Diagnosis

Undiagnosed Groin, Abdominal, and Pelvic (UGAP) pain is not an uncommon condition and millions of patients, both females and males suffer from it. It is a great masquerader mimicking several different lower abdominal, groin and pelvic conditions.
Let’s all think of UGAP pain in patients presenting with atypical pain over the lower abdomen, groin, and pelvis. This is one of the few enigmatic conditions where a diagnosis can be strongly suspected in the majority of the patients just on clinical examination.

Let’s help these “Silent Sufferers” and prevent them from doctor shopping, minimize expensive diagnostic workup and prevent unnecessary endoscopies and even unnecessary surgeries. In the process, we will be saving billions of dollars which are currently spent in diagnosing and treating these unfortunate patients.

UGAP pain can be strongly suspected on clinical examination usually within 40-50 minutes. Lab tests, x-rays and endoscopies are used primarily to rule out other serious conditions and are used sparingly.

It is important to rule out other commonly seen conditions which cause groin, lower abdominal and pelvic pain. Your primary care physicians, gynecologist, general surgeons, are aware of these conditions and they will be able to diagnose it. After unsuccessful treatments of these conditions, if the pain persists then think of UGAP pain.

Detailed history with emphasis on some of the following points is helping.

Pain gets worse on physical activity.
Previous history of lower abdominal surgeries, especially multiple surgeries.
History of infections in pelvic organs, i.e. cystitis, prostatitis, pelvic inflammatory disease.
History of tendonitis in other parts of the body, i.e. tennis elbow, plantar fascitiis, etc.
Previous diagnosis of fibromyalgia.
Very few gastro-intestinal symptoms.

On physical exam besides detailed examination of the abdomen, including pelvic and rectal exam, use of seven signs described by us are very helpful in strongly suspecting UGAP pain. Confirmation of UGAP pain is made by giving a series of strategically placed steroid injections.