin

“Torsion” means to twist, and this is exactly what your ovary does if you have ovarian torsion. Most people with this condition have large cysts that cause an ovary to twist. Without emergency care, the twisting can stop blood flow to the ovary, causing the tissue to die. Get to an ER immediately if you’re experiencing symptoms of ovarian torsion. ... Ovarian torsion is a medical emergency where one of your ovaries twists on the tissues supporting it. Your ovaries are oval-shaped glands located on both sides of your uterus. They release eggs during your reproductive years and make hormones that control your menstrual cycle and pregnancy. They’re held in place by bands of tissue (ligaments) suspended in your pelvic cavity. ... The twisting can cut off the blood supply to the affected ovary, causing sudden, severe abdominal pain. Without emergency care, the tissue in your ovary may die, causing you to lose that ovary. ... The main symptom of ovarian torsion is sudden, severe abdominal pain. It’s frustrating because abdominal pain is a defining symptom of many conditions —and not all of them require an emergency room visit. But when it comes to ovarian torsion, getting to an ER quickly can save your ovary. ... you’re ... . Usually, people describe ... with ovarian torsion as ... - Sharp and stabbing (more common) or dull and crampy. - Located throughout your lower belly (most common) or only on the side of the affected ovary (usually your right side). - Isolated to just your lower belly or radiating (spreading) to your thighs, sides (flank) and lower back. - Constant (common) or intermittent (uncommon). Although it’s uncommon, ovarian torsion symptoms can be intermittent, which means the pain comes and goes. Sometimes, the ovary will twist and then untwist. The twisting cuts off blood flow, causing pain. When the ovary untwists and regains access to blood, the pain may go away. The back and forth can feel confusing. Even if your pain is intermittent, you need to see a healthcare provider for treatment if you’re experiencing ovarian torsion. ... Ovarian torsion happens when something upsets the balance that allows your ovary to stay in place. A growth, like an ovarian cyst (especially a large one), can add extra weight to your ovary, causing it to shift or twist on the ligament holding it. Although it’s less common, cancerous tumors or other solid masses on your ovary can shift the weight, too, and cause torsion. ... - Growths on your ovaries: Up to 85% of people diagnosed with ovarian torsion have ovarian cysts or other benign masses on their ovaries. The risk is greater if the cyst or mass is 5 centimeters (about 2 inches) across or more. ... Surgeons treat ovarian torsion by untwisting the ovary. They may also remove cysts that may be involved (ovarian cystectomy). Usually, they’ll be able to save your ovary. ... Get to an emergency room (ER) immediately if you’re experiencing unexplained pain in your lower abdomen — especially if you already know you have a mass (like an ovarian cyst) that increases your risk of ovarian torsion. ... alternating periods of pain and then no ... It can feel both frustrating and scary to experience a symptom like abdominal pain that may indicate something minor — or a medical emergency that requires care ASAP. When it comes to ovarian torsion, there’s no way to know that the source of pain is a twisted ovary until your provider diagnoses you. Unfortunately, most people aren’t aware they have a (usually harmless) condition, like an ovarian cyst, that’s a risk factor for ovarian torsion.

Chronic pelvic pain persists in some women with endometriosis even after lesion removal and optimized hormonal treatment. ... In endometriosis, an inflammatory disease affecting reproductive-aged women associated with infertility and pain, endometrial tissue grows outside the uterus as estrogen-dependent/progesterone-resistant pelvic lesions with their own blood supply and innervation (Al-Sabbagh et al., 2012;Berkley et al., 2004;McKinnon et al., 2015;Zondervan et al., 2020). Endometriosis-associated pain, usually a triad of dysmenorrhea, non-menstrual pelvic pain, and dyspareunia, begins early in reproductive life and persists, imposing a significant burden (Schliep et al., 2015;Stratton and Berkley 2011). Gynecologists have attributed the pain to endometriosis lesions(Fauconnier and Chapron 2005). Thus, standard treatment focuses on surgery to remove lesions and hormone administration to prevent lesion growth. ... Thus, persistent endometriosis-related pelvic pain cannot be explained by the presence of lesions. It may be, rather, that bidirectional communication between central and peripheral pain processes initiates and maintains pathologic neuroplastic changes, perpetuating pain (Aredo et al., 2017;Berkley et al., 2005;Stratton et al., 2015). Sensitization manifests as regional allodynia, hyperalgesia, and pain beyond the visceral pathology(Latremoliere and Woolf 2009). Sensitization is commonly assessed by quantitative cutaneous sensory testing of peripheral areas using thermal or mechanical stimulation modalities (Arendt-Nielsen and Yarnitsky 2009). However, such limited testing inadequately illustrates the association between sensitization and myofascial dysfunction, which often independently contribute to pain persistence. Fundamental to myofascial dysfunction are myofascial trigger points–hard, tender nodules in a taut band of skeletal muscle that, when palpated, often reproduce a person’s pain(Simons 1999). In endometriosis-associated pain, palpation of pelvic floor muscles in spasm may reproduce a woman’s pelvic pain (Langford et al., 2007). The presence of co-morbid non-pelvic pain, sensitization and myofascial trigger points have rarely been studied in the endometriosis population (As-Sanie et al., 2013;Bajaj et al., 2003;Grundstrom et al., 2019;Yosef et al., 2016). ... On the neuro-musculoskeletal exam, all women had widespread myofascial dysfunction as evidenced by myofascial trigger points in more than two-thirds of assessed regions. Fourteen (47%) of 30 women had myofascial trigger points in all 26 assessed regions. A low pressure-pain threshold was observed in all of the assessed myofascial trigger points (Figure 3). Most women had widespread (17/30, 57%), thoracic (21/30, 70%), and lumbosacral/pelvic (18/30, 60%) spinal segment sensitization. Cervical spinal segment sensitization was manifested as low pressure-pain thresholds; in addition, orofacial pain was reported in 21/30 (70%) or recurrent severe headaches in 23/30 (77%). The pressure-pain thresholds over the interspinous ligaments were generally low within the cervical, thoracic, and lumbosacral/pelvic regions (Figure 4). Overall, sixteen (53%) of 30 women had low pressure-pain thresholds over all interspinous ligaments. ... , the gynecological examination showed that these women all had pelvic floor muscle spasm, frequently encompassing at least four of six pelvic floor muscles, that, when palpated, evoked their typical pelvic pain. Importantly, the neuro-musculoskeletal examination revealed that all women also had widespread myofascial dysfunction with palpable myofascial trigger points and low pressure-pain thresholds in nearly all muscles tested. Similarly, widespread and regional sensitization were observed in most women in addition to low pressure-pain thresholds over the interspinous ligaments. Our findings demonstrate that women with endometriosis-associated chronic pelvic pain may have widespread myofascial dysfunction and sensitization beyond the pelvic focus of pain. Previous studies have provided translational evidence of ways in which endometriosis lesions can engage the nervous system and contribute to sensitization that sustains persistent pain. Endometriosis-associated chronic pelvic pain may develop and be maintained by compression or infiltration of nerves near the lesions, innervation of blood vessels vascularizing developing lesions, and innervation of endometrial lesions by sensory and sympathetic nerve fibers (Anaf et al., 2000;Berkley et al., 2004;Ramer and Bisby 1999;Stratton and Berkley 2011;Woolf 1996). In animal models, Li et al. showed persistent pain hypersensitivity in mice with endometriosis compared with controls while Yano et al. found that non-noxious abdominal stimulation in macaques with endometriosis activated the thalamus and insula– brain regions associated with pain– to a greater degree than in healthy controls (Li et al., 2018;Yano et al., 2019). Moreover, Dodds et al. ... Our findings suggest that women with endometriosis-associated chronic pelvic pain experience widespread myofascial dysfunction as well as generalized and regional sensitization, often unevaluated and unrecognized by the clinician. Moreover, we found that patients reporting diffuse pain on pelvic exam were more likely to have lumbosacral and widespread sensitization. Clinicians should elicit and use such patient-reported descriptions to signal the need to evaluate pain symptomatology and signs of sensitization beyond the pelvic region. Importantly, given that palpation of the pelvic floor spasm recreated these patients’ chronic pelvic pain, this area might be considered a “pain generator.” As a pain generator, the pelvic floor spasm could transmit sensory information via peripheral nerves and then to central neurons, leading to amplification of signaling and establishing hyperalgesic priming after the initial peripheral pathology has been resolved (Dodds et al., 2019;Eller-Smith et al., 2018). In our previously reported case series of women this cohort who received open-label onabotulinumtoxinA to treat pelvic floor muscle spasm, we observed a reduction in pelvic floor muscle spasm that was associated with a decrease in patient-reported pain and disability(Tandon et al., 2019). Whether this clinical improvement was associated with reduction in myofascial dysfunction or sensitization awaits further study. ... Pain and sensitization beyond the pelvis have rarely been studied in women with endometriosis-associated chronic pelvic pain. The clinical importance of these findings underscore the complementary nature of a standardized pain-focused gynecologic assessment and a broader neuro-musculoskeletal examination. Together, these provide a more comprehensive picture of the individual patient’s chronic pain phenotype that could inform a more holistic approach to treatment. Our observations also suggest the prevalence of widespread myofascial dysfunction in women with endometriosis-associated chronic pelvic pain, supporting the role of central sensitization in the maintenance of pain after surgical resection and with ongoing hormonal management. In turn, those with widespread pain, sensitization, and myofascial dysfunction may have pain generators outside the pelvic floor that will likely not respond to localized pelvic treatment or surgery. These diffuse and focal myofascial and central nervous system manifestations warrant consideration in pain management in this population. increased recognition of myofascial dysfunction and sensitization in the diagnosis and treatment of chronic pain conditions could elucidate more effective and targeted therapeutic approaches and improve patient outcomes. ... Women with endometriosis often have pelvic pain persisting after surgery despite hormonal therapies. ... Sensitization and myofascial dysfunction are widespread, beyond the pelvic region. On-going pelvic floor spasm may initiate or maintain sensitization.

