Pelvic pain: Difference between revisions
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==Female== |
==Female== |
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Most women, at some time in their lives, experience pelvic pain. |
Most women, at some time in their lives, experience pelvic pain. |
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* 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 |
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| ⚫ | 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. |
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This is a condition that although common, direly needs to be studied more closely. |
This is a condition that although common, direly needs to be studied more closely. |
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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. |
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. |
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===Etiologies=== |
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Many different etiologies have been proposed, including: |
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* less common emergencies: [[ovarian torsion]], [[appendicitis]] |
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* Gynecologic Etiologies |
* Gynecologic Etiologies |
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** [[Dysmenorrhea]] |
** [[Dysmenorrhea]] |
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** [[Endometriosis]] |
** [[Endometriosis]] |
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** Müllerian abnormalities |
** [[Müllerian abnormalities]] |
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** [[Pelvic inflammatory disease]] |
** [[Pelvic inflammatory disease]] |
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** Ovarian abnormalities |
** [[Ovarian abnormalities]] |
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* Abdominal Etiologies |
* Abdominal Etiologies |
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** [[Proctitis]] |
** [[Proctitis]] |
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** [[Colitis]] |
** [[Colitis]] |
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===Workup=== |
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| ⚫ | 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. |
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==Male== |
==Male== |
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Revision as of 03:50, 14 March 2010
| Pelvic pain |
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Pelvic pain is a symptom that can affect both women and men. The pelvic pain that persists for a period of 3 months or more to be considered chronic while less than this duration is considered acute. The pain may indicate the existence of poorly-understood conditions that likely represent abnormal psychoneuromuscular function.
Female
Most women, at some time in their lives, experience pelvic pain.
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.
Etiologies
Many different etiologies have been proposed, including:
- 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, appendicitis
- pelvic girdle pain (SPD or DSP)
- Gynecologic Etiologies
- Abdominal Etiologies
Workup
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.
Male
Men 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.[1] There are no standard diagnostic tests; diagnosis is by exclusion of other disease entities. Multimodal therapy is the most successful treatment option,[2] and includes α-blockers,[3] phytotherapy,[4][5] and protocols aimed at quieting the pelvic nerves through myofascial trigger point release with psychological re-training for anxiety control.[6][7] Antibiotics are not recommended.[8][9]
Differential diagnosis
In men, chronic pelvic pain (category IIIB) is often misdiagnosed as chronic bacterial prostatitis and needlessly treated with antibiotics exposing the patient to inappropriate antibiotic use and unnecessarily to adverse effects with little if any benefit in most cases. Within a Bulgarian study, where by definition all patients had negative microbiological results, a 65% adverse drug reaction rate was found for patients treated with ciprofloxacin in comparison to a 9% rate for the placebo patients. This was combined with a higher cure rate (69% v 53%) found within the placebo group.[10]
See also
References
- ^ Luzzi GA (2002). "Chronic prostatitis and chronic pelvic pain in men: aetiology, diagnosis and management". Journal of the European Academy of Dermatology and Venereology : JEADV. 16 (3): 253–6. doi:10.1046/j.1468-3083.2002.00481.x. PMID 12195565.
- ^ Potts JM (2005). "Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome". Current urology reports. 6 (4): 313–7. doi:10.1007/s11934-005-0030-5. PMID 15978236.
- ^ Yang G, Wei Q, Li H, Yang Y, Zhang S, Dong Q (2006). "The effect of alpha-adrenergic antagonists in chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis of randomized controlled trials". J. Androl. 27 (6): 847–52. doi:10.2164/jandrol.106.000661. PMID 16870951.
...treatment duration should be long enough (more than 3 months)
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Shoskes DA, Zeitlin SI, Shahed A, Rajfer J (1999). "Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial". Urology. 54 (6): 960–3. doi:10.1016/S0090-4295(99)00358-1. PMID 10604689.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Elist J (2006). "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". Urology. 67 (1): 60–3. doi:10.1016/j.urology.2005.07.035. PMID 16413333.
- ^ Anderson RU, Wise D, Sawyer T, Chan C (2005). "Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men". J. Urol. 174 (1): 155–60. doi:10.1097/01.ju.0000161609.31185.d5. PMID 15947608.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Anderson RU, Wise D, Sawyer T, Chan CA (2006). "Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training". J. Urol. 176 (4 Pt 1): 1534–8, discussion 1538–9. doi:10.1016/j.juro.2006.06.010. PMID 16952676.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Alexander RB, Propert KJ, Schaeffer AJ; et al. (2004). "Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial". Ann. Intern. Med. 141 (8): 581–9. PMID 15492337.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) - ^ Nickel JC, Downey J, Clark J; et al. (2003). "Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial". Urology. 62 (4): 614–7. doi:10.1016/S0090-4295(03)00583-1. PMID 14550427.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) - ^ J. Dimitrakov. "A Prospective, Randomized, Double-Blind, Placebo-Controlled Study Of Antibiotics For The Treatment Of Category Iiib Chronic Pelvic Pain Syndrome In Men". Third International Chronic Prostatitis Network. Retrieved 4 September 2009.
The results of our study show that antibiotics have an unacceptably high rate of adverse side effects as well as a statistically insignificant improvement over placebo...
{{cite web}}: Unknown parameter|coauthors=ignored (|author=suggested) (help)
External links
- Pelvic Pain Support Network
- International Pelvic Pain Society
- American Pain Society
- University of Michigan Pelvic Pain Program
- University of North Carolina Pelvic Pain Program
- Tailbone pain (coccyx pain, coccydynia): Free medical article online at eMedicine
- Pelviperineology The multidisciplinary open access pelvic floor journal