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What is chronic pelvic pain?

Chronic pelvic pain is a common condition, affecting 1 woman every 7, that is defined by the presence of pain in the pelvic region for more than 6 months.

Chronic pelvic pain can have multiple causes, from intestinal to gynecological or urological problems, therefore its treatment should be multidisciplinary.

 

Is it a frustrating disease, since most patients see many doctors but 1/3 of them will not get a diagnosis and a proper treatment. These patients experience bad quality of life, work absenteeism and important psychological distress.

For this reason is very important to be visited by the right doctor, that is able to focus on patient’s problem and help him/her to find the right diagnostic and therapeutic pathway.

 

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What causes chronic pelvic pain?

Chronic pelvic pain can be caused by:

  • Pelvic inflammatory disease
  • Pelvic endometriosis
  • Urinary tract infection and interstitial cystitis
  • Irritable bowel syndrome
  • Puborectalis syndrome
  • Pudendal chronic neuralgia
  • Diverticular disease

Treatment for chronic pelvic pain:

Treatment varies according to etiology, therefore a careful diagnosis is mandatory.

Pelvic inflammatory disease (PID) is an infection of the upper part of the female reproductive system namely uterus, fallopian tubes, and ovaries. Chlamydia trachomatis and Neisseria gonorrhoeae are usually the main cause of PID. Its symptoms are: fever, cervical motion tenderness, lower abdominal pain, new or different discharge, painful intercourse, uterine tenderness, adnexal tenderness, or irregular menstruation. If pelvic inflammatory disease is not cured, might lead to endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis. Even when the PID infection is cured effects of the infection may be permanent, therefore its early identification is essential. Formation of scar tissue due to one or more episodes of PID can lead to tubal blockage, increasing the risk of the inability to get pregnant and long-term pelvic and abdominal pain.

Pelvic endometriosis is one of the main causes of chronic pelvic pain. It is characterized by the growth of the uterine lining (endometrium) outside of the uterus. This endometrium behaves exactly as the one inside the uterus, undergoing the cyclic changes including monthly bleeding, that in this case happen into the abdomen or other organs, causing inflammatory reaction, development of adhesions (scar tissue), or appearance of cysts filled with blood which, over time, acquire a consistency of liquid chocolate (chocolate cysts). Endometriosis cause not only chronic pelvic pain, but also heavy menstrual periods, pain during intercourse and infertility.  Endometriosis can be treated through a number of methods resulting in the lessening or cessation of pains as well as the other symptoms of the disease.

Urinary tract infection (UTI) and interstitial cystitis are very common disease in women, affecting 1/5 of the young population, and can have a long-lasting impact on quality of life. Women are more likely to have chronic UTI because of the location of their urethra in relation to the rectum and because women have shorter urethra than men. This makes it easier for bacteria to reach the bladder and multiply.

Interstitial cystitis, also called painful bladder syndrome, is a chronic condition causing bladder pain, frequent and painful urination and pelvic pain.

The bladder expands until it's full and then signals your brain that it's time to urinate, communicating through the pelvic nerves. With interstitial cystitis, these signals get mixed up, so you feel the need to urinate more often and with smaller volumes of urine than most people.

Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system. It causes stomach pain, cramps and bloating, flatulence, diarrhea and/or constipation, urgent need to go to the toilet, feeling that you have not fully emptied your bowels after going to the toilet, passing mucus with the stool. Symptoms tend to come and go in periods lasting a few days to a few months at a time, often during times of stress or after eating certain foods. Many medical therapies are available in the aim to relieve the symptoms.

Puborectalis syndrome and pudendal chronic neuralgia can be diagnosed only after a careful visit with palpation of the levator ani and the different trigger points. Then, if necessary, nerve conduction studies can be performed in order to confirm the diagnosis. Then, biofeedback and pelvic floor rehabilitation are offered and can guarantee very good results. In very selected cases, direct infiltration with local anesthetics and corticosteroids are performed directly on the nerve.

In diverticular disease, small bulges (diverticula) develop in the lining of the large intestine. Diverticulitis is when these pockets become inflamed or infected. Symptoms of diverticular disease include: lower abdominal pain and feeling bloated, sometimes they can be more serious like more severe abdominal pain, especially on the left side, high temperature (fever) of 38C (100.4F) or above and bloody diarrhoea. The majority of people with diverticula will not have any symptoms; this is known as diverticulosis.

Diagnosis is made with colonoscopy and treatment consists in a special diet and preventive cycles of antibiotics and probiotics.

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