Endometriosis causes severe pain, cramps, and stomach and bowel problems in some women, while others only have mild symptoms or notice nothing at all. Endometriosis symptoms mainly occur during your menstrual period, but you may also experience them at other times. The severity of symptoms doesn't always depend on how much endometriosis tissue a woman has in her body. ... Very painful menstrual periods (dysmenorrhea): When a woman has her period (menstruation), the muscles in the wall of her womb repeatedly tighten and squeeze in order to shed the lining of the womb. This can cause period pain. Women who have endometriosis may have particularly severe pain and cramping during their period. Many girls and women think this is normal because things have always been that way for them. It never crosses their mind that their severe period pain might be caused by a medical condition. ... Abdominal (lower belly) pain: Various degrees of pain may be felt in different parts of the abdomen, sometimes radiating to the back or legs. Some describe their pain as being diffuse. It doesn't necessarily only occur during your monthly period. The pain can also become chronic. ... Endometriosis can also affect your fertility and sometimes prevents women from becoming pregnant. ... be measured objectively. ... how much the ... . Some women describe their pain ... distressing – for example, “like being stabbed in ... lower belly” or ... The pain can affect things like your performance at work and your ability to do sports and household chores. Women who have very severe pain often feel incapacitated and have to withdraw from everyday life for several days. Painkillers ... 't always help enough, either. Sometimes other people don't take the disease seriously, which ... make it harder to cope with.

In endometriosis, functioning endometrial cells (those from the lining of the uterine cavity) are implanted in the pelvis outside the uterine cavity. Symptoms depend on location of the implants. The classic triad of symptoms is dysmenorrhea, dyspareunia, and infertility, but symptoms may also include dysuria and dyschezia. Severity of symptoms is not related to disease stage. Diagnosis is often clinical, based on characteristic symptoms, and on physical findings, if present. Imaging studies (transvaginal ultrasound, MRI) are sometimes useful in supporting the diagnosis. Direct visualization and sometimes biopsy (usually via laparoscopy) is useful in planning treatment but is not required; treatment may be initiated based solely on a clinical diagnosis. Treatments include nonsteroidal anti-inflammatory drugs, medications to suppress ovarian function and endometrial tissue growth, surgical ablation and excision of endometriotic implants, and, if disease is severe and no childbearing is planned, hysterectomy alone or hysterectomy with bilateral salpingo-oophorectomy. ... Some women with extensive endometriosis are asymptomatic; some with minimal disease have incapacitating pain. The classic triad of symptoms of endometriosis is dysmenorrhea, dyspareunia, and infertility. Cyclic midline pelvic pain preceding or during menses (dysmenorrhea) and pain in the abdomen during sexual intercourse (deep dyspareunia) are typical and can be progressive and chronic (lasting > 6 months). Dysmenorrhea that begins after several years of relatively pain-free menses is an important diagnostic clue. Patients may also have noncyclic pelvic pain. ... - Characteristic symptoms, including dysmenorrhea, dyspareunia, dysuria, dyschezia, chronic pelvic pain, and/or infertility - Pelvic ultrasound or MRI - Sometimes direct visualization with or without biopsy of suspicious, usually during pelvic laparoscopy ... - Consider endometriosis if patients have persistent pelvic pain, particularly if they also have dyspareunia or infertility. ... Patients with suspected endometriosis are often treated empirically first. If symptoms are controlled with noninvasive measures, surgery can be avoided (1). Symptomatic medical treatment begins with analgesics (usually NSAIDs) and hormonal contraceptives. If these are ineffective, patients are counseled about proceeding with more intensive pharmacologic treatment (GnRH analogs, aromatase inhibitors, or danazol) or undergoing laparoscopy for confirmation of the diagnosis and concomitant treatment. ... Usually, NSAIDs are used to relieve pain. They may be all that is needed if symptoms are mild and the patient has completed childbearing. Medications that suppress ... of endometriotic ... . Pharmacologic treatment ... for controlling pain ... rates in women with minimal or mild endometriosis ... Specific indications for laparoscopic surgery include - Moderate to severe pelvic pain that does not respond to medications - Endometrioma - Significant pelvic adhesions - Fallopian tube obstruction - A desire to become pregnant within a few months after surgery - Dyspareunia (surgical treatment is second-line treatment unless performed during diagnostic laparoscopy) ... after salpingo-oophorectomy in women > 50 years old, estrogen therapy is not recommended as it may worsen pelvic symptoms. In this case, continuous progestin therapy ... (norethindrone acetate 2.5 to 5 mg, medroxyprogesterone acetate 5 mg orally once a day, ... ized progesterone 100 to 200 mg orally at bedtime) ... be tried for relief of hot flushes. ... - Endometriosis is the presence of endometrial tissue implanted in the pelvis outside the uterine cavity, most commonly the ovaries, broad ligaments, posterior cul-de-sac, uterosacral ligaments, and peritoneum. - The classic triad of symptoms is dysmenorrhea, dyspareunia, and infertility, but symptoms may also include dysuria and dyschezia. - For suspected endometriosis, treat pain with analgesics (eg, NSAIDs) and hormonal contraceptives. - If initial medications are ineffective, proceed with more intensive pharmacologic treatment (GnRH analogs, aromatase inhibitors, or danazol) or laparoscopy. - Perform diagnostic laparoscopy to confirm the diagnosis with visual inspection; a biopsy is not mandatory but may aid in the diagnosis.

Timely and effective management of endometriosis has the potential to ... pain, improve fertility and quality of life, and enhance long- ... outcomes. Early intervention may also help mitigate the financial and ... with delayed diagnosis and treatment. ... Endometriosis is a chronic condition that requires a patient-centred and individualized approach to long term management which may be multidisciplinary and include medical, surgical, pain and/or fertility interventions. (high) ... Medical treatment can be an effective option for managing endometriosis pain symptoms, however, each of the various options has unique advantages and side-effects (high). ... Patients with chronic/persistent pain and endometriosis are likely to have better improvement in quality of life using a biopsychosocial approach that addresses concurrent pain contributors and nociplastic pain mechanisms, which are often present in long-standing cases. (moderate) ... For patients not considering immediate fertility, hormonal therapy should be offered and can be used long-term for symptom control. (high, strong) ... Following conservative (ovarian and uterine preservation) endometriosis surgery, patients not desiring immediate pregnancy should be offered long-term hormonal therapy to reduce the risk of symptom recurrence and possibly disease recurrence. (high, strong) ... When considering surgery for endometriosis, it is important to assess for overlapping chronic pain conditions and other potential comorbidities that may affect the surgical plan and prognosis. (high, strong)

Endometriosis Is More Than Just ‘Painful Periods’ Yale Medicine

Refer women who are haemodynamically unstable, or in whom there is significant concern about the degree of pain or bleeding, directly to A&E. [2012] ... Be aware that ectopic pregnancy can present with a variety of symptoms. Even if a symptom is less common, it may still be significant. Symptoms of ectopic pregnancy include: - common symptoms: - abdominal or pelvic pain - amenorrhoea or missed period - vaginal bleeding with or without clots - other reported symptoms: - breast tenderness - gastrointestinal symptoms - dizziness, fainting or syncope - shoulder tip pain - urinary symptoms - passage of tissue - rectal pressure or pain on defecation. [2012] ... Be aware that ectopic pregnancy can present with a variety of signs on examination by a healthcare professional. Signs of ectopic pregnancy include: - more common signs: - pelvic tenderness - adnexal tenderness - abdominal tenderness - other reported signs: - cervical motion tenderness - rebound tenderness or peritoneal signs - pallor - abdominal distension - enlarged uterus - tachycardia (more than 100 beats per minute) or hypotension (less than 100/60 mmHg) - shock or collapse - orthostatic hypotension. [2012] ... During clinical assessment of women of reproductive age, be aware that: - they may be pregnant, and think about offering a pregnancy test even when symptoms are non-specific and - the symptoms and signs of ectopic pregnancy can resemble the common symptoms and signs of other conditions – for example, gastrointestinal conditions or urinary tract infection. [2012] ... Refer immediately to an early pregnancy assessment service (or out-of-hours gynaecology service if the early pregnancy assessment service is not available) for further assessment of women with a positive pregnancy test and the following on examination: - pain and abdominal tenderness or - pelvic tenderness or - cervical motion tenderness. [2012] ... Exclude the possibility of ectopic pregnancy, even in the absence of risk factors (such as previous ectopic pregnancy), because about a third of women with an ectopic pregnancy will have no known risk factors. [2012] ... Refer to an early pregnancy assessment service (or out-of-hours gynaecology service if the early pregnancy assessment service is not available) women with bleeding or other symptoms and signs of early pregnancy complications who have: - pain or - a pregnancy of 6 weeks' gestation or more or - a pregnancy of uncertain gestation. The urgency of this referral depends on the clinical situation. [2012] ... Use expectant management for women with a pregnancy of less than 6 weeks' gestation who are bleeding but not in pain, and who have no risk factors, such as a previous ectopic pregnancy. Advise these women: - to return if bleeding continues or pain develops - to repeat a urine pregnancy test after 7 to 10 days and to return if it is positive - a negative pregnancy test means that the pregnancy has miscarried. [2012, amended 2019] ... Refer women who return with worsening symptoms and signs that could suggest an ectopic pregnancy to an early pregnancy assessment service (or out-of-hours gynaecology service if the early pregnancy assessment service is not available) for further assessment. The decision about whether she should be seen immediately or within 24 hours will depend on the clinical situation. [2012]

Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches to the lining of the uterus. An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus. An ectopic pregnancy most often occurs in a fallopian tube, which carries eggs from the ovaries to the uterus. This type of ectopic pregnancy is called a tubal pregnancy. Sometimes, an ectopic pregnancy occurs in other areas of the body, such as the ovary, abdominal cavity or the lower part of the uterus (cervix), which connects to the vagina. An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue may cause life-threatening bleeding, if left untreated. ... You may not notice any symptoms at first. However, some women who have an ectopic pregnancy have the usual early signs or symptoms of pregnancy — a missed period, breast tenderness and nausea. ... Often, the first warning signs of an ectopic pregnancy are light vaginal bleeding and pelvic pain. If blood leaks from the fallopian tube, you may feel shoulder pain or an urge to have a bowel movement. Your specific symptoms depend on where the blood collects and which nerves are irritated. ... If the fertilized egg continues to grow in the fallopian tube, it can cause the tube to rupture. Heavy bleeding inside the abdomen is likely. Symptoms of this life-threatening event include extreme lightheadedness, fainting and shock. ... Seek emergency medical help if you have any signs or symptoms of an ectopic pregnancy, including: - Severe abdominal or pelvic pain accompanied by vaginal bleeding - Extreme lightheadedness or fainting - Shoulder pain ... A tubal pregnancy — the most common type of ectopic pregnancy — happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role. ... - Inflammation or infection. Sexually transmitted infections, such as gonorrhea or chlamydia, can cause inflammation in the tubes and other nearby organs, and increase your risk of an ectopic pregnancy. ... An ectopic pregnancy can cause your fallopian tube to burst open. Without treatment, the ruptured tube can lead to life-threatening bleeding. ... - Limiting the number of sexual partners and using a condom during sex helps to prevent sexually transmitted infections and may reduce the risk of pelvic inflammatory disease. - Don't smoke. If you do, quit before you try to get pregnant.

The uterus, or womb, is the place where a fetus grows during pregnancy. In an ectopic pregnancy, the fertilized egg grows in the wrong place outside the uterus. It usually occurs in the fallopian tubes. These tubes carry eggs from the ovaries to the uterus. Sometimes, an ectopic pregnancy can occur in the ovaries, abdominal cavity, or the lower part of the uterus (cervix). Ectopic pregnancies can't end in a healthy pregnancy because the egg cannot grow. If the pregnancy continues, the fallopian tube can burst. This can cause internal bleeding, which can be a life-threatening emergency that needs immediate surgery. ... - Previous ectopic pregnancy - Prior pelvic, abdominal, or fallopian tube surgery - Certain sexually transmitted infections (STIs) - Pelvic inflammatory disease - Endometriosis - Becoming pregnant while using an intrauterine device (IUD) for birth control - Becoming pregnant after a tubal ligation ... You may not notice any symptoms at first. Or you may have some of the usual signs of pregnancy such as a missed period, breast tenderness, or nausea. Early signs of an ectopic pregnancy may be light vaginal bleeding and pelvic pain. Ectopic pregnancy can be a medical emergency. Get medical care right away if you have these signs: - Abdominal (belly) pain - Shoulder pain - Vaginal bleeding - Feeling dizzy or faint ... An ectopic pregnancy can't be diagnosed without blood tests and an ultrasound. Your health care provider will do a pregnancy test to confirm that you're pregnant. They may do a pelvic exam to check for areas of pain, tenderness, or a mass. ... An ectopic pregnancy needs treatment to stop any damage to your organs. Your provider will use medicine or surgery to take out the ectopic tissue.

3. Women should be given written information at the time of diagnosis of an ectopic pregnancy regarding their diagnosis and management. They should be counselled regarding signs of clinical deterioration when they should present for review and given information about emergency contacts. Best Practice 4. A urinary beta-human chorionic gonadotrophin (β-hCG) test should be performed in all women of reproductive age presenting to a maternity or adult general hospital/unit with abdominal pain, vaginal bleeding, gastrointestinal symptoms, dizziness, or collapse. Grade 1B ... 7. There should be prompt escalation of care if there are any red flag symptoms on triage assessment or abnormal vital signs in the presence of a positive urinary HCG. This should include referral to an Obstetrics/Gynaecology doctor, IV access and use of an assessment room. Best Practice ... 18. Medical management is appropriate in women with serum β-hCG <5000 U/L, no contraindications to methotrexate, no evidence of fetal cardiac activity and no significant pain or hemoperitoneum. Grade 1B 19. Medical management is most successful in women with a serum β-hCG of 3,000 U/L and less. Grade 1B 20. All hospitals/units need to have local protocols for assessment, monitoring, and follow-up of women who choose expectant or medical management for ectopic pregnancy. Best Practice 21. Surgical management is appropriate when there is evidence of rupture, significant pain, β-hCG levels >5000 U/L, fetal cardiac activity, an adnexal mass >3cm on TVUS, where the ectopic pregnancy is not suitable for medical management or where there has been unsuccessful medical management, and in some scenarios of preference or where the woman is not available for follow up. Grade 1A ... Symptoms of ectopic pregnancy can vary between women. Symptoms of an EP can include pain (unilateral, generalised pelvic or shoulder tip pain), bleeding, gastrointestinal symptoms (diarrhoea and/ or vomiting), dizziness/light-headedness or collapse. 11 These symptoms can present clinically similar to appendicitis, urinary caliculi, early pregnancy loss or trauma. 12 The earliest symptom is usually brown discharge, and the intensity of bleeding can vary with some women having heavy blood loss. Pain may be present however may be a later symptom of EP and typically follows tubal miscarriage. Almost 10% of women diagnosed with EP have no abdominal pain. 13 Of those who attend an emergency department with bleeding, pain, or both, in early pregnancy the prevalence of EP is up to 16%. 14 Healthcare professionals should be aware of presenting symptoms, relevant findings on clinical examination and risk factors which will make a woman at higher risk of having an EP. Women of reproductive age presenting with any symptoms of abdominal pain or vaginal bleeding should have a urinary beta-human chorionic gonadotrophin (β-hCG) performed as an initial investigation. 15 Some women with an EP will present in haemorrhagic shock. Pallor, tachycardia, and hypotension should alert the examiner to major abdominal bleeding, regardless of the intensity of abdominal pain. Relative bradycardia can still be present with significant intraperitoneal bleeding and therefore a high index of concern should remain. 16 If the woman is haemodynamically stable, a detailed clinical history should be taken paying particular attention to her last menstrual period (LMP) and the potential risk factors for EP. Half of women diagnosed with an EP have no known risk factors. 12 Risk factors include previous ectopic pregnancy, smoking, endometriosis, pelvic inflammatory disease (PID), previous pelvic surgery, invitro fertilisation (IVF), or intrauterine contraceptive device (IUCD) use at conception. Those risk factors which are strongly associated with the occurrence of an ectopic pregnancy include previous ectopic pregnancy, previous tubal surgery and documented tubal pathology for ectopic pregnancy. 17 Endometriosis has been found in a metanalysis to be associated with an odds ratio of 2.16-2.66 however further research is required to further establish this link. 18 The use of assisted reproductive technologies greatly increases the risk of heterotopic pregnancy which is the presence of an intrauterine pregnancy alongside an ectopic to 1:100 from a background risk of 1:30,000 19 and IVF with frozen embryo transfer is associated with an increased odds ratio for ectopic pregnancy of 8.99. 20 When pregnancy occurs with an IUCD in place it is more likely to be an ectopic pregnancy. 20 ... • Women presenting to an emergency department or primary care with vaginal bleeding, abdominal pain, gastrointestinal (GI) disturbance, dizziness or collapse should have a urinary hCG performed and a prompt assessment of vital signs. • Management should not be delayed waiting for urinary or serum β-hCG results in cases of haemodynamic instability. • There should be prompt escalation of care if there are any red flag symptoms on triage assessment or abnormal vital signs in the presence of a positive urinary HCG. This should include referral to a clinician, IV access and use of an assessment room. • A clinical history and physical examination should be undertaken to assess for risk factors for EP. An obstetric history should include previous pregnancies and outcomes, date of LMP and if the woman has had an ultrasound in this pregnancy. It is important to know if the woman is currently under the care of an EPAU for either pregnancy of unknown location (PUL) or EP. ... peritonism, cervical excitation, rarely an adnexal ... • Women should be informed of the 8-14% risk of a PUL being an ectopic pregnancy and advised to seek prompt review for worsening or new symptoms (including but are not limited to; worsening pain, GI symptoms, feeling faint and heavy bleeding). They should be given information on emergency contact information. ... Once a diagnosis of a tubal ectopic pregnancy has been made on ultrasound, a serum β-hCG should be performed to help guide management. The level of serum β-hCG is a prognostic indicator of success in medical management with methotrexate or expectant management with tubal ectopic pregnancy. 37 There are three options for treatment of ectopic pregnancy: expectant, medical or surgical. The management should be based on the woman’s choice following assessment of her clinical status and serum β-hCG level, with appropriate counselling. Discussion of risk should be undertaken by a clinician with experience of ectopic pregnancy to facilitate informed decision making. A woman can be helped to make an informed decision by using the ‘ask three questions’ 38 model: ... Expectant management should be abandoned if the serum β-hCG levels are not decreasing, a woman develops pain or if there are signs of tubal rupture. There remains a risk of rupture until full resolution and women should be given information on where to present for emergency care if they develop signs or symptoms of rupture. Such signs and symptoms include abdominal or pelvic pain, gastrointestinal symptoms or collapse. ... MTX treatment can be offered to women who; are haemodynamically stable with no contraindications to methotrexate, have β-hCG levels of <5000 U/L with an ectopic size of <35mm with no fetal heart activity and are able to return for follow up. There should be no signs of EP rupture and no evidence of an intrauterine pregnancy. ... Surgical Management Surgical management of tubal ectopic pregnancy should be recommended to all women who are haemodynamically unstable, and where expectant or medical management is not appropriate or has failed. It may also be a woman’s preference. Options include salpingectomy or salpingostomy which can be performed laparoscopically or by laparotomy. Laparoscopy is preferable in the haemodynamically stable woman as it associated with decreased hospital stay, less blood loss and fewer analgesic requirements. 58

