Chronic pelvic pain resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: : Roghayeh Marandi, M.D.

Synonyms and keywords:

Overview

Chronic pelvic pain is a symptom, not a diagnosis, and is defined as persistent or recurrent pelvic pain of either men or women for longer than three to six months. It can be classified into two subgroups: specific disease-associated pelvic pain that there is a pathology to explain the pain such as pelvic inflammatory disease, infections, adnexal pathologies, endometriosis, etc., and chronic pelvic pain syndrome (CPPS), which its diagnosis often based on the history and physical examinations and imaging and laboratory findings are often inconclusive in diagnosing it, and usually, no specific etiology can be found. Ninety-nine percent of all cases of chronic pelvic pain are female. The Pathophysiology of chronic pelvic disease could be related to the somatic structure or viscera pathologies, central sensitization of pain, or both. Treatment of chronic pelvic pain is often complicated and is usually focused on the suspected etiology of the chronic pelvic pain, such as treating a comorbid mood disorder, neuropathy, or uterine dysfunction, which can exacerbate chronic pain.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Ovarian cyst
• Malignancy

Gender-specific causes classification

Women

Infection, Endometriosis, Dysmenrrhea, Dysparenia, Myofascial Pain Syndrome, Vulvodynia, Vulvitis, Cystitis,bladder pain syndrome, Ovarian Remnant Congestion, Sympathetically Mediated Pain, Pelvic Congestion, Pelvic Fibrosis, Pelvis Neurodystonica, Irritable Bowel Syndrome, Sexual/Physical Abuse, Cancer, Psychiatric Disorders, Surgical Procedures(adhesions), Pelvic floor muscle pain syndrome, Vulvodynia,Vestibular pain syndrome,Endometriosis- associated pain syndrome

Men

Prostatitis, Chronic Orchalgia, Prostadynia, Interstitial Cystitis, Ureteral Obstruction, Irritable Bowel Syndrome, bladder pain syndrome,Sexual/Physical Abuse, Cancer,Psychiatric Disorders, Proctalgia fugax, Radiation proctitis, Surgical Procedures (adhesions), Rectal pain syndrome,Pelvic floor muscle pain syndrome,Prostatic pain syndrome, Scrotal pain syndrome, Testicular pain syndrome, Epididymal pain syndrome, Penile pain syndrome, Urethral pain syndrome, Post-vasectomy scrotal pain syndrome

Common Causes

Commonly proposed etiologies of chronic pelvic pain(CCP) include:

• Endometriosis (very controversial) Deeply Infiltrative Endometriosis may be more important
• Infection or post-infectious neurological hypersensitivity
• Exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
• Ovarian cysts, uterine leiomyoma

Diagnosis

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Characterize the pelvic pain ❑Duration: more than 3-6 months ❑Frequency: cyclical or non-cyclical ❑ Type: like paresthesia, numbness, burning, or lancinating pain ❑location: in the pelvis, anus, and/or genitals

Ask about associated symptoms ❑Gynecological: Painful periods painful ovulation painful intercourse heavy bleeding with periods irregular periods vaginal discharge pain during ejaculation ❑Gastrointestinal: Painful bowel movement with menses the urgency with bowel movement bloating diarrhea or constipation nausea, vomiting Abdominal pain (episodic or constant) Abdominal distension Fever Weight gain or loss Anorexia Dyspepsia ❑Musculoskeletal: Low back pain pain with certain movements ❑Urinary tract: Dysuria, polyuria ❑Psychological: Stress, depression, anxiety, anger

Inquire about ❑ Past medical history ❑Psychological disorder ❑Previous abdominal or pelvic surgery

Examine the patient General Appearance ❑ Check for: ❑ ❑ ❑

Order ❑ Blood tests ❑ ❑ ❑

CPP

CPPS

Treatment

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Do's

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Don'ts

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References

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