Chronic pelvic pain

Chronic pelvic pain

= Women and chronic pelvic pain =

DiseaseDisorder infobox
Name = Pelvic and perineal pain
ICD10 = ICD10|R|10|.2|n|80
ICD9 = |625.9Most women, at some time in their lives, experience pelvic pain. When the condition persists for longer than 3 months, it is called chronic pelvic pain (CPP). This is a poorly-understood condition that likely represents abnormal neurological function, either in the peripheral nervous system or central nervous system. Many different etiologies have been proposed for CPP, but a major problem is that virtually none of them have been validated. Commonly proposed etiologies include:

* endometriosis
* infection or post-infectious neurological hypersensitivity
* exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
* ovarian cysts, uterine leiomyoma - often found in asymptomatic patients as well, however
* less common emergencies: ovarian torsion - sudden loss of circulation to the ovary, appendicitis - infection of one part of the intestine, with right lower abdominal pain
* pelvic girdle pain (SPD or DSP) Women with symptoms of pain may want to see a gynecologist if problems don't go away after a few days, and workup should begin with a careful history and examination, followed by a pregnancy test. Some women may also need bloodwork or additional imaging studies, and a handful may also benefit from having surgical evaluation using small telescopes (laparoscopy). Many women will also benefit from a consultation with a physical therapist, a trial of anti-inflammatory medications, hormonal therapy, or even neurological agents.

This is a condition that although common, direly needs to be studied more closely.

As girls enter gynecologic maturity, pelvic or abdominal pain becomes a frequent complaint.

Chronic pelvic pain (CPP) accounts for 10% of all visits to gynecologists. In addition, CPP is the reason for 20 - 30% of all laparoscopies in adults.

Etiology

* Gynecologic Etiologies
** Dysmenorrhea
** Endometriosis
** Müllerian abnormalities
** Pelvic inflammatory disease
** Ovarian abnormalities

* Abdominal Etiologies
** Loin pain hematuria syndrome
** Proctitis
** Colitis

Men and chronic pelvic pain

Man also experience chronic pelvic pain. In men it is called Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and is also known as "chronic nonbacterial prostatitis". Men in this category have no known infection, but do have extensive pelvic pain lasting more than 3 months.cite journal |author=Luzzi GA |title=Chronic prostatitis and chronic pelvic pain in men: aetiology, diagnosis and management |journal=Journal of the European Academy of Dermatology and Venereology : JEADV |volume=16 |issue=3 |pages=253–6 |year=2002 |pmid=12195565 |doi=] There are no standard diagnostic tests; diagnosis is by exclusion of other disease entities. Multimodal therapy is the most successful treatment option,cite journal |author=Potts JM |title=Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome |journal=Current urology reports |volume=6 |issue=4 |pages=313–7 |year=2005 |pmid=15978236 |doi=] and includes α-blockers,cite journal |author=Yang G, Wei Q, Li H, Yang Y, Zhang S, Dong Q |title=The effect of alpha-adrenergic antagonists in chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis of randomized controlled trials |journal=J. Androl. |volume=27 |issue=6 |pages=847–52 |year=2006 |pmid=16870951 |doi=10.2164/jandrol.106.000661 |quote=...treatment duration should be long enough (more than 3 months)] phytotherapy,cite journal |author=Shoskes DA, Zeitlin SI, Shahed A, Rajfer J |title=Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial |journal=Urology |volume=54 |issue=6 |pages=960–3 |year=1999 |pmid=10604689 |doi=] cite journal |author=Elist J |title=Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a randomized, double-blind, placebo-controlled study |journal=Urology |volume=67 |issue=1 |pages=60–3 |year=2006 |pmid=16413333 |doi=10.1016/j.urology.2005.07.035] and protocols aimed at quieting the pelvic nerves through myofascial trigger point release with psychological re-training for anxiety control.cite journal |author=Anderson RU, Wise D, Sawyer T, Chan C |title=Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men |journal=J. Urol. |volume=174 |issue=1 |pages=155–60 |year=2005 |pmid=15947608 |doi=10.1097/01.ju.0000161609.31185.d5] cite journal |author=Anderson RU, Wise D, Sawyer T, Chan CA |title=Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training |journal=J. Urol. |volume=176 |issue=4 Pt 1 |pages=1534–8; discussion 1538–9 |year=2006 |pmid=16952676 |doi=10.1016/j.juro.2006.06.010] Antibiotics are not recommended.cite journal |author=Alexander RB, Propert KJ, Schaeffer AJ, "et al" |title=Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial |journal=Ann. Intern. Med. |volume=141 |issue=8 |pages=581–9 |year=2004 |pmid=15492337 |doi=] cite journal |author=Nickel JC, Downey J, Clark J, "et al" |title=Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial |journal=Urology |volume=62 |issue=4 |pages=614–7 |year=2003 |pmid=14550427 |doi=]

References

* Milburn A, Reiter R, Rhomberg A: Multi-disciplinary approach to chronic pain. Obstet Gynecol Clin 1993;20:643 - 661.
* Stovall DW: Endometriosis associated pelvic pain: Evidence for an association between the stage of disease and a history of chronic pelvic pain. Fertil Steril 1997;68:13 - 17.
* Schroeder B, Sanfillippo JS: [http://www.health.am/gyneco/chronic-pelvic-pain/ Chronic Pelvic Pain and Recurrent Abdominal Pain in Female Adolescents] . Pediatr Clin North Am 1999;46:566 - 567.
* Elisabeth Thibaud, Hyams JS: Clinical aspects of recurrent abdominal pain. [http://www.health.am/gyneco/pediatric-gynecology/ Pediatric and Adolescent Gynecology] Pediatr Ann 2001;30:17–21.
* Jantos M.: [http://www.pelviperineology.org/practical/chronic_pelvic_pain.html Understanding Chronic Pelvic Pain] . Pelviperineology Vol. 26 N.2 June 2007 66-68

ee also

* Abdominal adhesions
* Coccydynia (coccyx pain, tailbone pain)
*CP/CPPS

External links

* [http://www.pelvicpain.org International Pelvic Pain Society]
* [http://www.ampainsoc.org American Pain Society]
* [http://www2.med.umich.edu/departments/obgyn/index.cfm?fuseaction=Obgyn.pelvicPainClinic University of Michigan Pelvic Pain Program]
* [http://www.med.unc.edu/obgyn/services_algs.html University of North Carolina Pelvic Pain Program]
* [http://www.emedicine.com/pmr/topic242.htm Tailbone pain (coccyx pain, coccydynia): Free medical article online at eMedicine]
* [http://www.pelviperineology.org/ Pelviperineology] The multidisciplinary open access pelvic floor journal


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