chronic%20pelvic%20pain
CHRONIC PELVIC PAIN
Chronic pelvic pain (CPP) is a persistent, distressing, & 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.
It is severe enough to cause functional disability or need medical care.
In women, CPP is not restricted to intercourse or menstruation & is not associated w/ pregnancy.
It is a symptom w/ a number of contributory factors & not a diagnosis; pathophysiology is complex & not well understood.
It is assumed that in the development of chronic pain, the nervous system is affected among others by inflammatory & chemical mediators & hormones.
A complex problem that is both multifactorial & multidimensional

Chronic%20pelvic%20pain Signs and Symptoms

Introduction

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

Definition

  • Chronic pelvic pain (CPP) is a persistent, distressing, & 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; & is severe enough to cause functional disability or need medical care
    • In women, CPP is not restricted to intercourse or menstruation & is not associated with pregnancy

Etiology

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

    *Please refer to the corresponding disease management chart for more information
    1Urinary Tract Infection – Complicated or Urinary Tract Infection – Uncomplicated management charts
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