What is ectopic pregnancy and what are the signs and symptoms? The Telegraph

- • Bacterial infection that occurs in the urinary tract - • Symptoms include pain during urination, having urge to pee often, blood in urine, cloudy or foul-smelling urine, fever - • Treatments include antibiotics - • Involves urology, pediatric urology program, obstetrics, gynecology & reproductive sciences, infectious diseases ... When you feel a burning sensation while peeing, the first thing you may wonder is: “Do I have a urinary tract infection?” It’s a telltale symptom of a well-known condition that doesn’t have long-lasting effects when caught and treated early. ... “A change in urinary symptoms should not be ignored—if you experience pain with urination, pelvic pressure, or certainly blood in the urine seek medical attention,” says Yale Medicine urologist Joseph Brito III, MD. ... A urinary tract infection occurs when bacteria causes inflammation and/ ... discomfort within the urinary tract. ... The anatomy of the urinary tract of women makes them more likely to have a urinary tract infection than men. In particular, women have a shorter urethra than men, which means bacteria has less distance to travel to reach the bladder where it can cause an infection. ... - Pregnancy - Obesity - A personal or family history of urinary tract infections - Using spermicide and/or a diaphragm as birth control - Having frequent sexual encounters - Urinary incontinence - Sexually transmitted infections - Enlarged prostate - Having an uncircumcised penis (for boys up to 1 year of age) - Kidney transplant - Catheter usage - Certain chronic ... conditions, like diabetes or kidney disease - A weakened immune system ... People who have urinary tract infections in the urethra or bladder often have symptoms such as: - Pain or burning when peeing - Having the urge to pee often - Awakening with the urge to pee two or more times per night - The presence of blood in the urine - Urine that looks cloudy - Urine that has an unpleasant smell - Pelvic pain or pressure - Inability to fully empty the bladder - Wetting the bed at night or having accidents during the daytime ... To arrive at a diagnosis, your doctor will ask about symptoms, including whether you have pain or burning while peeing. If you’ve had urinary tract infections in the past, the doctor will want to know. ... Doctors test pregnant women for urinary tract infections at routine prenatal visits. Those who are found to have bacteria in the urinary tract are treated, even if they don’t have symptoms. (Untreated infections during pregnancy may lead to low birthweight babies or early delivery.) ... The usual treatment for a urinary tract infection is a course of oral antibiotics, which helps to eradicate bacteria in the urinary tract. Some are single-dose treatments, while others are taken for several days. ... - Over-the-counter painkillers, to alleviate pain or fever - Phenazopyridine, which helps to relieve pain and burning within the urinary tract ... Although urinary tract infections may be ... , they can be cured with ... . People who have recurrent infections should be ... by their doctors to find a possible cause for repeat infections.

Bacterial urinary tract infections (UTIs) most commonly involve the bladder (cystitis) or kidneys (pyelonephritis). Symptoms may be absent or include urinary frequency, urgency, dysuria, lower abdominal pain, and flank pain. Systemic symptoms and even sepsis may occur with kidney infection. Diagnosis is based on analysis and culture of urine. Treatment is with antibiotics and removal of any urinary tract catheters and obstructions. ... Structural and functional urinary tract abnormalities that predispose to UTI usually involve obstruction of urine flow and poor bladder emptying. Urine flow can be compromised by calculi and tumors. Bladder emptying can be impaired by neurogenic dysfunction, pregnancy, uterine prolapse, cystocele, and prostatic enlargement. UTI caused by congenital factors manifests most commonly during childhood. Most other risk factors are more common among older adults. ... Uncomplicated UTI refers to infection that is confined to the bladder in afebrile men or women. It is characterized by local bladder symptoms (eg, dysuria, urgency, frequency, suprapubic pain) without systemic symptoms or signs. ... Acute urethral syndrome, which occurs in women, is a syndrome involving dysuria, frequency, and pyuria (dysuria-pyuria syndrome) and resembles cystitis. However, in acute urethral syndrome (unlike in cystitis), routine urine cultures are negative or show colony counts that are lower than ... for diagnosis of bacterial cystitis. Urethritis due to organisms such as C. trachomatis, M. genitalium, and Ureaplasma urealyticum, which are not detected on routine urine culture, is a possible cause of acute urethral syndrome. ... Cystitis onset is usually sudden, typically with frequency, urgency, and burning or painful voiding of small volumes of urine. Nocturia, with suprapubic pain and often low back pain, is common. The urine is often turbid, and microscopic (or rarely gross) hematuria can occur. A low-grade fever may develop. Pneumaturia (passage of air in the urine) can occur when infection results from a vesicoenteric or vesicovaginal fistula or from emphysematous cystitis. In men, prostatitis should be suspected as the cause of cystitis if they also have pain or pressure in the perineum. ... acute pyel ... Occasionally, UTI is present despite lower colony counts, possibly because of prior antibiotic therapy, very dilute urine (specific gravity < 1.003), or obstruction to the flow of grossly infected urine. Repeating the culture improves the diagnostic accuracy of a positive result, ie, may differentiate between a contaminant and a true positive result. Molecular (eg, PCR) urine testing may sometimes reveal unusual pathogens in patients with refractory or recurrent UTI. ... dysuria, pyuria ... In women with recurrent UTI, physical examination should include pelvic examination to detect manageable conditions, such as vulvovaginal atrophy, urethral diverticulum, fecal incontinence, and vaginal prolapse. Men with recurrent UTI should be evaluated for prostatitis, urethritis, and incomplete bladder emptying. In women who experience ≥ 3 UTIs/year, behavioral measures are recommended, including increasing fluid intake, avoiding spermicides and diaphragm use, not delaying urination, wiping front to back after defecation, avoiding douching, and urinating immediately after sexual intercourse. If these techniques are unsuccessful, antibiotic prophylaxis should be considered. Common options are continuous and postcoital prophylaxis. ... In pregnant patients, effective prophylaxis of UTI is ... to that in nonpregnant patients, ... use of postcoital prophylaxis. Appropriate patients include those with acute pyelonephritis during a pregnancy, patients with ... episode (despite ... ) of UTI or bacteriuria during pregnancy, and patients who ... recurrent UTI before pregnancy. ... - Do not test for or ... asymptomatic bacteriuria except in pregnant patients or before an invasive u ... - In general, culture urine in patients with suspected complicated UTI but not in patients with uncomplicated cystitis

## For women under 65 years with suspected lower urinary tract infections (UTIs) or lower recurrent UTIs (cystitis or urethritis) ... - Dysuria: Burning pain when peeing - New nocturia: Needing to pee in the night - Cloudy urine: Pee looks cloudy ... - Frequency: Peeing more often than usual - Urgency: Feeling the need to pee immediately - Haematuria: Blood in your urine - Suprapubic pain: Pain in your lower tummy ... much alcohol, fizzy ... that can irritate your ... for pain relief, ... had no previous side effects ... If you have none, or only one of, dysuria, new nocturia or cloudy urine, or you have a vaginal discharge (on its own or with any of the above): ... to check for a UTI - ... are less likely to help; and - the infection will usually ... 5 to 7 ... - Self-care and pain relief - symptoms may get better on their own ... self-care and pain relief. Start antibiotics ... your symptoms: - get worse, or do not get a little better with self-care within 4 ... If you have 2 or more of dysuria, new nocturia, cloudy urine or bacteria in your urine and no vaginal discharge: ... - a UTI is more likely and antibiotics should help - you should start to improve within 48 hours - symptoms usually last 3 days - Immediate treatment with antibiotics, plus self-care - If your symptoms are mild, start delayed or backup treatment with antibiotics, plus self-care ... - Stop bacteria spreading from your bowel into your bladder. Wipe from front (vagina) to back (bottom) after using the toilet - Avoid waiting to go to the toilet. Pee as soon as you need to - Go for a pee after having sex to flush out any bacteria that may be near the opening to the urethra - Wash the external vagina area with water before and after sex to wash away any bacteria that may be near the opening to the urethra - Drink enough fluids to make sure you pee regularly throughout the day, especially during hot weather ... - You have shivering, chills and muscle pain - You feel confused, or are very drowsy - You have not been for a pee all day - You are vomiting - You see blood in your urine - Your temperature is above 38ºC or less than 36ºC - You have kidney pain in your back just under ... ribs - Your symptoms get worse - Your symptoms are not starting to improve within 48 hours of taking antibiotics

