Pelvic pain

Definition:
Pelvic pain is pain in the lowest part of your abdomen and pelvis. In women, pelvic pain may refer to symptoms arising from the reproductive or urinary systems or from musculoskeletal sources. Pelvic pain can occur suddenly, sharply and briefly (acute) or over the long term (chronic). Chronic pelvic pain refers to any constant or intermittent pelvic pain that has been present for more than a few months. It can affect both women and men.

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Depending on its source, pelvic pain may be dull or sharp; it may be constant or off and on (intermittent); and it may be mild, moderate or severe. Pelvic pain can sometimes radiate to one’s lower back, buttocks or thighs.

Common causes in include: endometriosis in women, bowel adhesions, irritable bowel syndrome, and interstitial cystitis. The cause may also be a number of poorly understood conditions that may represent abnormal psychoneuromuscular function.

Most women, at some time in their lives, experience pelvic pain. As girls enter puberty, pelvic or abdominal pain becomes a frequent complaint.
Sometimes, it is noticed that pelvic pains only at certain times, such as when  urinating  or during sexual activity.

According to the CDC, Chronic pelvic pain (CPP) accounted for approximately 9% of all visits to gynecologists in 2007. In addition, CPP is the reason for 20—30% of all laparoscopies in adults.

Causes:
Several types of diseases and conditions may cause pelvic pain. Often chronic pelvic pain results from more than one condition.

Pelvic pain may arise from one’s digestive, reproductive or urinary system. Recently, doctors have recognized that some pelvic pain, particularly chronic pelvic pain, may also arise from muscles and connective tissue (ligaments) in the structures of the pelvic floor. Occasionally, pelvic pain may be caused by irritation of nerves in the pelvis.

The different conditions that may cause pelvic pain includs:

*exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
pelvic girdle pain (SPD or DSP)

Gynecologic:

*Dysmenorrhea—pain during the menstrual period

*Endometriosis—pain caused by uterine tissue that is outside the uterus. Endometriosis can be visually confirmed by laparoscopy in approximately 75% of adolescent girls with chronic pelvic pain that is resistant to treatment, and in approximately 50% of adolescent in girls with chronic pelvic pain that is not necessarily resistant to treatment.

*Müllerian abnormalities

*Pelvic inflammatory disease—pain caused by damage from infections

*Ovarian cysts—the ovary produces a large, painful cyst, which may rupture

*Ovarian torsion—the ovary is twisted in a way that interferes with its blood supply

*Ectopic pregnancy—a pregnancy implanted outside the uterus

Abdominal:

*Loin pain hematuria syndrome

*Proctitis—infection or inflammation of the anus or rectum

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*Colitis—infection or inflammation of the colon

*Appendicitis—infection or inflammation of the bowel

Internal hernias are difficult to identify in women, and misdiagnosis with endometriosis or idiopathic chronic pelvic pain is very common. One cause of misdiagnosis that when the woman lies down flat on an examination table, all of the medical signs of the hernia disappear. The hernia can typically only be detected when symptoms are present, so diagnosis requires positioning the woman’s body in a way that provokes symptoms.

Female reproductive system:
Pelvic pain arising from the female reproductive system may be caused by conditions such as:

*Adenomyosis
*Endometriosis
*Menstrual cramps (dysmenorrhea)
*Ectopic pregnancy (or other pregnancy-related conditions)
*Miscarriage (before the 20th week) or intrauterine fetal death
*Mittelschmerz (ovulation pain)
*Ovarian cancer
*Ovarian cysts
*Pelvic inflammatory disease (PID)
*Uterine fibroids
*Vulvodynia

Other causes in women or men:
Examples of other possible causes of pelvic pain — in women or men — include:

*Colon cancer
*Chronic constipation
*Crohn’s disease
*Diverticulitis
*Fibromyalgia
*Interstitial cystitis (also called painful bladder syndrome)
*Intestinal obstruction
*Irritable bowel syndrome
*Kidney stones
*Past physical or sexual abuse
*Pelvic floor muscle spasms
*Prostatitis
*Ulcerative colitis
*Urinary tract infection (UTI)

Diagnosis:
The diagnostic workup begins 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.

The absence of visible pathology in chronic pain syndromes should not form the basis for either seeking psychological explanations or questioning the reality of the patient’s pain. Instead it is essential to approach the complexity of chronic pain from a psychophysiological perspective which recognises the importance of the mind-body interaction. Some of the mechanisms by which the limbic system impacts on pain, and in particular myofascial pain, have been clarified by research findings in neurology and psychophysiology.

Differential diagnosis:
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.

Treatment:
Many women will benefit from a consultation with a physical therapist, a trial of anti-inflammatory medications, hormonal therapy, or even neurological agents.

A hysterectomy is sometimes performed.

Spinal cord stimulation has been explored as a potential treatment option for some time, however there remains to be consensus on where the optimal location of the spinal cord this treatment should be aimed. As the innervation of the pelvic region is from the sacral nerve roots, previous treatments have been aimed at this region; results have been mixed. Spinal cord stimulation aimed at the mid- to high-thoracic region of the spinal cord have produced some positive results.

The sensation of pain travels through nerves up the spinal cord to the brain. Mild antidepressants like amitriptyline and gabapentin can block these transmissions and relieve the pain. They are especially effective if combined with anti-inflammatory medications like ibuprofen.

IBS and food allergies should also be tackled. Sometimes avoiding milk or wheat or both, and tackling abnormal gut motility works.

Physical activity reduces pain to an extent. Walking, jogging or running for 40 minutes a day is important. This should be combined with stretching and pelvic exercises. And if there is stress, cut it down with yoga and meditation.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Pelvic_pain
http://www.mayoclinic.org/symptoms/pelvic-pain/basics/definition/sym-20050898
http://www.telegraphindia.com/1141103/jsp/knowhow/story_18992189.jsp#.VFmWH2d2E1I

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