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Pelvic and perineal pain

Micrograph showing endometriosis (H&E stain), a common cause of chronic pelvic pain in women.
ICD-10 R10.2
ICD-9 625.9

Pelvic pain is a symptom that can affect both women and men. The pelvic pain that persists for a period of 3 months or more to be considered chronic while less than this duration is considered acute. The pain may indicate the existence of poorly-understood conditions that likely represent abnormal psychoneuromuscular function.

FemaleEdit

Most women, at some time in their lives, experience pelvic pain. Many different etiologies have been proposed, including:

  • endometriosis
  • infection or post-infectious neurological hypersensitivity
  • exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
  • ovarian cysts, uterine leiomyoma - often found in asymptomatic patients as well, however
  • less common emergencies: ovarian torsion - sudden loss of circulation to the ovary, appendicitis - infection of one part of the intestine, with right lower abdominal pain
  • pelvic girdle pain (SPD or DSP)

Women with symptoms of pain may want to see a gynecologist if problems don't go away after a few days, and workup should begin with a careful history and examination, followed by a pregnancy test. Some women may also need bloodwork or additional imaging studies, and a handful may also benefit from having surgical evaluation using small telescopes (laparoscopy). Many women will also benefit from a consultation with a physical therapist, a trial of anti-inflammatory medications, hormonal therapy, or even neurological agents.

This is a condition that although common, direly needs to be studied more closely.

As girls enter gynecologic maturity, pelvic or abdominal pain becomes a frequent complaint.

Chronic pelvic pain (CPP) accounts for 10% of all visits to gynecologists. In addition, CPP is the reason for 20 - 30% of all laparoscopies in adults.

Pelvic pain and sexual abuseEdit

Main article: Pelvic pain and sexual abuse

While there are physical causes of such pain psychologists care interested in possible psychological causes for the expression of such symptoms. One possible cause is sexual abuse. This is perhaps an unresearched area.


MaleEdit

Main article: Chronic prostatitis/chronic pelvic pain syndrome

Men also experience chronic pelvic pain. In men it is called Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and is also known as chronic nonbacterial prostatitis. Men in this category have no known infection, but do have extensive pelvic pain lasting more than 3 months.[1] There are no standard diagnostic tests; diagnosis is by exclusion of other disease entities. Multimodal therapy is the most successful treatment option,[2] and includes α-blockers,[3] phytotherapy,[4][5] and protocols aimed at quieting the pelvic nerves through myofascial trigger point release with psychological re-training for anxiety control.[6][7] Antibiotics are not recommended.[8][9]

Differential diagnosisEdit

In men, chronic pelvic pain (category IIIB) is often misdiagnosed as chronic bacterial prostatitis and needlessly treated with antibiotics exposing the patient to inappropriate antibiotic use and unnecessarily to adverse effects with little if any benefit in most cases. Within a Bulgarian study, where by definition all patients had negative microbiological results, a 65% adverse drug reaction rate was found for patients treated with ciprofloxacin in comparison to a 9% rate for the placebo patients. This was combined with a higher cure rate (69% v 53%) found within the placebo group.[10]

See alsoEdit

ReferencesEdit

  1. Luzzi GA (2002). Chronic prostatitis and chronic pelvic pain in men: aetiology, diagnosis and management. Journal of the European Academy of Dermatology and Venereology : JEADV 16 (3): 253–6.
  2. Potts JM (2005). Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome. Current urology reports 6 (4): 313–7.
  3. Yang G, Wei Q, Li H, Yang Y, Zhang S, Dong Q (2006). The effect of alpha-adrenergic antagonists in chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis of randomized controlled trials. J. Androl. 27 (6): 847–52.
  4. Shoskes DA, Zeitlin SI, Shahed A, Rajfer J (1999). Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology 54 (6): 960–3.
  5. Elist J (2006). Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a randomized, double-blind, placebo-controlled study. Urology 67 (1): 60–3.
  6. Anderson RU, Wise D, Sawyer T, Chan C (2005). Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J. Urol. 174 (1): 155–60.
  7. Anderson RU, Wise D, Sawyer T, Chan CA (2006). Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training. J. Urol. 176 (4 Pt 1): 1534–8; discussion 1538–9.
  8. Alexander RB, Propert KJ, Schaeffer AJ, et al. (2004). Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial. Ann. Intern. Med. 141 (8): 581–9.
  9. Nickel JC, Downey J, Clark J, et al. (2003). Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial. Urology 62 (4): 614–7.
  10. J. Dimitrakov, J. Tchitalov, T. Zlatanov, D. Dikov. A Prospective, Randomized, Double-Blind, Placebo-Controlled Study Of Antibiotics For The Treatment Of Category Iiib Chronic Pelvic Pain Syndrome In Men. Third International Chronic Prostatitis Network. URL accessed on 4 September 2009.


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