Chronic Abdominal Pain of Gynecologic Causes: Diagnosis and Treatment

Abstract

Chronic abdomino-pelvic pain or chronic pelvic pain (CPP) is estimated to affect 4 % of women, decreasing quality of life and work productivity, with healthcare costs of more than two billion dollars per year in the United States. Diagnosis of the etiology is difficult as symptoms can be vague and often the patient has several sources for her pain. Non-gynecologic disorders are associated with higher prevalence rates than gynecologic disorders and include: Irritable bowel syndrome (IBS), interstitial cystitis/painful bladder syndrome (IC/PBS), abdominal/pelvic myofascial pain, and neuralgias (discussed in other chapters of this book). Gynecologic disorders include: endometriosis, prior pelvic inflammatory disease, leiomyomata, adenomyosis, tuberculous salpingitis, ovarian remnant syndrome, ovarian retention syndrome, and pelvic congestion syndrome. Dysmenorrhea (pain with the menstrual cycle) and dyspareunia (pain with sexual intercourse) are also common symptoms. Other non-gynecologic disorders, such as depression, fibromyalgia, migraines, low back pain, or a history of physical/sexual abuse, should be evaluated and addressed. Patients with CPP often have been to multiple doctors and had numerous interventions without any improvement of pain or even a diagnosis. A patient–physician relationship based on empathy and trust, along with patient education and setting realistic goals (including pain decrease with improvement of daily functioning), is extremely important.