A urinary tract infection is a very common type of infection in your urinary system. It can involve any part of your urinary system. Bacteria — especially E. coli — are the most common cause of UTIs. Symptoms include needing to pee often, pain while peeing and pain in your side or lower back. Antibiotics can treat most UTIs. ... Urinary tract infection symptoms most commonly cause problems peeing. However, you may also have flu-like symptoms or pain around your affected areas. ... A UTI causes inflammation in the lining of your urinary tract. The inflammation may cause the following problems: - Pain in your flank, abdomen, pelvic area or lower back. - Pressure in the lower part of your pelvis. - Cloudy, foul-smelling pee. - Urinary incontinence. - Frequent urination. - Urge incontinence. - Pain when you pee (dysuria). - Blood in your pee (hematuria). ... The best thing to do for a urinary tract infection is to see a healthcare provider. You need antibiotics to treat a UTI. Your provider will select an antibiotic that works best against the bacteria responsible for your infection. ... The outlook for urinary tract infections is good. Most UTIs usually respond very well to treatment. A UTI can be annoying or uncomfortable before you start treatment. However, once a healthcare provider identifies the bacteria and prescribes the appropriate antibiotic, your symptoms should improve quickly. ... Is. This ... if you have a vagina because your urethra is much shorter, and it ... for E. coli to move from your rectum back into your body. Always wipe from front to back after a bowel movement ... pooping) to avoid this ... During your menstrual cycle, it’s also a good idea to regularly change your period products, including pads and tampons. You should also avoid using any deodorants on your vagina. ... Peeing can play a big role in getting rid of bacteria from your body. Your pee is a waste product, and each time you empty your bladder, you help remove that waste from your body. Peeing frequently can reduce your risk of developing an infection, especially if you get UTIs a lot. You should also try to pee right before and right after having sex. Sex can introduce bacteria to your urethra, and peeing before and after sex helps flush it out. If you can’t pee, wash the area with warm water. ... re postmenopausal, a healthcare provider ... . These creams ... UTI by changing the pH of your vagina. Talk to a healthcare provider ... you’re postmenopausal and get a lot of UTIs ... Call a healthcare provider if you have symptoms of a UTI. Call them again if they diagnosed you with a UTI and your symptoms worsen. You may need a different treatment. ... - Fever. - Back pain. - Vomiting. ... Urinary tract infections are when you have an infection in your urinary system. You may feel embarrassed if you have symptoms that affect your genitals or cause incontinence, but it’s OK — you haven’t done anything wrong. A healthcare provider can prescribe antibiotics to treat the infection, and your symptoms should go away in a few days. Follow your provider’s instructions and take your full course of antibiotics to ensure the UTI goes away.

10 Possible Reasons for White Tissue in Urine HealthCentral

Acute renal colic is a severe and sudden flank pain primarily caused by ureteral calculi obstructing the urinary tract. The pain typically originates at the costovertebral angle and radiates anteriorly and inferiorly toward the groin or testicle. Ureteral stones, which can occur anywhere along the path between the kidneys and the bladder, are the leading cause of this condition. Contributing factors to urolithiasis include aciduria, low urine volume, urinary infections, hypercalciuria, hyperoxaluria, hyperuricosuria, and hypocitraturia. Initial evaluation of acute renal colic involves detailed history-taking, physical examination, laboratory testing, urinalysis, and imaging studies. Appropriate imaging studies include ultrasonography with resistive index, a plain abdominal x-ray of the kidney, ureter, and bladder, and unenhanced (non-contrast) computed tomography scans. ... Acute renal colic is a severe and sudden flank pain that typically originates at the costovertebral angle and extends anteriorly and inferiorly toward the groin or testicle. This condition is usually caused by an acute urinary tract obstruction due to calculus and is often associated with nausea and vomiting. Urolithiasis, ... , is a ... some point in their lives ... crystalline aggregate travels ... kidney through the ... obstructing urinary flow, usually in the ureter. This obstruction leads to proximal ureteral and renal ... dilation (hydroureteronephrosis), ... is the primary cause of the intense ... renal colic.[1][2][3][4] The intensity of pain is related to the degree of obstruction, rather than the size of the stone, although stone size can help predict the likelihood of spontaneous passage. Although kidney stones are not the only cause of flank pain, their prevalence and the severity of the pain they cause make ureterolithiasis the most likely presumptive diagnosis when sudden, severe flank pain occurs, particularly when associated with hematuria. The nature, onset, location, and ... the pain vary depending on the underlying cause. However, for most patients, the pain typically peaks 1 to 2 hours after its initial onset. Underlying causes of urolithiasis include inadequate hydration, aciduria, chronic urinary infections, hypercalciuria, hyperoxaluria, hyperuricosuria, and hypocitraturia. The initial ... of a patient presenting with acute renal colic involves laboratory testing, urinalysis, and appropriate imaging studies. The immediate treatment of acute renal colic due to urolithiasis includes pain control, intravenous (IV) hydration, antiemetics, and antibiotics (if indicated). Patients with severe or refractory symptoms may require hospital observation or admission. In some cases, urgent surgical intervention is necessary, such as in obstructive pyelonephritis (pyonephrosis), where emergent drainage of the infected renal pelvis is required. Definitive treatment for obstructing ureteral stones may involve conservative or procedural approaches. Surgical options include cystoscopy with double J stenting, extracorporeal shockwave lithotripsy (ESWL), ureteroscopy with stone basketing, and laser therapy, as open surgery for ureteral stones is rarely necessary. Please see StatPearls' companion resource, " Ureterolithiasis," for more information. ... As a kidney stone moves through the renal collecting system, it can significantly disrupt urine flow in the genitourinary tract by causing either constant or intermittent obstruction and hydronephrosis of the ureter. This leads to urine backing up into the kidney, ureteral dilation, pyelolymphatic backflow, and stretching of the renal capsule, which triggers pain by releasing prostaglandins. ... Pain arises from a combination of factors, including ureteral muscle spasms ... teral dilation, enhanced peristalsis driven by intrinsic ... teral pacemakers, localized inflammatory changes induced ... the stone, renal swelling with capsular stretching, edema, and irritation. ... processes activate submucosal stretch ... , renal pelvis, and ... stretching of the renal pelvis, peripelvic renal capsule, and renal calyces closely ... and pyel ... Renal blood flow ... before gradually diminishing. ... vasodilation ... the afferent preglomer ... arterial blood supply. Within 5 ... renal blood flow ... inal pressures return to normal levels or ... decrease further. ... The severity of the pain does not reliably correlate with stone size or the likelihood of spontaneous expulsion.[21] Fortunately, acute renal colic pain is self-limited and lasts around 24 hours. Subsequently, the blocked ureter usually ceases further stretching, and it reaches equilibrium. Severe pain or other symptoms persisting for more than 3 days are likely to require surgical intervention. ... Patients with renal colic typically present with an acute onset of flank pain radiating inferiolaterally to the lower abdomen, groin, or testicle. They often describe a dull, constant discomfort, which is interspersed with colicky episodes of intense, sharp pain. The constant discomfort is usually due to the stretching of the renal capsule from obstruction, while the colicky pain results from peristalsis of the ureteral smooth muscle. Many patients report associated nausea or vomiting, and most (85%) will exhibit gross or microscopic hematuria. As the kidney stone moves distally toward the bladder, the patient may experience increasing lower urinary tract symptoms, such as dysuria, urinary frequency, urgency, or difficulty urinating. ... " Acute Abdomen ... Urinalysis reveals microscopic or gross hematuria in 85% of stone patients and should also be assessed for crystalluria, pH levels, and signs of infection (such as white blood cells [WBCs] and bacteria). A urinary pH greater than 7.5 may suggest a urease-producing bacterial infection, while a pH below 5.5 may indicate the presence of uric acid calculi. If there are signs of infection, a urine culture should be obtained. Please see StatPearls' companion resources, " Uric Acid Nephrolithiasis" and " Struvite and Triple Phosphate Renal Calculi," for more information ... . Studies have ... 48] ... ronephrosis ... Pregnancy can complicate the diagnosis and management of renal colic. The pressure from the gravid uterus on surrounding structures can alter the flow of urine from the renal pelvis to the urinary bladder. Additionally, pregnant patients may excrete higher levels of calcium in their urine.[110] ... management includes providing adequate analgesia, antiemetics, and IV hydration. Antibiotics should be administered if the patient presents with systemic signs of infection or has infected ... . NSAIDs and opioids are considered ... -line therapies for analgesia. ... ysis showing at ... (HPF ... urine dipstick ... pain, nausea, or vomiting lasting more than ... Hospital admission is indicated for significant renal stones in a solitary kidney, severe kidney injury, infected renal stones, intractable pain or nausea, urinary extravasation, or sepsis.

