Diagnosis Of Chronic Pelvic Pain Research Articles

Gynecologic presentation of interstitial cystitis as detected by intravesical potassium sensitivity

Objective: To document the initial clinical diagnoses, determine the prevalence of urinary symptoms, and test for intravesical potassium sensitivity in gynecologic patients with chronic pelvic pain. Methods: Gynecologists at three United States medical centers administered the Potassium Sensitivity Test to consecutive unselected pelvic pain patients. Before testing, each patient was given an initial clinical diagnosis based on the patient’s chief symptomatic complaint(s) and surveyed for urologic symptoms. Results: Of 134 patients, 114 (85%) had positive potassium sensitivity. Positive potassium sensitivity rates were similar across all three sites and all clinical diagnoses including endometriosis, vulvodynia (vulvar vestibulitis), and pelvic pain. A total of 75% of the subjects reported urologic symptoms, but only 2.9% received an initial diagnosis of interstitial cystitis. Conclusion: A significant majority of gynecologic patients presenting with pelvic pain have a positive Potassium Sensitivity Test, indicating their pain may have a bladder component (interstitial cystitis). Interstitial cystitis deserves greater consideration in the differential diagnosis of chronic pelvic pain.

Pelvic pain: A chronic visceral pain syndrome

Patients with chronic pelvic pain are usually evaluated and treated by gynecologists, gastroenterologists, urologists, and internists. In many patients with chronic pelvic pain the examination and work-up remain unrevealing and no specific cause of the pain can be identified. In these cases it is important to recognize that pain is not only a symptom of pelvic disease, but that the patient is suffering from a chronic pelvic pain syndrome. Once the diagnosis of chronic pelvic pain is made, treatment should be directed to symptomatic pain management. This article outlines treatment options currently available. Despite the challenge inherent in the management of chronic pelvic pain, many patients can be treated successfully using a multidisciplinary pain management approach. The first important step is to recognize that patients with chronic pelvic pain might suffer from a chronic visceral pain syndrome.

The role of laparoscopy as a diagnostic tool in chronic pelvic pain

More than 40% of laparoscopies are performed for the diagnosis of chronic pelvic pain (CPP). Although laparoscopic evaluation is sometimes considered a routine part of the evaluation, ideally the decision to perform a laparoscopy should be based on the patient's history, physical examination and findings of non-invasive tests. About 65% of women with CPP have at least one diagnosis detectable by laparoscopy and it is common to attribute causality to this diagnosis. Endometriosis is diagnosed in one-third of laparoscopies for CPP. Endometriosis requires histological confirmation to assure an accurate diagnosis. Adhesions are diagnosed in about one-quarter of laparoscopies. Ovarian cysts, hernias, pelvic congestion syndrome, ovarian remnant syndrome, ovarian retention syndrome, post-operative peritoneal cysts and endosalpingiosis are other diagnoses that can be made laparoscopically in some cases. Laparoscopic conscious pain mapping has the potential to improve the accuracy of laparoscopy as a diagnostic tool in CPP.

GnRH analogue in assessing chronic pelvic pain in women with residual ovaries

To assess whether suppression of ovarian function by a gonadotrophin releasing hormone (GnRH) analogue could assist in the diagnosis of chronic pelvic pain in women with residual ovaries. Uncontrolled, observational study. District general hospital (seven women) and teaching hospital (one woman). Eight women with residual ovaries and chronic pelvic pain. Goserelin 3.6 mg every 28 days was used followed by surgery to remove residual ovaries. The women's response to goserelin and surgery (12 months or more post-operatively) was assessed clinically. RESULTS. Goserelin was associated with resolution of pelvic pain in the six women who obtained relief of pain with oophorectomy. The only woman who did not respond to goserelin also failed to gain relief with surgery. One woman who responded to goserelin declined surgery. Suppression of ovarian function by GnRH analogues may allow differentiation of pelvic pain caused by the residual ovary syndrome from other causes. This would enable selection of cases likely to benefit from surgery, avoiding potentially difficult surgery in women who will gain little or no relief of symptoms with surgery. Only eight cases are reported and a randomised controlled trial would be required to determine the place of GnRH agonists in the treatment of the residual ovary syndrome.

Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain

Study Objective. To document the abnormal findings at hysteroscopy and laparoscopy in patients with chronic pelvic pain. Design. Prospective evaluation at surgery of women treated consecutively between January 1, 1991, and December 30, 1992. Setting. A private practice. Patients. One hundred forty-one women with pelvic pain (average age 35 yrs). Interventions. Laparoscopy was performed in all patients, and hysteroscopy in all but one, who had had a hysterectomy. Endometrial and endocervical biopsies were performed. Measurements and Main Results. In 42 (30%) of 140 patients with a primary diagnosis of chronic pelvic pain, hysteroscopic evaluation with endometrial and endocervical biopsies revealed an abnormality. Findings at hysteroscopy included leiomyomas in 25 patients (18%), intrauterine polyps in 9 (6.4%), and cervical stenosis in 4 (2.9%). Three women (2.1%) had intrauterine scarring and one (0.7%) had a bicornuate uterus. Endometrial biopsies showed adenomatous hyperplasia with atypia, and cystic hyperplasia in one patient each. Endocervical biopsies revealed cervical dysplasia in four women (2.89%). An abnormal finding was documented on laparoscopic examination in all 141 patients. These included endometriosis in 113 patients (80%), adhesions in 67 (48%), leiomyomas in 59 (42%), and enlarged globular uterus in 34 (24%). In addition, appendiceal abnormalities were present in three women (2.1%) and hernia in two (1.4%). Conclusions. Hysteroscopic abnormalities were found in 30% and laparoscopic abnormalities in 100% of patients who had a primary diagnosis of chronic pelvic pain.

Irritable Bowel Syndrome and Chronic Pelvic Pain

The irritable bowel syndrome (IBS) is a common functional bowel disorder diagnosed by characteristic symptoms. It is often associated with gynecologic symptoms, especially chronic pelvic pain (CPP). IBS symptoms worsen during menstruation and are correlated with increased levels of various perimenstrual symptoms. Psychosocial factors including depression, somatization, substance abuse, and childhood abuse are similar in IBS and CPP. IBS predisposes women to undergo hysterectomy and negatively influences pain improvement postoperatively. Therefore, IBS should be considered in the differential diagnosis of CPP. Collaboration between gynecologists and gastroenterologists is needed in the care of women with CPP and IBS as well as in the conduct of additional research on the relationship of these two disorders.

Laparoscopy in the Diagnosis of Gynecologic Chronic Pelvic Pain

Laparoscopy was performed on 126 women with undiagnosed chronic pelvic pain. Abnormalities were demonstrated in 62.7% of the cases. Endometriosis was present in 32.5% of the women. Laparoscopy is useful in the differential diagnosis of chronic pelvic pain and is indicated when symptoms persist for over 6 months.

Laparoscopy in the diagnosis of gynecologic chronic pelvic pain

Laparoscopy was performed on 126 women with undiagnosed chronic pelvic pain. Abnormalities were demonstrated in 62.7% of the cases. Endometriosis was present in 32.5% of the women. Laparoscopy is useful in the differential diagnosis of chronic pelvic pain and is indicated when symptoms persist for over 6 months.