1 cagdas-obygn
Chronic pelvic pain;
- Lasts for more than 6 months
- Persistent in pelvis, anterior abdominal wall, lumbosacral back region
- Causes function loss, requires treatment.
• More common in women
- Most common cause is gynecological problems; endometriosis and pelvic adhesions (bowel
movements restricted and distention is seen.)
- Non gynecological; IBS
• characteristics; pain disproportionate to tissue damage, physical functional loss, depression, disrupted
family dynamics.
• epid; mostly seen in reproductive phase, around age of 30.
• Acute pelvic pain < 7 days. Ectopic pregnancy, ovarian cyst rupture, ovarian cyst torsion—> before it
detorsion and cystectomy is done.
GI etiology;
✓ IBS; most common cause of GIS of cpp. Colic style, cramp style, increasing of pain after 1-1.5 hrs of
eating. Increase or decrease in number of defections, diarrhea or constipation. Relief with defecation
✓ Pain, distention, swelling symptoms
✓ appendicitis, diverticulitis, hernias, GIS cancers, constipation
Urological etiology;
✓ interstitial cystitis; chronic bladder inflammation ==>pollakuria, nocturia, urgency. Relief with peeing.
✓Chronic urinary infection, urethral syndrome, urinary stones, urinary cancer, urethral diverticule/ polyp
Gynecological etiology;
✓ Cyclic—>endometriosis (most common)/ adenomyosis/ ovarian remnant syndrome/ cervical stenosis.
✓ Non-Cyclic—> adhesive disease, pelvic inflammatory diseases/ pelvic congestion syndrome/
vaginismus.
• Endometriosis; endometrial tissues outside of uterine cavity, mostly on ovary, posterior cul-de-sac,
uterosacral ligament. Seen in patients who have laparoscopy.
- findings; dysmenorrhea, dyspareunia, disfertility.
- Light ends..; NSAII
-First group of med; OKS—>inhibition of ovulation 2nd group; progesterone..
• Adenomyosis; inner lining of uterus (endometrium), breaks through muscle wall of uterus (myometrium)
- symptoms; menorrhagia, dysmenorrhea, big uterus.
- Medical diagnosis; progesterone, KOH, NSAII, GnRH analogues—>often fails
• Mittleschmertz (moderate pain) (ovulation pain); can take a few mins to hours. Small amount of bleeding
with sudden DECREASE of estrogen during ovulation.
• Ovarian remnant syndrome; symptoms from pelvic pain to ureter and bowel obstruction, are seen in
patients who undergo oophorectomy. Pelvic pain, disparoni or pelvic mass in patients who have left one
or 2 ovaries during hysterectomy.
• Adhesions; most common findings in diagnostic laparoscopy for chronic pelvic pain. Pelvic mapping.
• Pelvic inflammatory disease; upper genital way inf or inflammation; endonephritis, salpingitis, tubes-
ovarian abscess/ pelvic peritonitis. Uterine/cervical tenderness.
• Pelvic vascular congestion syndrome (taylor syndrome); pelvic pain and dyspareunia together w/ pelvic
varicosity due to retrograde flow.
2 cagdas-obygn
- May increase after prolonged standing, sitting, intercourse
- USG, CT or trans uterine venography used.
- Selective venous embolization or hysterectomy
• Pelvic floor pain syndrome; spams of pelvic wall muscles. Pain hits hips and legs.
• Primary dysmenorrhea; no pelvic pathology.
- Reason is increase production of endometrial prostaglandins during menses.
- Occurs in ovulatory cycles
- Pain in form of colic and suprapubic. Few hrs before or with mens. Lasts 48-72 hrs.
- Treatment; prostaglandin synthesis inhibition, diagnostic laparoscopy, KOK, LUNA, presacral
neurectomy or hysterectomy.
• Secondary dysmenorrhea; pelvic pathology CAN be seen. In older ages
- Most common cause; endometriosis or adenomyosis.
- Pain starts 1-2 weeks before menses and continues for a few days after.
—>laparoscopy; whole pelvis and abdomen is seen. Performed in cases that DONT respond to NSAID
treatments. If theres endometrial focus—>burned. infection—>cultured. adhesion—>adhesiolysis
—>LUNA (fibers from inferior hypogastric plexus)
—> presacral neurectomy; from superior hypogastric plexus.
—> hysterectomy