Flank pain is a sensation of discomfort, distress, or agony in the part of the body below the rib and above the ilium, generally beginning posteriorly or in the midaxillary line and resulting from the stimulation of specialized nerve endings upon distention of the ureter or renal capsule. Similar pain is sometimes caused by extraurinary abnormalities. Causes of flank pain are listed in Table 182.1. ... Flank pain that radiates to the ipsilateral testicle is usually caused by proximal ureteral or renal pelvic obstruction due to the common innervation of the testicle and the renal pelvis (T11–12). This pain usually originates in the posterior part of the flank and radiates to the testicle of the male or the labia of the female. The pain becomes lower and more anterior in the flank when the obstruction occurs in the middle third of the ureter. The pain is still lower, radiates to the scrotal skin (rather than the testicle), and is associated with voiding symptoms such as urinary frequency and urgency when the obstruction occurs at the level of the ureterovesical junction. The degree of severity of the pain is directly related to the acuteness of the obstruction rather than the degree of obstruction. Therefore, a stone that passes into the ureter and suddenly becomes lodged in one position usually causes extremely severe pain. But flank pain can be very mild or absent in the presence of very severe but chronic obstruction. Mild and chronic flank pain associated with severe ureteral obstruction can produce irreversible renal damage. A stone passing through the ureter will often cause severe but intermittent pain. The intermittent pain is related to obstruction produced when the stone becomes lodged in the ureter. Therefore, each episode of pain is likely to be associated with a stone becoming lodged in a new and more distal position in the ureter. ... absent with acute ureteral ... Although ureteral stone is the most common cause of flank pain, many other causes should be considered (see Table 182.1). Flank pain resulting from acute ureteral obstruction can also be caused by blood clots or sloughed renal papillae passing through the ureter. Blood clots can be produced by many pathologic lesions of the kidney, tumors being the most common cause. Renal papillary necrosis should be considered in patients with a history of analgesic abuse or diabetes mellitus. Flank pain caused by chronic ureteral obstruction is generally much less severe. Occasionally, congenital anomalies such as ureteropelvic junction obstruction produce flank pain associated with a diuresis after oral intake of a large volume of fluid. Bilateral chronic ureteral obstruction or ureteral obstruction of a solitary kidney can be associated with symptoms of renal failure such as apathy, lethargy, anorexia, muscle twitching, headache, hypertension, and poor growth of a child. A dull or mild flank pain should make the clinician consider many possible causes including congenital ureteral obstruction, ureteral tumor or an extrinsic tumor compressing the ureter, acquired stricture of the ureter due to a previous operation or radiation therapy, retroperitoneal fibrosis, and a ureteral stone. ... A patient should be suspected of being an analgesic abuser when he or she presents with a history of acute severe flank pain, uric acid stones, previous reactions to contrast media, and a residence a great distance away. The physician should not be fooled by hematuria because narcotic addicts find ways to place blood in their urine specimens. Extraurinary diseases of the abdomen and chest can also cause flank pain. These diseases produce pain less characteristic of the typical "renal colic" seen with acute ureteral obstruction. Nevertheless, this vague, dull, mild flank pain is similar to the pain seen with chronic ureteral obstruction, making the differential diagnosis unclear. The correct diagnosis is made by thinking of ... the diseases that have been discussed, considering the associated symptoms, physical examination, urinalysis, and performing carefully selected laboratory tests and radiographic studies. ... Flank pain originating in the urinary system is caused by distention of the ureter or renal pelvis or distention of the renal capsule. The severity of the pain is directly related to the rapidity of the distention and not to the degree of distention. Therefore, a patient with acute distention of the ureter will have extremely severe pain. This patient usually has mild dilation of the ureter and no irreversible renal damage. However, a patient with a greatly dilated ureter and irreversible renal damage might have no pain or mild pain because the ureteral dilation has developed over a long period of time. ... presenting symptom of ... especially when it ... in order to ... renal damage. ... of irreversible renal damage resulting from ureteral obstruction is related to ... obstruction, degree of obstruction ... diminished function;

A confirmed urological diagnosis was identified in 54.7% of patients, with urinary tract infection (27.8%) and urolithiasis (19.8%) being the most frequently documented conditions. Urinary WBC levels demonstrated higher diagnostic performance than serum creatinine (AUC: 0.82 vs. 0.76). In multivariable analysis excluding imaging-derived variables, urinary WBC levels (OR: 3.12, 95% CI: 2.64–3.68, p = 0.01) and serum creatinine (OR: 2.08, 95% CI: 1.72–2.51, p = 0.03) were significantly associated with confirmed urological diagnoses. Combined models incorporating laboratory and clinical parameters showed improved discriminative performance (AUC up to 0.86). Imaging findings, including hydronephrosis and urinary stones, were more frequently observed in patients with confirmed urological diagnoses (p = 0.01). ... Flank pain is a common yet diagnostically challenging symptom encountered across multiple medical disciplines, including urology, internal medicine, gynecology, orthopedics, and emergency medicine. Its broad differential diagnosis includes both urological and nonurological conditions, making accurate and timely evaluation critical for optimizing patient management [1, 2]. While urological disorders such as urinary tract infections (UTIs), nephrolithiasis, and structural abnormalities are among the most common causes of flank pain, nonurological conditions such as musculoskeletal disorders, gastrointestinal diseases, neurological syndromes, and gynecological pathologies may present with similar symptoms, leading to diagnostic uncertainty [3, 4]. In female patients, the diagnostic approach for flank pain is more complex than that in male patients. The broader range of potential etiologies in women includes gynecological disorders (e.g., ovarian cysts, endometriosis, and pelvic inflammatory disease), gastrointestinal conditions (e.g., irritable bowel syndrome, diverticulitis), and musculoskeletal pain syndromes. This diversity complicates initial clinical evaluation and often necessitates a structured, multidisciplinary diagnostic approach [5, 6]. Pain characteristics provide useful diagnostic clues: acute onset colicky pain is often associated with urological causes such as ureteral obstruction, whereas chronic dull pain is more commonly linked to musculoskeletal disorders [7]. ... Female patients aged between 18 and 65 years who presented with newly developed flank pain during the study period were considered eligible for inclusion. Only patients with available laboratory and radiological imaging data obtained at the time of initial evaluation were included in the analysis to ensure consistency in diagnostic assessment. Patients were excluded if they had a previously diagnosed chronic urological disease, were experiencing active menstrual bleeding at the time of presentation, had incomplete medical records, or were outside the defined age range. The requirement for both laboratory and imaging data at presentation was applied to maintain a uniform diagnostic approach across the study population. ... All patients underwent a structured clinical evaluation at the time of presentation. Clinical data included pain characteristics such as onset (acute or chronic), duration, laterality (right, left, or bilateral), and pain type (colicky, dull, or sharp). Associated symptoms, including fever, dysuria, nausea, vomiting, and hematuria, were systematically recorded. Given the broad differential diagnosis of flank pain in female patients, the clinical assessment also included evaluation for potential non-urological causes based on available clinical findings and medical records. These included musculoskeletal conditions, gastrointestinal disorders, and gynecological pathologies when clinically suspected. In addition, dermatological causes such as herpes zoster were considered during physical examination, particularly in patients presenting with localized pain or skin findings. Clinical decision-making was based on routine outpatient evaluation protocols, and diagnostic categorization was performed according to the findings documented in patient records [14]. ... Laboratory evaluations were performed at the time of presentation as part of routine clinical assessment. Serum creatinine levels were measured to evaluate renal function. Complete blood count parameters, including white blood cell (WBC) count, were recorded as indicators of systemic inflammatory response. Urinalysis was performed in all patients to assess urinary red blood cells (RBCs) and white blood cells (WBCs), which were considered markers of hematuria and urinary tract inflammation, respectively. Urinary WBC levels were used as indicators of potential infection or inflammatory processes affecting the urinary tract. In patients with clinical suspicion of urinary tract infection, urine culture results were reviewed when available and used to support diagnostic classification. ... Radiological imaging was utilized to identify structural abnormalities of the urinary tract as part of routine clinical evaluation. Ultrasonography (USG) was employed as the first-line imaging modality to assess for hydronephrosis, renal masses, and the presence of larger urinary stones. Non-contrast computed tomography of the kidneys, ureters, and bladder (CT-KUB) was performed when clinically indicated to confirm the presence, size, and location of urinary stones and to further evaluate equivocal findings on ultrasonography. The selection of imaging modality was based on clinical judgment and routine diagnostic protocols of the outpatient clinic. Imaging findings were used to support clinical diagnosis but were not included as independent variables in multivariable regression analyses to avoid potential circularity with the outcome definition. ... Imaging findings of the study population are presented in Table 2. Hydronephrosis was identified in 278 patients (15.2%) in Group 1 and in 77 patients (5.1%) in Group 2 (p = 0.01). Urinary stones were detected in 362 patients (19.8%) in Group 1 and in 20 patients (1.3%) in Group 2 (p = 0.01). ... onset pain was reported in 1124 patients (61.4%) in Group 1 and in 427 patients (28.1%) in Group 2 (p = 0.02). Colicky pain was observed in 1079 patients (58.9%) in Group 1 compared with 292 patients (19.2%) in Group 2 (p = 0.01). Dysuria was present in 782 patients (42.7%) in Group 1 and in 188 patients (12.4%) in Group 2 (p = 0.05). ... Imaging plays a pivotal role in distinguishing urological from non-urological causes of flank pain [29]. Hydronephrosis and urolithiasis were significantly more common in the urological group (p = 0.01), underscoring their diagnostic importance. Non-contrast computed tomography (CT-KUB) remains the gold standard for detecting urinary stones, with high sensitivity and specificity. However, imaging variables were not included in multivariable analyses in this study to avoid circularity between diagnostic criteria and outcome definition. ... This study demonstrated that urological causes account for a substantial proportion of flank pain presentations in female patients evaluated in a urology outpatient setting, with urinary tract infections and urolithiasis being the most frequently documented conditions. While urinary WBC counts, serum creatinine measurements, and imaging findings provide useful diagnostic information, no single parameter alone is sufficient for definitive diagnosis. These findings support the need for a structured, multiparametric approach integrating clinical assessment, laboratory markers, and imaging to improve diagnostic accuracy. Pain characteristics also play an important role in the initial evaluation of flank pain. Factors such as onset, severity, laterality, and associated symptoms should be assessed together with laboratory and radiological findings. A structured diagnostic workflow may help reduce unnecessary testing and imaging, particularly in patients with low clinical suspicion of urological pathology.

