Chronic pelvic pain By Dr. Dalya Muthefer

Chronic pelvic pain: Chronic pelvic pain refers to pain in the region between the hips, below the bellybutton. In order to be considered chronic, the pain must last for at least six months or longer. Chronic pelvic pain syndrome: chronic pelvic pain causing emotional and behavioral changes.

Types of pain:- Visceral pain Referred Pain Somatic Pain Myalgia Hyperalgesia Neuroinflammation

Sources of chronic pelvic pain :- Gynecological Urological Gastrointestinal Musculoskeletal Neuropathic Others

Incidence:- 14 – 24% of women b/w 18 and 50 years. 1/3 do not consult doctor. 60% who consult are not referred to tertiary centre. Population studies: GI (37%), Urinary (31%), Gynae (20%). Laparoscopic findings: No pathology (35%), Endometriosis (33%), Adhesions (24%).

Causes:

Signs and Symptoms:- Pain during intercourse Cramping or sharp pains Heaviness or a feeling of pressure inside the pelvis Extreme and constant pain Intermittent pain A dull ache Pain during bowel movements .

General Examination:- Gait- Musculoskeletal Check  Abdominal Wall – Point trigger, Ovarian point tenderness Inspection of Vulva & introitus- Vestibulitis Check for Pelvic Floor Myalgia Single Digit Pelvic Exam Bimanual exam Rectovaginal exam

Investigations:- WCC, ESR CA – 125 HVS / Endocervical swabs USS Laproscopy

Differential Diagnosis for Chronic Pelvic Pain:-

Differential Diagnosis for Chronic Pelvic Pain:-

Treatment:- Possible treatments for chronic pelvic pain include: Birth control pills to stop menstruation Progestogen (medroxy progesterone acetate (MPA)) was effective after 4 months’ treatment Over the counter pain relief medications, such as ibuprofen or aspirin Relaxation exercises, massage or physical therapy Antibiotics Psychological counseling Surgery to correct pelvic abnormalities Antibiotics if infection is the source of the pain Antidepressants Trigger point injections

Surgical management:- Adhesion release. beware of prolapse and bladder. Presacral neurectomy: beware of vessel injury, bladder/bowel. Hysterectomy with BSO Surgical mx of non gynae causes.

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