Etiology Of Chronic Pelvic Pain Research Articles

Chronic Pelvic Pain: Approaches to Diagnosis and Treatment

Chronic pelvic pain is a common debilitating and complex condition that can be associated with significant morbidity. The etiology of chronic pelvic pain remains poorly understood, although it has been associated with endometriosis, adhesions, infection, and irritable bowel syndrome, as well as musculoskeletal and neuropathic conditions. Current therapeutic interventions include a multidisciplinary approach that acknowledges the complex interactions between physiological, neurological, and psychological mechanisms. The goal of this paper is to review strategies to diagnose and manage chronic pelvic pain conditions.

A cognitive behavioural based assessment of women with chronic pelvic pain

From population-based surveys, chronic pelvic pain (CPP) in women is a common condition with a spectrum of associated disability and distress. Those seen by gynaecologists in a referral setting often have substantial impairment of function and mood disturbance. Because in most cases, the aetiology of CPP cannot be explained and the range of effective interventions remains limited, treatment of CPP might easily result in a sense of frustration not only for the patient but also for the gynaecologist. To avoid this situation in clinical practice, a structured assessment of women suffering from CPP using a cognitive behavioural model, is suggested. This type of assessment provides information about the impact of CPP on a particular patient's daily life. It also facilitates referral for pain management. Future studies are needed to show further evidence of benefit of this approach for women with CPP.

Interstitial Cystitis Is an Etiology of Chronic Pelvic Pain in Young Women

Study Objective The prevalence of interstitial cystitis (IC) in young women, especially in those 18 years old or younger, is not well defined. This case series was performed to investigate IC as a cause of chronic pelvic pain (CPP) in young women. Design Case series. Setting University medical center. Participants Twenty-eight women with CPP, ages 13 to 25, who underwent concomitant laparoscopy and cystoscopy. Interventions All subjects underwent concomitant diagnostic laparoscopy and cystoscopy with hydrodistension for evaluation of CPP. Charts were reviewed to discern preoperative symptoms, operative findings, and postoperative diagnoses. Main Outcome Measure Diagnosis of IC based on symptoms and cystoscopic findings. Results All 28 women had CPP, 23 (82%) had dysmenorrhea, and 12 of 25 (48%) sexually active subjects had dyspareunia. Twenty-six subjects (93%) had urinary symptoms including frequency (75%), nocturia (32%), urgency (25%), and dysuria (18%). Eleven (39%) subjects were diagnosed with IC and 18 (64%) with endometriosis, including 7 (25%) subjects with both IC and endometriosis. Laparoscopic findings were normal in 6 (21%) subjects. Of the 26 subjects with urinary symptoms, 21 (81%) had findings on laparoscopy or cystoscopy. In this cohort of young women with chronic pelvic pain, urinary frequency and dyspareunia were significantly associated with the diagnosis of IC. Conclusions The results of this study suggest that interstitial cystitis is an etiology of CPP in young women. Evaluation of the bladder as an origin of pelvic pain is warranted in young women with CPP and urinary frequency or dyspareunia.

Laparoscopy as a Diagnostic Tool in the Evaluation of Chronic Pelvic Pain in Women

Chronic pelvic pain is a common and significant disorder of women. Often the etiology of chronic pelvic pain is not clear. Chronic pelvic pain is a common problem and presents a major challenge to health care providers because of its unclear etiology, complex natural history, and poor response to therapy. Diagnostic laparoscopy is an important tool in the evaluation of women with chronic

Mensendieck somatocognitive therapy as treatment approach to chronic pelvic pain: Results of a randomized controlled intervention study

The etiology of chronic pelvic pain is disputed and multifactorial. We studied the effect of Mensendieck somatocognitive therapy aimed at reducing physical pain by changing posture, movement and respiration patterns combined with standard gynecological treatment. Women with chronic pelvic pain unexplained by pelvic pathology were randomized into 2 groups: (1) standard gynecological treatment and (2) gynecological treatment plus somatocognitive therapy. A Mensendieck test of motor function (posture, movement, gait, sitting posture, respiration) and a visual analogue score of pain were obtained before and after the 90-day treatment period. The test results of patients treated by standard gynecological measures were unchanged (nonsignificant). By contrast, the patients receiving somatocognitive therapy in addition improved scores by 25% to 60% for all motor functions (P < .01, largest improvement for respiration, up from average 2.98 [SEM 0.30] to 4.72 [0.37]), and pain scores reduced by 50% (down from 5.60 [0.40] to 2.89 [0.40], P < .01). Mensendieck somatocognitive therapy combined with standard gynecological care improved pain experience and motor functions of women with chronic pelvic pain better than gynecological treatment alone.

