chronic%20pelvic%20pain%20in%20women
CHRONIC PELVIC PAIN IN WOMEN
Chronic pelvic pain (CPP) is a persistent, distressing, and severe pain of >6-month duration.
It occurs intermittently, cyclically, or situationally.
Localized to the pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks.
In women, CPP is not restricted to intercourse or menstruation and is not associated with pregnancy.
A complex problem that is both multifactorial & multidimensional.

Chronic%20pelvic%20pain%20in%20women Signs and Symptoms

Introduction

  • It is a symptom with a number of contributory factors and not a diagnosis; pathophysiology is complex and not well understood
    • It is assumed that in the development of chronic pain, the nervous system is affected among others by inflammatory and chemical mediators and hormones
  • A complex problem that is both multifactorial and multidimensional
  • Chronic pelvic pain (CPP) mechanisms include acute pain that is in progress involving visceral or somatic tissue, chronic pain involving the central nervous system (CNS), and cognitive, behavioral, emotional, and sexual responses and mechanisms
  • CPP may be subdivided into specific disease-associated pain (conditions with well-defined pathology) and chronic pelvic pain syndrome (CPPS) (without obvious pathology)

Definition

  • CPP is a persistent, distressing, and severe pain of >6 months duration; occurs intermittently, cyclically, or situationally; localized to the pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks; and is severe enough to cause functional disability or need medical care
    • In women, CPP is not restricted to intercourse or menstruation and is not associated with pregnancy

Etiology

  • The following are the common causes of CPP
  • Treatment is directed towards the specific condition and according to its specific guidelines
 Gastrointestinal  Gynecological  Musculoskeletal
  • Irritable bowel syndrome (IBS)*
  • Inflammatory bowel disease (IBD)*
  • Abscess
  • Chronic appendicitis
  • Constipation*
  • Diverticulitis*
  • Neoplastic lesions
  • Chronic intermittent bowel obstruction
  • Hemorrhoids*
  • Anal fissure*
  • Proctitis
  • Endometriosis*
  • Dysmenorrhea*
  • Pelvic adhesions
  • Pelvic inflammatory disease*
  • Vulvodynia
  • Chronic endometritis
  • Adenomyosis
  • Gynecologic malignancies
  • Deformities/Prolapse
  • Ovarian cysts
  • Residual ovary syndrome
  • Ovarian remnant syndrome
  • Post-hysterectomy pain
  • Pelvic congestion syndrome
  • Fibroids or Leiomyomas*
  • Myofascial pain (trigger points)
  • Pelvic floor myalgia and spasms/prolapse
  • Pelvic girdle pain
  • Coccygodynia
  • Stress fractures
  • Chronic back pain
  • Disc disease
  • Levator ani syndrome
  • Hernias
  • Musculoskeletal and connective tissue malignancies
 Psychiatric/Neurological  Urological  Others
  • Depression*
  • History of or current physical or sexual abuse
  • Sleep disturbance
  • Nerve entrapment syndrome
  • Psychological stress (work, marital)
  • Substance abuse
  • Neurologic dysfunction
  • Neuropathic pain*
  • Somatoform pain disorders
  • Schizophrenia*, schizotypal and delusional disorders
  • Interstitial cystitis
  • Urethral syndrome
  • Chronic urinary tract infection*1
  • Bladder stones or dysfunction
  • Urolithiasis*
  • Urological malignancies
  • Infectious diseases
  • Chronic pain syndromes
  • Mesh infection
  • Sickle cell disease
  • Porphyria
  • Hyperparathyroidism*
  • Herpes zoster
  • Heavy metal poisoning
*Please refer to the corresponding disease management chart for more information
1Urinary Tract Infection in Women – Complicated or Urinary Tract Infection – Uncomplicated disease management charts
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