Suprapubic pain

Specialty: Nephrology and urology.

• hypogastric pain
• pain in the lower abdomen of bladder origin

Why it occurs

• Acute bacterial cystitis (urothelial inflammation and spasmodic contraction of the detrusor cause localized pain)
• Acute urinary retention (rapid and painful distension of the muscle fibers of the bladder that forms a visible or palpable bladder balloon)
• Interstitial cystitis (chronic inflammatory process that worsens with bladder filling and is temporarily relieved with urination)
• Bladder lithiasis (stones inside the bladder that mechanically irritate the urinary trigone)
• Pelvic inflammatory disease with localized peritonitis (inflammation of the female genital tract that extends to the suprapubic parietal peritoneum)

Initial workup

Urinalysis with sediment and urine culture; urgent suprapubic ultrasound to immediately rule out massive bladder distention or bladder stones; complete blood count, C-reactive protein (CRP) and procalcitonin; CT of the abdomen and pelvis if perforation, pelvic abscess or concomitant acute diverticulitis is suspected.

Standard management

• Metamizole magnesium — 500 mg to 2 g every 8 hours orally or intravenously as an analgesic
• Butylscopolamine bromide — 10-20 mg orally or intravenously every 8 hours as a spasmolytic to relieve bladder colic pain, contraindicated if there is suspicion of mechanical urinary retention
• Oriented empirical antibiotic therapy (e.g., Ciprofloxacin 500 mg every 12 hours or Fosfomycin 3 g in a single dose if acute bacterial cystitis is confirmed).