Medical management of chronic pelvic pain

Summary Chronic pelvic pain (CPP) forms a significant cause of morbidity, resulting in patients seeking help in the primary care and hospital setting. CPP is a poorly understood condition. It is defined as both cyclical and non-cyclical pain that has a duration of more than 6 months. The aetiology of CPP is not limited to the realms of the gynaecologist but encompasses the disciplines of gastroenterology, urology, psychiatry, physical therapy and genitourinary medicine. Given the numerous facets of this condition, it is best managed in a multidisciplinary setting. Investigations into the cause of CPP have a low yield, making treatment difficult. This review aims to provide an evidence-based medical management of the main causes of CPP.

Growth of nerve fibres into murine peritoneal adhesions

Adhesions in the peritoneal cavity have been implicated in the cause of intestinal obstruction and infertility, but their role in the aetiology of chronic pelvic pain is unclear. Nerves have been demonstrated in human pelvic adhesions, but the presence of pain-conducting fibres has not been established. The purpose of this study was to use an animal model to examine the growth of nerves during adhesion formation at various times following injury and to characterize the types of fibres present. Adhesions were generated in mice by injuring the surface of the caecum and adjacent abdominal wall, with apposition. At 1-8 weeks post-surgery, adhesions were processed and nerve fibres characterized histologically, immunohistochemically, and ultrastructurally. Peritoneal adhesions had consistently formed by 1 week after surgery and from 2 weeks onwards, all adhesions contained some nerve fibres which were synaptophysin, calcitonin gene-related peptide, and substance P-immunoreactive, and were seen to originate from the caecum. By 4 weeks post-surgery, nerve fibres were found to originate from both the caecum and the abdominal wall, and as demonstrated by acetylcholinesterase histochemistry, many traversed the entire adhesion. Ultrastructural analysis showed both myelinated and non-myelinated nerve fibres within the adhesion. This study provides the first direct evidence for the growth of sensory nerve fibres within abdominal visceral adhesions in a murine model and suggests that there may be nerve fibres involved in the conduction of pain stimuli.

Laparoscopic Evaluation of Chronic Pelvic Pain in Women

Background: Chronic pelvic pain is a common and significant disorder of women. Often the etiology of chronic pelvic pain is not clear. Methods: A descriptive hospital based study was done which included 55 women with chronic pelvic pain of more than six months duration. Ultrasonography and diagnostic laparoscopy were performed in all patients. These patients also had a psychological assessment with the SRQ (Self Reporting Questionnaire). The various causes of pelvic pain were assessed. Result: The mean age of women presenting with chronic pelvic pain was 37.1 ± 2.3 years. Ultrasonography detected abnormality in only 21 (38.2%) patients. The most common pathology detected was ovarian cysts in seven patients. Diagnostic laparoscopy was able to detect pathology in 45 (81.8%) patients. Pelvic adhesions was the most common cause of chronic pelvic pain which was present in 16 (29%) of the women, followed by PID (pelvic inflammatory disease) in seven (12.7%), endometriosis in five (9.1%), pelvic congestion in four (7.2%), pelvic tuberculosis in four (7.2%), fibroid uterus in four (7.2%), ovarian cysts in four (7.2%) and parafimbrial cyst in one patient. No abnormality on laparoscopy was detected in 10 (18.2%) patients. When evaluated for associated psychological illness it was detected in 24 (43.6%) patients. Results: Chronic pelvic pain is a common problem and presents a major challenge to health care providers because of its unclear etiology, complex natural history, and poor response to therapy. Diagnostic laparoscopy is thus an important tool in the evaluation of women with chronic pelvic pain. Key words: chronic pelvic pain, laparoscopy, ultrasonography. DOI: 10.3126/jnhrc.v7i1.2279 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 45-48