Chronic Pelvic Pain Signs and Symptoms

Cập nhật: 25 September 2023
Được đánh giá bởi

Giới thiệu

  • A persistent, distressing, and severe pain symptom of >6 months duration (not a clinical diagnosis)
  • Occurs intermittently, cyclically, or situationally
  • Localizes to the pelvis of either men or women, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks
  • May be severe enough to cause functional disability or need medical care
  • Not restricted to intercourse or menstruation in females and is not associated with pregnancy

Definition

  • Chronic primary pelvic pain syndrome (CPPPS)
    • Considered when there is no proven infection or without obvious pathology but still including biological mechanisms that may account for the pain being experienced
    • Should be further subdivided into its corresponding phenotype
  • Chronic secondary pelvic pain
    • There is well-defined pathology or specific disease-associated pain

Nguyên nhân

  • The following are the common causes of CPP
  • Treatment is directed towards the specific condition and according to its specific guidelines
    • The following are the common causes of CPP
    • Treatment is directed towards the specific condition and according to its specific guidelines
    Gastrointestinal: Gynecological: Musculoskeletal: Psychiatric/Neurological: Urological: Others:
    Irritable bowel syndrome1 Endometriosis1 Myofascial pain (trigger points) Depression1 Interstitial cystitis Infectious diseases
    Inflammatory bowel disease1 Dysmenorrhea1 Pelvic floor myalgia and spasms/prolapse History of or current physical or sexual abuse  Urethral syndrome Mesh infection
    Abscess Pelvic adhesions Pelvic girdle pain Sleep disturbance Chronic urinary tract infection1  Sickle cell disease
    Chronic appendicitis Pelvic inflammatory disease1 Coccygodynia Nerve entrapment syndrome Bladder stones or dysfunction  Porphyria
    Constipation1 Vulvodynia Stress fractures Psychological stress (work, marital) Urolithiasis1 Hyperparathyroidism1
    Diverticulitis1 Chronic endometritis Chronic back pain Substance abuse Urological malignancies1 Herpes zoster1
    Neoplastic lesions Adenomyosis Disc disease Neurologic dysfunction Chronic prostatitis Heavy metal poisoning
    Chronic intermittent bowel obstruction Gynecologic malignancies1 Levator ani syndrome Neuropathic pain1   Genetic mechanisms
    Hemorrhoids1 Deformities/prolapse Hernias Somatoform pain disorders    
    Anal fissure1 Ovarian cysts/mass1 Musculoskeletal and connective tissue disease or malignancies Schizophrenia1, schizotypal and delusional disorders    
    Proctitis Residual ovary syndrome        
      Ovarian remnant syndrome        
      Post-hysterectomy pain        
      Pelvic congestion syndrome        
      Fibroids or leiomyomas1        

    1Please refer to the corresponding disease management chart for further information                 

Sinh lý bệnh

  • A complex and not well understood with several contributory factors
  • Mechanisms include:
    • Acute pain which may be due to affectation of the visceral and/or somatic tissues
    • Chronic pain which may be due to:
      • The effects of inflammatory and chemical mediators and hormones on the nervous system
      • Abnormalities or dysfunction of the cognitive, behavioral, emotional, and sexual responses and mechanisms