Chronic pelvic pain

Introduction Chronic pelvic pain (CPP) is a common and complex condition that is debilitating and its cause remains unclear. Refers to non-periodic, pelvic pain that lasts for more than 6 months (also considered to be more than 3 months) and is ineffective for non-opioid therapy. Chronic pelvic pain is one of the most common symptoms in women. Pelvic pain has acute and chronic points. Chronic pelvic pain is characterized by a complex etiology. Sometimes, even if a laparoscopic or open laparotomy is performed, no obvious cause can be found. The degree of pain is not necessarily proportional to the degree of the disease. It is associated with marked morbidity and loss of physical and sexual function. Patients often suffer from their continued development of symptoms, extensive re-examination, and the inability of existing medicines to effectively diagnose and treat. Many patients also said that they were very depressed because they could not let others take their pain seriously, or were prompted that their pain might be caused by psychological reasons.

Cause

1. Gastrointestinal system: constipation, irritable bowel syndrome, enteritis, intestinal diverticulitis.

2. Urinary system: urethritis, cystitis.

3. Nerve, muscle ~ skeletal system: pelvic floor tension myalgia, piriformis syndrome, abdominal hernia, rectus abdominis sprain, myofascial inflammation.

4. Reproductive system: genital inflammation, pelvic cysts, uterine fibroids, genital malformations, history of previous pelvic surgery, endometriosis, adenomyosis, pelvic congestion syndrome, cervical obstruction, residual ovarian syndrome.

an examination

Related inspection

Gynecological inflammation check gynecological routine examination

(1) Chronic inflammation: Chronic pelvic inflammation is the most common cause of pelvic pain. Most chronic inflammation has a history of acute inflammation. Due to the heavier infection, weaker constitution, the treatment is not timely or incomplete and delays become chronic. Often occurs after the birth, abortion or artificial abortion, unclean sexual life and other infections, followed by local inflammation of the uterus, fallopian tube intima, through the muscle layer caused by inflammation of the surrounding connective tissue or pelvic peritoneum. After the acute phase, because the pelvic drainage is not poplar, the cavity is more, so that the inflammatory exudate accumulates and overflows, spreads to the surrounding tissues, forms adhesions, wraps the chronic lesions, stands by and recurs; or wears out to the adjacent organs to form a swelling. Sometimes the leak is very small, and when it is closed, it causes the inflammation to recur for a long time, forming scars, and some form small abscesses and ulcers, which will not heal for a long time. Scar adhesion often causes organ displacement, such as uterine flexion, fixation, ovarian ptosis and increased pelvic pain. Due to blood circulation disorders, congestion in the basin, stimulation of the pelvic nerve and long-term recurrence of pelvic pain of varying degrees and nature. In addition, cervical edema caused by acute and chronic cervicitis, hypertrophy, severe erosion, cervical valgus and multiple retention cysts, is also a common cause of oppression and stimulation of the pelvic nerve plexus, resulting in lower abdominal pain and excessive vaginal discharge.

(2) After pelvic trauma: pelvic genital surgery or post-traumatic. Childbirth, especially after vaginal dystocia, tissue trauma, organ resection, organ displacement, etc. require a considerable period of blood circulation readjustment, wound repair, scar softening . When the blood circulation is adjusted, the body gradually adapts, and the symptoms gradually disappear and pelvic pain and bulging occur. Such as total uterine resection, patients with ovarian preservation, mild inflammatory infiltration of the surrounding tissues after ovarian fixation, thickening or fibrosis of the ovarian capsule, ovulation difficulties occur in the ovulation period, lower abdominal pain, also the shortening or fixation of the uterine ligament And postoperative pain.

(3) pelvic blood stasis: pelvic extraperitoneal venous plexus, with the widest ligament and pelvic floor. The pelvic cavity is located at the lowermost part of the abdominal cavity and is most susceptible to crushing and falling. Therefore, there are many opportunities for venous blood stasis, especially after women have been pregnant, the tissue in the basin is loose, and the possibility of blood stasis is increased. Therefore, pelvic venous stasis is more common in multiple births, tumor compression, genital drooping and so on. However, there are still pelvic blood stasis caused by congenital venous dysplasia, so primiparas can also occur, pelvic varicose veins do not have pelvic pain. Clinically, the broad ligament is often found in gynecological laparotomy, and there are large varicose veins around the ovary. Most of them are accompanied by genital drooping or pelvic floor relaxation, varicose veins are more severely stagnant, often with falling pain and lumbosacral discomfort. If venous thrombosis, ulceration, or broken hemorrhage is caused by irritation of the peritoneum or hematoma, there is obvious or even acute ipsilateral abdominal pain in the lower abdomen.

(4) pelvic floor relaxation: pelvic floor relaxation is often accompanied by sag of the pelvic organs, such as uterine posterior prolapse, bladder or rectal bulging. More common in women with maternal or twins, a history of great children or vaginal dystocia or heavy physical labor women. As the organ loses its strong support, it is drooped by the abdominal pressure. The ligaments and fascia are pulled, causing the pelvic cavity and anterior tibial nerve plexus to be pulled and the lower abdomen and back pain. If accompanied by ovarian prolapse, the ovarian peripheral nerve plexus deep in the lower abdomen is pulled and the deep pelvis occurs, and the pain and pain accompanying the posterior iliac crest.

(5) Intra-pelvic lesions: intrauterine endometriosis stimulation, tumor compression or malignant tumor metastases can cause pain.

(6) Sexual stimuli disorders: Sexual stimuli are unbalanced, such as excessive estrogen, progesterone deficiency can also cause pain in the basin. Excessive estrogen often causes tissue edema, blood vessels and lymphatic filling cause swelling of the tissue inside the basin, and compression of the surrounding pelvic nerve fibers causes bulging pelvic pain. More associated with premenstrual tension and increased aldosterone.

