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Wednesday, April 15, 2009

Chronic Pelvic Pain

1:29 PM

Description

1. Chronic pelvic pain (CCP) is defined as any ache or pain in the pelvic area that lasts at least 6 months. Chronic pelvic pain may be a steady pain or a pain that comes and goes, perhaps with a woman's menstrual cycle. The pain may be bad enough to interfere with normal daily activities. Numerous conditions can cause CPP, and the pain can take many forms. It may be dull or sharp, mild or extreme, or constant or intermittent. The pain might peak during intercourse or bowel movements, or it might flare up every time the woman sits down. It could become more intense during certain times in the menstrual cycle. The pain may wash over the entire pelvic area (roughly the zone under the belly button and between the hips), although it can also stay focused in one spot or shift from place to place. Depending on the condition, other symptoms may be present: heavy or irregular periods, vaginal discharge, or stomach cramps or discomfort, combined with alternating bouts of constipation or diarrhea.

Causes 2. Reproductive organ disease (70%): pelvic inflammatory disease, pelvic adhesions, and uterine displacement, infections, and endometriosis
3. Musculoskeletal-neurological (8%): poor posture, scoliosis, unilateral standing habits, lumbar lordosis, leg-length discrepancy, abnormal gait, abdominal wall trigger points, or history of low back trauma
4. Myofascial (7%)
5. Urologic (5%) urethral syndrome, interstitial cystitis
6. Gastrointestinal (10%): irritable bowel syndrome, chronic constipation, diverticulitis and irritable bowel syndrome
7. Psychological issues were present in 80% of these patients.



Symptoms

1. Pain is present for 6 months or longer
2. There has been very little relief from conventional, medical, or surgical treatment.
3. Pain is not necessarily proportional to tissue damage.
4. Vegetative signs of depression (sleep disturbances, constipation, slow body movements) are present.
5. Limitations have been placed on physical activity.
6. Emotional symptoms



Diagnosis

1. Physical exam
2. Psychometric test
3. Lab test



Treatment

1. Pain relief may be achieved with the scheduled dosing of a nonsteroidal anti-inflammatory drug (ibuprofen, Anaprox).
2. Trigger point injections: Bupivacaine, Triamcinolone
3. Tricyclic antidepressants (Tofranil, Elavil)
4. Relaxation techniques, stress management
5. Irritable bowel syndrome: daily psyllium supplements and increased dietary fiber
6. Surgical management: diagnostic laparoscopy, lysis of adhesions, uterine suspension, treatment of infections or endometriosis



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