Pelvic pain syndrome

Proven content

According to one study, nearly 16% of women suffer from pelvic pain. Almost half of them seek help from a GP. Although other statistics indicate that this disease affects “only” 3,8% of women, it is still a more common disease than migraine. The most important, however, is the nature of the pain and the degree of its severity, which can significantly worsen the quality of life of a woman suffering from pelvic pain syndrome.

What is the definition of a medical condition?

In the case of pelvic pain syndrome, we are talking about pain localized in the pelvic area, lasting more than 6 months, unrelated to monthly bleeding and significantly reducing the activity of a woman. In addition, it requires not only conservative, but even surgical treatment.

Before a woman reports to a doctor, she often suffers in silence for a long time. Initially, she tries to find the cause herself and treat herself with over-the-counter preparations. Often, as the first patient, the patient goes to the family doctor, who, after excluding some of the diseases, refers the patient further, e.g. to the gynecologist.

We start the diagnosis process

One of the most important diagnostic elements is the patient’s interview and examination. A detailed interview brings a lot of information, which greatly facilitates further diagnostic and therapeutic procedures. Even special forms have been constructed to make it easier for patients to provide all data relevant to the diagnosis of the disease. Questions may also concern past pregnancies, as both pregnancy and delivery may be associated with some abnormal changes in the musculoskeletal system, further causing symptoms of the pain syndrome. The patient is asked to try to locate the pain. The word “test” is not used accidentally, because it happens that, despite its high intensity, it is difficult for a woman to accurately indicate the location of the ailment. These ailments may be accompanied by other pains, e.g. headaches and backaches. A woman, when going to a doctor, should be prepared for requests to determine when the pain arises, when it subsides, and whether there is anything that soothes or aggravates it, since when the woman feels it at all, and for how long. Certain diagrams and scales are also available to help you with a relatively accurate mapping of pain intensity and location.

Examination of the patient

The physical examination of the patient is to provide information on the location of tenderness or soreness, which may originate not only within the reproductive organ, but also in the musculoskeletal, digestive, urinary or even nervous systems. The examination is aimed both at detecting the disease and confirming the absence of changes, available both in palpation and imaging, such as ultrasound or computed tomography.

What could be the causes of pelvic pain syndrome?

As mentioned above, soreness can come from different origins. Often a woman suffers from more than one condition that may cause pain symptoms. There are also situations from the other extreme, where all diagnostic tests are exemplary and the woman reports pain. The typical gynecological diseases that should be taken into account in the differentiation include endometriosis, inflammation of the reproductive organ, tumors of the uterus and appendages, changes in the position of the uterus and others. Other suspected diagnoses include: irritable bowel syndrome, constipation, diarrhea, intestinal diverticulosis and other gastrointestinal complaints. The list of possible complications from the urinary or neurological system is also long. However, it should be realized that routinely performing all possible tests for all possible causes is unreasonable. At this point, it should be emphasized once again how important a thorough interview is. The more information the patient gives, the closer the doctor will be to making a good diagnosis.

In some cases, pelvic pain is confused by women with pain in the lower back, or they occur together. A thorough interview will allow for efficient differentiation of both conditions and proper referral of the patient to the appropriate doctor.

Describing each of the methods of diagnosing individual possible causes goes far beyond the scope of this article. However, it is important to mention one method, which is laparoscopy. It is an invasive method and may not only be a diagnostic tool, but also, if an operative change is detected during the procedure, it is also a therapeutic tool. The most frequently detected lesions during laparoscopy are: endometriosis and adhesions. Nevertheless, it should be noted that failure to find changes during laparoscopy does not exclude the disease and their removal does not always bring complete relief.

Undiagnosed pain, what next?

The pelvic pain unit is such a difficult problem that persistent pain, despite the lack of an unequivocal cause, should be treated. In this case, the pain itself becomes a disease and the investigation of its etiology is often unsuccessful. After all diagnostic methods have been used, including psychological examination and the exclusion of depression in the patient, pain management should be started. It includes not only pharmacology, but also psychotherapy and even neurodestruction.

In the case of chronic pain, the goal of treatment is not always to cure it or completely eliminate it, which is simply impossible. The aim is to relieve it and reduce the intensity of pain, which would allow the woman to return to normal life activities. The patient often refuses to agree to such a solution and, in desperation, changes doctors, looks for other methods of diagnosis and treatment. It is important, however, to be aware of the disease we are dealing with.

Text: Katarzyna Kuśmierczyk