Transcript Chronic pelvic pain

Chronic pelvic pain
Dr. Ahmed jasim
Ass.Prof.
MBChB-DOG-FICMS
COSULTANT OF GYN. &
OBST.
Def.
• 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.
Type of pain
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Visceral pain
Referred Pain
Somatic Pain
Myalgia
Hyperalgesia
Neuroinflammation
Sources of chronic pelvic pain
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Gynecological
Urological
Gastrointestinal
Musculoskeletal
Neuropathic
Other
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%).
Differential Diagnosis for Chronic
Pelvic Pain
Gynecologic
Gastrointestinal
Endometriosis syndrome
Irritable bowel
Adhesions (chronic pelvic
inflammatory disease)
Chronic Appendicitis
Leiomyomata
disease
Inflammatory bowel
Adenomyosis
Diverticulosis
Pelvic congestion syndrome
Diverticulitis
Meckel’s diverticulum
Differential Diagnosis
Urologic
Psychological
Abnormal bladder function
(detrusor instability)
Depression
Urethral syndrome
(chronic urethritis)
Somatization
Interstitial cystitis
Psychosexual dysfunction/
disorder
abuse
Personality
Differential Diagnosis
Musculoskeletal
Nerve entrapment (neuritis)
Chronic appendicitis
Fasciitis
Scoliosis
disease
Disc disease
disease
Spondylolisthesis
Osteitis pubis
Surgical
Hernia
Bowel
Adhesive
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
• Laparoscopy.
Treatment:
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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.