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CHRONIC PELVIC PAIN

DR OZORI E.S
FMCY, OnG
OUTLINE
• INTRODUCTION
• DEFINITION/ INCIDENCE
• CLASSIFICATION
• HISTORY
• PHYSICAL EXAMINATION
• INVESTIGATIONS
• TREATMENT
• CONCLUSION
• REFERENCES
INTRODUCTION
• PAIN = Unpleasant experience

• Mechanism = c fibres/
neuromodulators/neurotransmitters

• Acute or chronic pain


DEFINITION AND INCIDENCE
• Chronic pelvic pain = > 6 months in the
absence of pregnancy, intercourse, periods
• 10-15% of affected patient
• 20-30 of laparoscopies
• 10% of all hysterectomies
CLASSIFICATION
• Inflammatory infective : chronic PID, Chronic
endometritis
• Inflammatory non infective: endometriosis,
Vulvodynia
• Mechanical : pelvic organ prolapse, uterine
retroversion, pelvic adhesion.
• Functional : irritable bowel syndrome, pelvic
congestion syndrome
• Neuropathic : Vulvodynia, vestibulodynia, post
surgical
• Musculoskeletal: abdominal and pelvic trigger
points, postural muscle strain, pelvic floor
myalgia.
• GYNAECOLOGICAL CAUSES
1.Cyclical : intermenstrual pain,
dysmenorrhoea, endometriosis, adenomyosis,
premenstrual syndrome, pelvic congestion
syndrome, ovarian remnant syndrome,
ovarian residual syndrome.

2.Non cyclical ; uterine fibroid, IUCD , Ovarian


cyst, etc.
● NON GYNAECOLOGICAL CAUSES
Urological, GIT, MCS, Neurological, Hernias
HISTORY
• CHARACTERIZATION OF PAIN
• RULE OUT CAUSES
PHYSICAL EXAMINATION
• GENERAL – ( posture = anterior/ lateral /
posterior inspection; Trendelenburg test, Gait)
• Abdominal examination = trigger point/ carnet
sign)
• Musculoskeletal examination = iliopsoas test,
obturator test, straight leg raising test

• Pelvic examination (IPPA)


INVESTIGATIONS
• Pain dairy/ inventory= BPI/ VDS/ VAS
• Pain mapping, body diagram
• Urinalysis + mcs
• FBC, HVS mcs , Barium Enema
• X ray pelvis
• Abdominopelvic USS/ colour flow doppler
• Pessary test
• COCP
• Local anaesthetic test
• Laparoscopy/ sigmoidoscopy/ cystoscopy
TREATMENT
• Multidisciplinary = gynaecologist/
anaesthetist/ radiologist/ pain specialist/
clinical psychologist/ internist

• Treat causes = medical/ surgical


*photographic reinforcement/ writing
therapy/ static magnetic therapy
• Pain treatment armamentarium
Acetaminophen, NSAID, Opoid analgesic,
antidepressant, anticonvulsant, LUNA,
PRESACRAL NEURECTOMY, HYSTERECTOMY +
BSO.
CONCLUSION
• Clinical method is key
• Not all patient require laparoscopy
• Some therapeutic interventions are evidence
based.
REFERENCES
• Williams gynaecology 23RD EDITION
• Dewhurst textbook of Obstetrics and
Gynaecology
• Dutta’s text book of Gynaecology

• Current text book of Obstetrics and


Gynaecology
THANK