Groin injuries are commonly seen in athletes and account for up to 6% of all athletic injuries [1–3]. Most commonly seen in sports that require repetitive twisting, cutting, rapid acceleration and deceleration movements such as soccer, rugby, ice hockey and Australian Rules football [1, 4, 5]. Significant pain and disability in inguinal region during and after athletic activities have been reported and many terms have been employed for this condition, such as sportsman’s hernia, sports hernia, inguinal hernia, incipient hernia, cryptic hernia, Gilmore’s groin, hockey player’s syndrome, groin pull, sports groin, chronic symphysis syndrome, athletic pubalgia. Recently, a consensus has been achieved to rename this entity as inguinal disruption [6] while lately a clinically based taxonomy defines it as inguinal-related groin pain [7]. ... A consensus was reached by experts during the British Hernia Society’s conference in Manchester, UK 2012 [6]. The agreed term, to accurately describe the pain in the inguinal region close to pubic tubercle is inguinal disruption. It is referred as the abnormal tension in the inguinal canal and it is recognised as posterior wall weakness, disruption of the external oblique aponeurosis, external inguinal ring (EIR), conjoint tendon tears and inguinal ligament dehiscence but with no obvious hernia. It is seen in very active sports persons and may have an acute or insidious onset. The diagnosis can be made if at least three out of the five clinical signs are present (Table I). ... The aetiology varies widely in ... literature. It is defined as a bulge or weakness of the posterior wall of the inguinal canal without the presence of a true hernia [2, 15, 16], which widens the inguinal canal, compresses the genital branch of the genitofemoral nerve and forces the rectus abdominus muscle to retract cranially and medially [17]. ... Inguinal disruption may develop from overuse, increased shear forces across the pelvis, trunk and leg, coordination imbalances, loss of dynamic abdominal wall rotational stability or congenital inguinal wall weakness [4, 23]. Excessive shear forces across the pubic symphysis from the stronger hip adductor muscles—pulling down—against a weaker lower abdominal musculature (the conjoined tendon)—pulling up and rotating the trunk—may cause a disruption of the fascia transversalis and or conjoined tendon [1, 24]. Restricted hip range of movements (abduction, external and internal rotations) [25–27], reduced muscle strength endurance [28], extensibility and coordination imbalances may increase the stress in inguinal region leading to attenuation or tearing of the fascia transversalis, conjoined tendon [29] and dilation of the inguinal rings [29, 30]. It has been suggested that when the hip is in 90 degrees of flexion, adduction and internal rotation (anterior impingement test for femoroacetabular impingement [FAI]) there is increased rotation at the symphysis pubis initiating the inguinal disruption [31]. ... The diagnosis is based on patient’s history and clinical examination. The onset may be sudden but most often is insidious, present for several months with the athletes complain of a dull, diffuse ache in their groin. The pain is usually unilateral, sharp or burning in nature and radiates to lower abdomen, proximal thigh, low back, perineum or scrotum [17, 18, 21]. It is exacerbated by athletic activities like sprinting/running, kicking/striking a ball, cutting/twisting, sit-ups, side-stepping [17]. Coughing, sneezing or other Valsava-type manoeuvres may worsen the pain. Getting out of bed can be painful but rarely wake up patients from sleep as it is activity-related pain and relieved by rest [17]. ... Thorough examination of the groin and hip should be performed. Inspection of an obvious bulge in the inguinal area may expose a true inguinal or femoral hernia. Palpation over the pubic tubercle, conjoined tendon, medial inguinal canal, insertion of rectus abdominus or adductor origin may reveal pain or tenderness [17, 30, 35]. A dilated external inguinal ring or weak inguinal floor can be diagnosed through scrotal invagination but no hernia is palpated during coughing or sneezing (Valsava manoeuvre) [17, 35–37]. ... Because of the close proximity of numerous anatomical structures there is a strong likelihood of co-existing pathologies including muscle injuries, hip pathologies, low back problems, nerve entrapments, intestinal, genitourinary and gynaecological pathologies (Table II) [17, 35]. ... | Other pathologies | | --- | | Orthopaedic | Muscle injuries (adductors strain/avulsion, distal rectus abdominus strain/avulsion, iliopsoas strain) | | Hip problems (FAI, intra-articular injuries, degenerative changes) | | Osteitis pubis/athletic pubalgia | | Stress fracture (pubic ramus, femoral neck) | | Nerve entrapment, irritation, low back pain | | Genitourinary | Prostatitis, epididymitis | | Hydrocele, varicocele | | Urinary tract infections | | Gynecological | Endometriosis | | Menstrual pain | | Urinary tract infections | | Intestinal | Diverticulitis, irritable bowel syndrome, adhesions, appendicitis | ... The initial treatment consists of activity modification with 6–8 weeks of rest, anti-inflammatory medication and physical therapy with core strengthening and stretching exercises. Ultrasound treatment, electrical stimulation, ice, deep massage with soft-tissues mobilization may be helpful [29, 50, 51]. An active programme to improve muscular strength, endurance, balance and coordination of trunk and hip stabilizing muscles has been proved to be more effective [52]. Gradually the patient is allowed to perform sport-specific exercises and at ∼10–12 weeks when patient is pain-free may return to sports [30].

A muscle strain is the stretching or tearing of muscle fibers. Most muscle strains happen for one of two reasons: either the muscle has been stretched beyond its limits or it has been forced to contract too strongly. In mild cases, only a few muscle fibers are stretched or torn, and the muscle remains intact and strong. In severe cases, however, the strained muscle may be torn and unable to function properly. ... strain. This is a moderate strain, ... a greater number of injured fibers and more severe muscle pain and tenderness ... , and sometimes ... - Grade III strain. This strain tears the muscle all the way through, sometimes causing a "popping" sensation at the time of injury as the muscle rips into two separate pieces or shears away from its tendon. Grade III strains are serious injuries that cause complete loss of muscle function, as well as considerable pain, swelling, tenderness, and discoloration. Because Grade III strains usually cause a sharp break in the normal outline of the muscle, there may be an obvious "dent" or "gap" under the skin where the ripped pieces of muscle have come apart. Although the risk of muscle strain is especially high during sports activities, you also can strain a muscle by lifting a heavy carton or by simply stepping off a curb. Almost all types of athletic activity carry some risk of muscle strains, but these injuries tend to happen most often in contact sports such as football, and in sports that require quick starts such as basketball and tennis. ... - muscle pain and tenderness, especially after an activity that stretches or violently contracts the muscle (pain usually increases when you move the muscle but is relieved by rest) - muscle swelling, discoloration, or both - muscle cramp or spasm - either a decrease in muscle strength or a complete loss of muscle function (especially with Grade III strains) - a popping sensation in the muscle at the time of injury - a gap, dent, or other defect in the normal outline of the muscle (with Grade III strains). ... Your doctor will want to know what type of activity triggered your muscle pain and whether there was a popping sensation in the muscle at the time of injury. The doctor will ask about your symptoms, especially any decrease in muscle strength or any difficulty moving. ... - Warm up before participating in sports and activities. - Follow an exercise program aimed at stretching and strengthening your muscles. - Increase the intensity of your training program gradually. Never push yourself too hard, too soon. - Maintain a healthy body weight. Excess weight can stress muscles, especially in your legs and back. - Practice good posture when you sit and stand. - Use the correct technique when you lift heavy loads. ... - R est the injured muscle (and ... a temporary break from sports activities). ... To help relieve muscle pain and swelling, your doctor may suggest that you take acetaminophen (Tylenol and others) or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin, and others). For someone with a painful back strain that does not improve ... NSAIDs or acetaminophen, prescription pain ... or muscle relaxants may be ... - You hear or feel a pop in your muscle at the time of injury. - You have severe pain, swelling, or discoloration in the injured muscle. - Your injured muscle is obviously weak or has difficulty moving compared to the same muscle on the opposite side of your body. - You have muscle symptoms that worsen or do not improve after 48 hours. - You have severe back pain that makes it impossible for you to do normal daily activities, or you have mild back pain that worsens after a few days. - You have back pain together with any of the following symptoms, which can signal a medical problem that is more serious than a mild back strain: - fever or chills - pain or a burning feeling when you urinate - sudden weakness, numbness, or tingling in a leg - numbness in your groin or rectum - difficulty controlling your bladder or bowel function.

Despite its name, a sports hernia (athletic pubalgia) is not a hernia. It’s an injury to a tendon or muscle in your lower abdomen or groin that causes chronic pain. Sports hernias are often caused by repetitive and forceful twisting of your pelvis. Sports hernias are treatable with physical therapy, medication and/or surgery. ... A sports hernia (also called athletic pubalgia, sportsman’s hernia and Gilmore’s groin) is an injury (usually a tear) in the muscles and/or tendons in your lower abdomen or groin that causes chronic pain. People who have a sports hernia can also experience nerve irritation from the injury, which can contribute to the pain and sensitivity of the affected area. The name “sports hernia” is misleading because there is no actual hernia involved. Healthcare professionals prefer to use the term “athletic pubalgia.” ... A sports hernia most often happens to people who play sports that require sudden changes of direction or severe twisting movements, but you don’t have to be playing a sport to get a sports hernia. ... Despite its name, a sports hernia is not actually a hernia. Healthcare professionals prefer to call a sports hernia “athletic pubalgia.” Although a hernia and a sports hernia symptoms are similar, the pain of a sports hernia is caused by soft tissue damage, such as a tear, in the lower abdomen or groin. A muscle or tendon is usually torn. The pain from a hernia is due to a gap in your abdominal muscle that causes your intestine or other soft tissue to protrude through, creating a bulge under the skin. ... Sports that involve repetitive, forceful motions, especially twisting your pelvis, can damage or cause a tear in the soft tissue of your lower abdomen or groin (a sports hernia). Sports that are most likely to cause a sports hernia include: ... Approximately 5% of adult athletes experience sports hernias every year. Sports hernias are more common in people who play sports that involve frequent and forceful twisting and turning. ... sudden, forceful movements, especially twisting of the pelvis, are most likely to get a sports hernia. Males are much more likely to get a sports hernia than females. Athletes between the ages of 26 and 28 most commonly develop a sports hernia. It is rare for older people and children to get sports hernias. You don’t have to be an athlete to get a lower abdomen or groin injury (sports hernia), but it is more common in athletes. ... A sports hernia (athletic pubalgia) happens when the deep layers of your lower abdominal wall or the tendons that attach muscles to your pelvis weaken or tear. The following situations can cause or contribute to a sports hernia: - Forceful and repetitive hip movements, like twisting, kicking, jumping and cutting/slicing. - Vigorous and unsafe abdominal and hip exercises. - Weakness in the abdominal muscles and a lack of proper sports conditioning. - An imbalance in strength between your hip and abdominal muscles. ... The main symptom of a sports hernia is ongoing (chronic) pain in your lower abdomen and/or groin. The following descriptions and situations of the pain more specifically apply to a sports hernia: - You experience sudden and intense pain at the time of the injury. - The pain is ongoing (chronic) and feels dull or burning. - It’s difficult to pinpoint the exact area of the lower abdomen and groin that the pain is coming from. - The pain radiates downward to your scrotum and/or inner thigh. - You feel pain when you’re exerting yourself, especially when sprinting, twisting, kicking or sitting up. - You feel pain in your groin when you cough or sneeze. - You have to stop participating in your sport or significantly cut back on your physical activity because of the pain. - The pain may go away after you’ve rested, but it comes back during sports activities. ... In general, the goals of sports hernia treatment and rehabilitation are to relieve pain, restore range of motion, restore strength, return function and return to sports and activities. Treatment plans for a sports hernia depend on many factors such as the severity of the injury, your age, your health, and what level of activity you want to return to. Sports hernias can be treated with non-surgical treatment or surgery. If you have a sports hernia, your healthcare provider will most likely have you go through non-surgical treatment first to see if that fixes your sports hernia before turning to surgery. ... A sports hernia usually requires formal treatment other than rest, so it is unlikely that a sports hernia will heal on its own. Physical therapy, anti-inflammatory drugs and/or corticosteroids are often needed to treat a sports hernia. In some cases, surgery is needed. A groin injury that is not a sports hernia, such as a mild muscle strain, could heal on its own. ... Sports hernias (athletic pubalgia) can be difficult to prevent because of the stress and strain placed on the pelvis and hips in certain sports. Your healthcare team may recommend a sports hernia prevention program if you are at high risk for a core muscle or tendon injury due to the type of sport you play. A sports hernia prevention program may include: - Abdominal and core strengthening exercises. - Exercises to strengthen the hip muscles. - Exercises to improve flexibility and minimize strain across the lower abdominal area where core muscle injuries often occur. ... While we all experience pain from time to time, chronic pain is not normal. Be sure to see your healthcare ... if you are experiencing ongoing pain in ... lower abdomen or groin. Sports hernias don’t usually heal on their own, so you will likely need treatment in order to feel better. Even though it can be ... , it is important to ... recovery and allow ... body to heal before returning to

