Pilot Study of Pelvic Girdle Pain in Women With and Without Laparoscopically Diagnosed Endometriosis

Paul J Yong

doi:10.23937/2378-3397/1410011

Abstract

Objective: Pelvic girdle pain is a well recognized cause of back pain in the pregnant and postpartum population. In this pilot study, we explore whether pelvic girdle pain is also involved in the etiology of back pain outside the pregnant/postpartum period, in women with or without laparoscopically diagnosed endometriosis. Methods: Retrospective review of new patients seen for pelvic pain from June – December 2012 at a tertiary referral centre. Patients self-rated back pain severity from 0-10. Pelvic girdle pain tests were sacroiliac dorsal ligament tenderness, right or left active straight leg raise, and right or left Faber tests. The examiner was blinded to the back pain severity. Pelvic girdle pain was tested for an association with the severity of back pain. Endometriosis was diagnosed on laparoscopy, and the presence or absence of endometriosis was also considered. Results: Sixty-three women with pelvic pain met the study criteria, with 82% having underlying endometriosis (32/39). Pelvic girdle pain (presence of at least one positive pelvic girdle pain test) was significantly associated with greater severity of back pain (5.6 +/2.9 vs. 3.5 +/- 2.9, Mann-Whitney test, p=0.009). Furthermore, the number of positive pelvic girdle pain tests was significantly associated with the severity of back pain (Spearman rho=0.30, p=0.016; linear regression b=0.53, p=0.031). Pelvic girdle pain was similarly present in women with or without endometriosis (63% (20/32) vs. 86% (6/7), Fisher Exact test, p=0.39). No other demographic variables, diagnoses, symptoms, or signs, were associated with severity of back pain. Conclusion: This pilot study provides initial evidence that pelvic girdle pain is involved in the etiology of back pain in the pelvic pain population, similar to the pregnant/postpartum population, in women with or without endometriosis at laparoscopy.

Highlights

Pelvic girdle pain affects one in five pregnant women, and may persist > 6 months postpartum in 3-30% [1,2]
Endometriosis is the presence of uterine endometrium outside of the uterus elsewhere in the pelvis, which is diagnosed by laparoscopy and affects 10% of reproductive-aged women, and is a common cause of chronic pelvic pain and infertility [6]
Five positive pelvic girdle pain tests were present in 6% (4/63), four positive tests in 10% (6/63), three positive tests in 11% (7/63), two positive tests in 22% (14/63), one positive test in 18% (11/63), and all tests were negative in 33% (21/63)

Summary

Introduction

Pelvic girdle pain affects one in five pregnant women, and may persist > 6 months postpartum in 3-30% [1,2]. Pelvic girdle pain has been defined as pain between the posterior iliac crest and gluteal fold that includes the sacroiliac joint [2]. Tu et al recently reported that posterior provocation was more common in non-pregnant/postpartum women with pelvic pain compared to controls (37% vs 5%) [5]. In our clinical experience, we have observed that pelvic girdle pain is common in non-pregnant/postpartum women with pelvic pain often related to endometriosis. Endometriosis is the presence of uterine endometrium outside of the uterus elsewhere in the pelvis, which is diagnosed by laparoscopy and affects 10% of reproductive-aged women, and is a common cause of chronic pelvic pain and infertility [6]

Methods

Results

Conclusion