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Pelvic Injuries in Young Girls

Location, timing and triggers are the key things to identify when it comes to pelvic pain in young girls. Alleviating the pain depends on what caused it.

By Dr. Jennifer Dietrich, Chief of Pediatric and Adolescent Gynecology at Texas Children’s Hospital

Pelvic pain is a common symptom experienced by prepubertal and adolescent girls. With summer’s outdoor activities still lingering and school athletic activities about to start, we must remember that accidents occasionally occur. When girls experience pain, it is important to note the location of the pain, timing, any inciting events, and things that alleviate the pain or exacerbate the pain response. However, it can be a difficult, partly due to the fact that many organs in the pelvic region are in close proximity to one another.

Acute pain may result from trauma, new exercise activities, ovulation, infection (i.e., appendicitis or bladder infection) or adnexal problems, such as ovarian torsion or ruptured ovarian cyst. This type of pain usually is sudden in onset, but factors which alleviate the pain may be different. For instance, acute pain resulting from injury may improve with over-the-counter, non-steroidal, anti-inflammatory agents, whereas acute pain resulting from a twisted ovary will not improve with any pain medications, but rather requires surgical intervention for pain relief.

Common reasons why young girls experience chronic pain may include both gynecologic and non-gynecologic reasons. Gynecologic causes may be related to menstrual cramps, onset of endometriosis, prior history of surgery with adhesive disease or prior history of pelvic inflammatory disease, to name a few. Non-gynecologic causes may be related to chronic bladder spasms, constipation or even musculoskeletal pain (a cause of pain in 30 to 50 percent of cases).

In girls, the most common type of pain seen is due to a “straddle injury.” This occurs when the force of a blunt object or surface compresses the soft tissue in the genital region, against the bony pelvis. Common examples of straddle injuries include falling on a bicycle seat, monkey bars or edge of a diving board. Such accidents may result in minor injuries, such as abrasions or bruises. Unfortunately, more serious trauma can occur as well.

Information about the type of event that happened, the kind of blunt object or surface involved or the presence of sharp substances is critical to pass on to medical providers when seeking emergent evaluation. It is additionally important to recognize whether there is abnormal swelling, bleeding, pain or an inability to void. In these situations, it is imperative to seek medical attention immediately. Despite such events being unpredictable and unpreventable, they may still be a traumatic experience for the child and the caregiver.

Fortunately, even serious straddle injuries heal well. Furthermore, minor injuries tend to heal rapidly and even major injuries heal relatively quickly. In the end, once children begin to feel better, they resume normal activities, monkey bars and all!

However, if pain occurs acutely or chronic pelvic pain persists, and does not improve with over-the-counter measures, an evaluation by your provider is necessary.

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