A groin strain is a muscle strain that affects any of the muscles in your groin. It’s one of the most common injuries that affect athletes. A healthcare provider can diagnose your injury, and tell you which treatments you need and when it’s safe to resume physical activities. ... - Pain. - Difficulty moving your leg or hip. - Muscle weakness. - Bruising or discoloration. - Swelling. - Muscle spasms. ... Groin strains happen when you stretch a ... in your groin enough to tear or ... - Sports injuries. - Repetitive strain injuries (healthcare providers sometimes call these microtraumas). - A direct blow to your groin. ... Anyone can experience a groin strain. Even if you don’t play sports or work out often, you can still strain your groin, especially if you suddenly exert yourself much harder than usual. ... - R est: Stop the physical activity that caused the strain to avoid further damaging your muscle. ... You shouldn’t need to miss work or school if you can do your job or schoolwork without putting stress on your strained groin muscles. Talk to your provider about which activities you should avoid while you’re recovering. ... Most people can walk with a groin strain. But you shouldn’t run, work out or do intense exercise while you’re recovering from a groin strain. If you start working out or playing sports again before your muscles have healed, there’s an increased chance you’ll re-injure them. ### What is the difference between a groin strain and a sports hernia? Groin strains are caused by tears in the fibers of your groin muscles. Unless they’re very severe, you can treat a groin strain at home with rest, icing and over-the-counter medicine after a healthcare provider diagnoses your injury. Sports hernias (athletic pubalgia) happen when the deep layers of your lower abdominal wall or the tendons that attach your abdominal muscles (your abs) to your pelvis weaken or tear. They’re more likely to cause chronic (long-term) pain. People who experience multiple groin strains are more likely to develop a sports hernia. ... Groin strains are injuries to any of the muscles in your groin. They’re one of the most common injuries in sports like hockey and soccer, but they can affect anyone. Visit a healthcare provider if you’re experiencing pain or other symptoms in your groin. It’s frustrating to skip practices, games, meets or matches, but don’t rush your recovery. Wait until your provider says it’s safe to get back out on the ice, field or court. Your groin muscles need time to heal, and once they do, you’ll be able to resume the sports or activities you love. Don’t push your body past its limits. Putting more stress on your injured groin can make a minor injury more severe and take longer to heal.

Adding to this concern, recent studies have reported a high prevalence of pelvic floor dysfunctions (PFD), particularly stress urinary incontinence (SUI), among female athletes, with reported rates exceeding 50% of participants in volleyball (3) and approaching 70–80% in demanding, impact-based disciplines such as high-intensity functional training (HIFT) (4) or trampoline gymnastics (5, 6). In athletic populations, PFD are often associated with repeated high-impact loading, elevated intra-abdominal pressure during strength or plyometric training, insufficient core muscle coordination, and lack of neuromuscular control (7). These dysfunctions, including SUI as their most common manifestation, are often normalized or underreported among athletes (8), contributing to their persistent invisibility in sports medicine. For instance, the study by Dakic et al. [2025] (9) highlighted the psychological and performance-related toll of PFD in elite athletes, noting that many altered their training or competition routines to manage symptoms, including training intensity reductions, activity avoidance (e.g., not jumping), restricting fluid intake prior to and during competition, wearing dark clothes or using pads. Despite growing awareness among healthcare and exercise professionals, comprehensive pelvic health screening, including assessment of PFM function, potential dysfunctions, and symptoms such as urinary incontinence (UI), remains uncommon in the athletic population. Many female athletes are never screened, and even those experiencing symptoms rarely seek or receive medical attention (6, 10). Evidence from a recent systematic review indicates that most female athletes manage PFD symptoms through self-devised strategies rather than seeking professional care, such as using pads or containment products, restricting fluid intake, pre-voiding before activity, or modifying certain movements or training routines to reduce leakage episodes (8). Furthermore, PFD are associated with emotional distress and reduced athletic confidence or performance, including feelings of embarrassment, fear, anxiety, and frustration, often accompanied by limitations in sport participation (8). ... PFM training (PFMT ... This question gains further relevance when considering the PFM’ biomechanical role. The PFM are an integral part of the deep core stabilizing system, working synergistically with the diaphragm, transversus abdominis, and multifidus muscles. Together, this system regulates intra-abdominal pressure, stabilizes the spine, and maintains lumbopelvic alignment during movement (2). The PFM contribute through anticipatory contractions that respond reflexively to postural demands and load variations, particularly during high-intensity or impact movements common in sport. This coordinated action is essential for spinal stiffness and efficient force transmission across the kinetic chain (15). If the PFM function is compromised, due to weakness, poor coordination, or impaired proprioception, the neuromuscular synergy required for athletic efficiency may be disrupted, increasing injury risk and limiting performance. Therefore, PFMT should be considered not only in clinical functional recovery after PFM injury or PFD, but also as a potential tool for performance enhancement in athletic populations. ... The endocrine regulation of pelvic floor tissues has been described across experimental, anatomical, and clinical contexts. When addressing pelvic floor health, it is essential to consider its strong endocrine dependence, particularly the influence of hormonal fluctuations across the menstrual cycle and under exogenous hormonal modulation (16). One experimental study with female rats has demonstrated that PFM, particularly the pubococcygeus, is hormonally responsive, with estrogens exerting a modulatory effect on muscle morphology and counterbalancing androgen-driven hypertrophy, which may be extrapolated to women. This interplay highlights the reciprocal influence of estrogenic and androgenic pathways on pelvic muscle structure and function, reinforcing the concept of the PFM as a hormonally dependent system (17). ... Such findings are consistent with current therapeutic approaches, including the use of dehydroepiandrosterone (DHEA) in the management of PFD, such as SUI or pain, particularly in postmenopausal women with vulvovaginal atrophy (19). They also align with clinical observations suggesting that a hyperandrogenic state, such as that observed in polycystic ovary syndrome, may be associated with enhanced PFM activity and strength (20). ... Beyond physiological mechanisms, the menstrual cycle can influence performance through perceived symptoms such as fatigue, mood changes, pain, and motivation fluctuations (30, 33, 34). These subjective responses may alter training quality and perceived exertion independently of measurable physiological changes. Hormonal contraceptives, by modifying or stabilizing hormonal patterns, can in turn affect the presence and intensity of these symptoms, potentially reducing variability for some athletes while introducing side effects for others (35). ... Taken together, the existing evidence reveals a pressing need to adopt a more integrative and physiology-informed approach to the study of female athletic performance (1), one that acknowledges the interconnected roles of pelvic floor function, hormonal modulation, and performance outcomes. These three branches have traditionally been treated as separate lines of study, often isolated within clinical urogynecology, endocrinology, or sports science. However, as we have outlined throughout this commentary, the pelvic floor is not merely a clinical concern, but a biomechanical and neuromuscular structure with direct implications for movement quality and performance efficiency. At the same time, its hormonal responsiveness links it intrinsically to the wider endocrine environment, positioning it at the crossroads between reproductive biology and physical performance (17). ... To move forward, researchers must embrace a more systematic and intersectional perspective that considers how endocrine factors influence not only reproductive health but also musculoskeletal integrity, neuromuscular performance, injury risk, and recovery capacity. Pelvic floor training should be reframed not solely as a rehabilitative or postpartum tool, but as a potential performance enhancer, especially in disciplines requiring high-impact loading, core stability, and precise motor control. Similarly, hormonal profiling and contraceptive counseling should be individualized and grounded in evidence, considering the athlete’s training goals, sport demands, and physiological responses.