What is Suprapubic Pain & How is it Treated?

Suprapubic Pain is the pain felt in the central lower part of the abdomen, which is below the umbilicus and just above the pubic bone. Suprapubic pain is a symptom of some underlying medical condition. There are many causes for supra-pubic pain. The cause of acute suprapubic pain is commonly infection, trauma and; whereas, the cause of sub-acute and chronic pain is lymphatic, inflammatory and vascular complications. The doctor should go over all these things carefully along with conducting physical examination and labs tests before confirming the diagnosis of the cause of suprapubic pain so appropriate treatment can be started. Treatment of suprapubic pain depends on the cause of the pain.

Some of the common causes of suprapubic pain are:

• Urinary tract infection.
• Constipation.
• Pyelonephritis.
• Hydrometrocolpos.
• Urinary retention.
• Pelvic fracture.
• Ectopic pregnancy.
• Trauma to the abdomen.
• Bladder rupture.
• Pubic symphysis separation.
• Cystitis.
• Appendicitis.
• Diverticulitis colon.
• Ovarian abscess.
• Seminal vesiculitis.
• Mittelschmerz.
• Endometriosis.
• Pyogenic nephrolithiasis.
• Acute prostatitis.
• Dysmenorrhea.
• Pelvic abscess.
• Perinephric abscess.
• Urinary obstruction.
• Urethral stricture.
• Urethral injury.
• Colon cancer.
• Renal stones.
• Bladder stones.
• Bladder tumor.
• Benign prostatic hyperplasia.
• Bladder muscle disorder.
• Cystocele.
• Septicemia.
• Ovarian cancer.
• Tubo-ovarian abscess.
• Tumors in the pelvic region.
• Slipped disc.
• Internal hemorrhage.
• Pelvic inflammatory disease (PID).

Lesser common causes of suprapubic pain are:

• Acute tubular necrosis.
• Crush injury.
• Hemolytic uremic syndrome.
• Cortical necrosis.
• Acute glomerulonephritis.
• Complications from surgery.
• Ruptured urethra.
• Uterine prolapse.

Suprapubic pain itself is a symptom of some underlying condition. Other symptoms, which the patient may have with suprapubic pain include: painful urination, frequent urination, nocturia, back pain, acute abdominal pain, hematuria, urinary retention, involuntary urination, vaginal itching and unusual odor/color of the urine.

Patient’s medical history and physical examination is done to pinpoint the cause of suprapubic pain. The diagnosis of the cause of suprapubic pain can be made by understanding the quality of the pain; whether it is sharp or dull; and colicky or constant in nature. The duration in which the suprapubic pain developed is also important.
Lab tests, such as urinalysis, urine culture, pregnancy test, pelvic exam, cystoscopy, colonoscopy, endoscopy and endoscopic biopsy of the urinary tract, complete blood count, basic metabolic profile, liver function tests, endocervical cultures, serial hCG titers and blood cultures can also be done.

Imaging tests include pelvic ultrasound, abdominal x-ray, abdominal ultrasound, transvaginal ultrasound, Computed Tomography (CT) scan of abdomen and testicular ultrasound.

Treatment of suprapubic pain depends on the underlying medical condition which is causing the suprapubic pain, as treating the cause will help in relieving the suprapubic pain. Treatment generally consists of:

• Antibiotics (oral/ intravenous) are started if the cause of suprapubic pain is some infection; whether pelvic or urinary.
• Protection of the patient’s airway should be done.
• A urine pregnancy test should be done if the Suprapubic Pain patient is of child bearing age.
• Intravenous fluid resuscitation is started and patient’s cardiovascular status is stabilized.
• Suprapubic Pain patient should not be allowed to take anything by mouth until patient’s clinical stability is established.
• Emergent imaging tests, such as pelvic, abdominal and transvaginal ultrasound are done to help diagnose the cause and treat it accordingly.
• Patient suffering from Suprapubic Pain is referred to a gynecologist if ectopic pregnancy is suspected.
• Suprapubic Pain patient is also referred for Urology or Surgery consultation if patient suffers from acute abdominal pain, which can be an indication of appendicitis, testicular torsion, perforated bowel or an enteric fistula.