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Pelvic pain syndrome is one of the most common reasons why women visit a gynecologist. According to research, it accounts for about 10-40 percent of all visits. However, pelvic pain syndrome affects not only women but also men, especially with prostatitis. Find out what are the causes and symptoms of pelvic pain syndrome and what it's being treated.

Pelvic pain syndrome(chronic pelvic pain - CPP) is a term for pain that occurs - bothin women, as well asin men- in the area of ​​the smaller pelvis, i.e. the anterior abdominal wall, below the navel or in the sacral area of ​​the back.

Research shows that pelvic pain syndrome is one of the most common reasons why women visit gynecology clinics, accounting for about 10-40 percent of all visits. The incidence of CPP in the population of women of reproductive age and postmenopausal women is higher than the frequency of migraines and comparable to the incidence of asthma and amounts to 4%.

Pelvic pain syndrome - causes

In the pelvis there are organs belonging to various systems - digestive, sexual, urinary, vascular and bone-muscular systems, therefore the causes of pelvic pain syndrome are complex.

In women with this pain syndrome, various gynecological diseases are often diagnosed, such as: endometriosis, adenomyosis, ovarian tumors, uterine fibroids, the presence of an intrauterine device (increases the risk of inflammation), vulvodynia, pelvic congestion syndrome, residual ovarian syndrome, pelvic adhesions, ectopic pregnancy.

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In men, the most common cause of pelvic pain syndrome is inflammation of the prostate gland.

Other possible causes of CPP include: irritable bowel syndrome, diverticular disease, enteritis, constipation, interstitial cystitis, appendicitis, spine lesions, transabdominal surgery (e.g. caesarean section, especially by the Pfannenstiel method).

Pain syndromepelvis may also have a psychological basis. Depression, mental stress, sleep disturbances, anxiety, and episodes of sexual abuse or physical abuse can also lead to the development of CPP.

Pelvic pain syndrome - symptoms

Pain in the lower abdomen is so intense that it is impossible to function normally.

You can talk about pelvic pain syndrome when pain symptoms persist for at least 6 months

May be accompanied by pain in the abdomen, epigastrium, lower back, perineum and lower limbs. Pain is periodic or continuous and of varying intensity.

Additionally, there are symptoms suggesting a disturbance in the functioning of the lower urinary tract, intestines, genital tract or sexual function, e.g. painful and / or irregular periods, pain during intercourse, diarrhea or constipation, problems with urination.

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Besides, painkillers taken turn out to be ineffective.

Pelvic pain syndrome - diagnosis

During the medical visit, the doctor should ask the patient about the history of inflammation in the abdomen and reproductive organs, pregnancy and childbirth, and perform a thorough physical examination.

Over 80 percent patients feel pain for more than a year before going to a doctor, and about 1/3 - more than 5 years

It is also recommended to perform a blood test, general urine test, bacteriological swab from the vagina and cervix, abdominal ultrasound, transvaginal ultrasound and laparoscopy.

If no abnormalities are found, it is worth going to a psychological consultation, as the disease may be psychogenic.

Pelvic pain syndrome - treatment

In order to reduce the pain, the patient may be given the following medications:

  • pain relievers such as non-steroidal anti-inflammatory drugs, paracetamol, and opioids (these are given as a last resort)
  • hormonal - contraceptives, progestogens, GnRH agonists, and danazol (for example, treatment with gestagens in CPP is beneficial in patients with possible endometriotic outbreaks)
  • antidepressants (it is indicated in some patients, especially when there are no visible causes of CPP in laparoscopy)
  • antibiotics (they are given in the case of infections in the smaller pelvis)

If this type of treatment is unsuccessful, the doctor may decide on more invasive methods, such as:

  • in pain therapyof the fascial pelvic floor and abdominal muscles, the injection of pain trigger points is performed
  • in the case of vulvodynia or inflammation of the vestibular glands, procedures are performed to remove or vaporize (vaporize) the tissues of the vulva and the vestibule of the vagina
  • changes inside the uterine cavity are an indication for their hysteroscopic removal
  • in the case of symptomatic fibroids, myomectomy (surgical removal) is performed
  • intraperitoneal adhesions of the smaller pelvis require removal
  • in the case of painful menstruation in the course of endometriosis, especially in medial pain, laparoscopic ablation of the uterosacral nerve or excision of the upper hypogastric plexus is performed

If these and other treatment options are exhausted, the doctor may decide to remove the uterus (if the cause is gynecological problems).

Bibliography: Robak-Chołubek D., Sobstyl M., Malec K., Jakiel G.,Pelvic pain syndrome,"Przegląd menopuzalny" 2007, No. 2

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Neurology