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.
