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I have a patient at 18 weeks who is pregnant and complains of  shooting pains in the vagina and rectum. She does not appear to be contracting; Her cervix is normal , and she does not appear to have any lesions or hemorrhoids. What are some other possible causes for this complaint?

Lancinating, or stabbing pain could be caused by a muscle spasm or by irritation or compression of a nerve.

The pains you describe seem similar to proctalgia fugax (momentary pains in the rectum) and coccydynia (pain in the coccygeal region) which are believed to be caused by spasms of the levator ani muscles that form the floor of the pelvis. The electrical activity of the levator ani muscles has been shown to be influenced by the increasing size and weight of the uterus as early as the the 8th week of pregnancy. Physical examination is often normal, although tenderness or tightness of the levator muscle, usually on the left, may be present.

Direct pressure from the baby's head as it pushes down on the cervix or the nerves that supply the perineum, vagina, and labia might also cause sharp or vague pains.

Varicose veins around the vulva and vagina could produce these sharp pains. However, the pain from varicose veins is more often described as a dull chronic aching pain. Wearing a V2 supporter may prevent excessive swelling of the vulvar veins and provide some relief.

 

REFERENCES

Shafik A, El-Sibai O.Levator ani muscle activity in pregnancy and the postpartum period: a myoelectric study.Clin Exp Obstet Gynecol. 2000;27(2):129-32.  PMID:10968354

Turgut F, Turgut M, Menteş E. Lumbosacral plexus compression by fetus: an unusual cause of radiculopathy during teenage pregnancy.Eur J Obstet Gynecol Reprod Biol. 1997 Jun;73(2):203-4. PMID:9228506

Carter BL, Racz GB. Iliohypogastric nerve entrapment in pregnancy: diagnosis and treatment.Anesth Analg. 1994 Dec;79(6):1193-4. PMID:7978446

Created: 12/3/2008
Reviewed: Mark Curran, M.D.


 

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