Chronic Pelvic Pain and Irritable Bowel Syndrome: Is Subclinical Inflammation Bridging the Gap?

Abstract

Irritable bowel syndrome (IBS) is characterized by a multitude of symptoms digestive and extra- digestive that need at some point a multidisciplinary approach. This study aimed at profiling IBS associated with chronic pelvic pain (CPP) in young females. A cross sectional observatory study on 40 consecutive young female patients (under 45 years) with IBS (Rome III) was performed. Patients were assigned in two groups, as matched pairs, based on the presence of chronic pelvic pain (CPP) symptoms: cystalgia, urinary urge and dyspareunia: CPP(+) vs. CPP(-) and undertook clinical examinations with special protocols related to migraine disability, fibromyalgia, temporo-mandibular joint dysfunction, as well as assessment of anxiety and severity of abdominal pain. Laboratory work-up (blood, urine and stool) as well as multiple exams: digestive endoscopy, abdominal and pelvic ultrasound//CT were performed. Results: CPP (+) group displayed higher CRP, TNF-alpha, gut dysbiosis (DB) and abdominal pain severity, as well as associated fibromyalgia, migraine and anxiety mood disorder. DB positively correlated with inflammatory markers and symptoms characterizing CPP. In conclusion, young female IBS patients with concurrent CPP symptoms often experienced other associated functional pain conditions like FM and migraine along with anxiety, more severe abdominal complaints as well as higher gut DB and consecutively subclinical pro-inflammatory status. Strong positive correlations of gut DB to inflammatory markers as well as to CPP symptoms give the relationship IBS-CPP a new perspective. Keywords: CPP, IBS, inflammation, gut dysbiosis