What is Chronic Pelvic Pain? A Simple Guide to Understanding and Managing It .. reference gtg 41 ,2012

What is Chronic Pelvic Pain? 🤔

Chronic Pelvic Pain (CPP) is pain that occurs in the lower abdomen or pelvis and lasts for at least 6 months. It can be constant or intermittent and is not necessarily related to your menstrual cycle, sexual activity, or pregnancy. CPP can significantly impact your daily life and well-being, affecting about 1 in 6 women. 🌸

Gathering Information 🩺

•  ask  about:

• The nature of your pain: When did it start? How often does it occur? Is it constant or does it come and go? What does it feel like (sharp, dull, burning)?

• Associated symptoms: Do you have bladder or bowel problems, such as pain during urination or bowel movements, or changes in bowel habits?

• Menstrual history: Is the pain related to your menstrual cycle?

• Sexual history: Does the pain occur during or after sexual intercourse?

• Psychological factors: Are you experiencing stress, anxiety, or depression?

• Previous medical conditions: Have you had any surgeries, injuries, or infections that might relate to your pain?

 💣Causes of CPP 💡

• Central and Peripheral Nervous System (🔍): Problems with the nerves that sense pain can lead to chronic pain.

• Endometriosis and Adenomyosis (🌸): Conditions where tissue similar to the lining of the uterus grows outside of it or within the uterine muscle, causing cyclic pain.

• Adhesions (🩹): Bands of scar tissue that can cause organs to stick together after surgery or infection.

• Irritable Bowel Syndrome (IBS) and Interstitial Cystitis (🌿): IBS affects bowel function, while interstitial cystitis affects the bladder, both contributing to pelvic pain.

• Musculoskeletal Pain (💪): Pain from the pelvic floor muscles or joints, often due to muscle tension or injury.

• Nerve Entrapment (⚡): Nerves getting trapped by scar tissue or other structures, causing sharp, localized pain.

PHYSICAL EXAMINATION🩺

 perform a thorough physical examination, which may include:

General Physical Examination (GPE) 👩‍⚕️: Ruling out commodities, checking for any underlying conditions that could be contributing to your pain. e.g fever 

Abdominal Examination 🤰: 

•   Palpation: Checking for tenderness, lumps (cysts, fibroids), or masses.
•   Observation: Looking for any visible abnormalities.
•   Focal Tenderness: On the anterior abdominal wall, sacroiliac joint, pubis symphysis, and pelvic floor.

Pelvic Examination 👩‍⚕️:

•   Speculum Examination: To inspect the vaginal walls and cervix for any abnormalities, discharge, or prolapse.

•   High Vaginal Swab and Endocervical Swab: To rule out infections in sexually active women.

•   Bimanual Examination: To feel the size, shape, and mobility of the uterus and ovaries, and check for tenderness or lumps.

•   Posterior Vaginal Wall: Checking for any nodules.

•   Cervical Consistency: Assessing the cervix for consistency and position.

•   Adnexal Fullness: Feeling for any masses or fullness in the adnexa (area around the ovaries).

Musculoskeletal Examination 💪: 

•   Pelvic Floor Check: Assessing for tenderness in the pelvic floor muscles.

•  Joint Assessment: Checking the sacroiliac joints and lower back for signs of musculoskeletal pain.

 Investigations 🧪

To find out more about the cause of your pain, your doctor may recommend some tests🩺:

1.   Blood Tests: Complete blood count (CBC) to check for any underlying conditions.
2.   Urine Tests: Midstream urinalysis to detect infections or other abnormalities.
3.   Infection Screening: Testing for sexually transmitted infections (STIs) like Chlamydia and gonorrhea.
4.   Transvaginal Ultrasound (TVS): To look at your pelvic organs for conditions like cysts, fibroids, endometriosis, adenomyosis, or hydrosalpinx.
5.    CA125 Blood Test: For women with persistent symptoms or those over 50, to check for certain types of cancer. This test is recommended if you have symptoms like bloating, pelvic pain, or urinary urgency that occur frequently.
6. if no cause is found , or suspicion of endometriosis, adhesions or tubal pathology dignostic laproscopy can be done , but give therapeutic trial / medicine before diagnostic laproscopy ,but remember In 30% to 50% of cases, the cause of pelvic pain may not be found during laparoscopy, leading to potential frustration and need for further investigations.

Managing Chronic Pelvic Pain 💊

👉Multidisciplinary Approach (MDT) 👩‍⚕️👨‍⚕️:

👉Referral to Psychologist: To address any psychological factors contributing to the pain.

👉Pain Management: Using medications and techniques to manage pain.

👉Dietary Modifications: Referral to a dietitian for tailored dietary advice, especially for IBS.

👉Lifestyle Modifications: Encouraging regular exercise, stress management, and healthy sleep habits.

👉Maintaining a Pain Diary: Keeping track of pain triggers, intensity, and duration to better understand and manage symptoms.

👉Treatment Options Based on Causes 🔍:

• Irritable Bowel Syndrome (IBS) 🌿:
•   Medications: Antispasmodics and other medications to manage IBS symptoms.
•   Dietary Changes: Modifying diet to avoid triggers and manage symptoms effectively.
•  Hormonal Treatments for Endometriosis and Adenomyosis 🌸:
•   Hormonal Therapy: Options like combined oral contraceptives, progestogens, or GnRH analogues to manage symptoms.
•   Mirena IUS: A hormone-releasing intrauterine system to reduce menstrual bleeding and pain.
• Surgical Options 🔪:

  - Laparoscopy: A minimally invasive surgery  sometimes treat conditions like endometriosis, adhesions, or other abnormalities like hydrosalpinx .but better to give hormonal medicines before laproscopy

    - Pros: Provides a clear view of the pelvic organs and allows for immediate treatment of certain conditions.

    - Cons: It is an invasive procedure with risks such as infection, bleeding, and anesthesia complications. 

👉Additional Support and Pain Relief 🧘‍♀️:

- Acupuncture and Complementary Therapies: Some women find these helpful in managing pain.

- Referral to Pain Clinics: For specialized pain management approaches.

Red Flag Signs 🚩: When to Seek Immediate Help

- Unexplained weight loss

- Bleeding after menopause

- Severe pain that doesn’t improve with treatment

- New symptoms in women over 50

- Symptoms suggestive of malignancy (e.g., CA125 elevation)

 Key Points to Remember 💡

- Chronic pelvic pain is a complex condition that can have multiple causes.

- A thorough medical history and physical examination are crucial for diagnosis.

- Effective management often requires a combination of treatments.

- Always seek medical advice if you notice red flag symptoms.

....................................................................................................................................................reference gtg 41,2013

This blog post aims to provide you with essential information about chronic pelvic pain, helping you understand your symptoms, the diagnostic process, and available treatments. Always discuss your concerns with your healthcare provider to get the best care for your situation.