(7) Non-organic pelvic pain: Unexplained or non-organic pelvic pain does exist.

1 is related to the state of mind. More common in sensitive women, introverted or impetuous. Subject to certain mental effects, there are potential concerns about genital diseases.

2 There are hidden ligaments or fascia or muscles in the pelvic cavity. Occasionally, if you are touched or involved (such as forced bowel movements, cough, vomiting, etc.), you will feel severe pain in the pelvic cavity.

3 phantom pain. Surgical resection of the pelvic genital organs, after the family planning, often caused by pelvic pain due to ideological concerns.

In addition, there are other pelvic pains that are willing to cause, such as young women undergoing uterine attachment resection or vaginal atrophy after senile menopause, dryness, resulting in discomfort or dryness; sexual intercourse discomfort or dryness caused by perineal or vaginal scar contracture, Causes pain in the pelvic cavity and soreness in the lumbosacral region.

Differential diagnosis

Chronic pelvic pain should be differentiated from pelvic cancer pain. Chronic non-localized pain should also consider other diseases not associated with gynecology, such as tuberculous peritonitis, intestinal adhesions, intestinal ascariasis, and neurosis.

Psychological chronic pelvic pain should be differentiated from organic lower abdominal pain: organic lower abdominal pain is sharp, sputum, intermittent, can occur at any time, can be awakened by pain during sleep, along the nerve distribution pathway Radiation, typical tender points, development or rapid improvement or more intense, produced or exacerbated after manual inspection, unaffected by emotions. Psychological pelvic pain is dull pain, persistent seizures, often pain after awakening, seizures in the presence of psychosocial factors, inconsistent pain and nerve distribution, no radiation pain, metastasis changes and diffuse, long-term maintenance of the same pain, It will not trigger or increase pain after the examination, and it will happen when the interpersonal relationship is not handled properly.

(1) Chronic inflammation: Chronic pelvic inflammation is the most common cause of pelvic pain. Most chronic inflammation has a history of acute inflammation. Due to the heavier infection, weaker constitution, the treatment is not timely or incomplete and delays become chronic. Often occurs after the birth, abortion or artificial abortion, unclean sexual life and other infections, followed by local inflammation of the uterus, fallopian tube intima, through the muscle layer caused by inflammation of the surrounding connective tissue or pelvic peritoneum. After the acute phase, because the pelvic drainage is not poplar, the cavity is more, so that the inflammatory exudate accumulates and overflows, spreads to the surrounding tissues, forms adhesions, wraps the chronic lesions, stands by and recurs; or wears out to the adjacent organs to form a swelling. Sometimes the leak is very small, and when it is closed, it causes the inflammation to recur for a long time, forming scars, and some form small abscesses and ulcers, which will not heal for a long time. Scar adhesion often causes organ displacement, such as uterine flexion, fixation, ovarian ptosis and increased pelvic pain. Due to blood circulation disorders, congestion in the basin, stimulation of the pelvic nerve and long-term recurrence of pelvic pain of varying degrees and nature. In addition, cervical edema caused by acute and chronic cervicitis, hypertrophy, severe erosion, cervical valgus and multiple retention cysts, is also a common cause of oppression and stimulation of the pelvic nerve plexus, resulting in lower abdominal pain and excessive vaginal discharge.

(2) After pelvic trauma: pelvic genital surgery or post-traumatic. Childbirth, especially after vaginal dystocia, tissue trauma, organ resection, organ displacement, etc. require a considerable period of blood circulation readjustment, wound repair, scar softening . When the blood circulation is adjusted, the body gradually adapts, and the symptoms gradually disappear and pelvic pain and bulging occur. Such as total uterine resection, patients with ovarian preservation, mild inflammatory infiltration of the surrounding tissues after ovarian fixation, thickening or fibrosis of the ovarian capsule, ovulation difficulties occur in the ovulation period, lower abdominal pain, also the shortening or fixation of the uterine ligament And postoperative pain.

(3) pelvic blood stasis: pelvic extraperitoneal venous plexus, with the widest ligament and pelvic floor. The pelvic cavity is located at the lowermost part of the abdominal cavity and is most susceptible to crushing and falling. Therefore, there are many opportunities for venous blood stasis, especially after women have been pregnant, the tissue in the basin is loose, and the possibility of blood stasis is increased. Therefore, pelvic venous stasis is more common in multiple births, tumor compression, genital drooping and so on. However, there are still pelvic blood stasis caused by congenital venous dysplasia, so primiparas can also occur, pelvic varicose veins do not have pelvic pain. Clinically, the broad ligament is often found in gynecological laparotomy, and there are large varicose veins around the ovary. Most of them are accompanied by genital drooping or pelvic floor relaxation, varicose veins are more severely stagnant, often with falling pain and lumbosacral discomfort. If venous thrombosis, ulceration, or broken hemorrhage is caused by irritation of the peritoneum or hematoma, there is obvious or even acute ipsilateral abdominal pain in the lower abdomen.

(4) pelvic floor relaxation: pelvic floor relaxation is often accompanied by sag of the pelvic organs, such as uterine posterior prolapse, bladder or rectal bulging. More common in women with maternal or twins, a history of great children or vaginal dystocia or heavy physical labor women. As the organ loses its strong support, it is drooped by the abdominal pressure. The ligaments and fascia are pulled, causing the pelvic cavity and anterior tibial nerve plexus to be pulled and the lower abdomen and back pain. If accompanied by ovarian prolapse, the ovarian peripheral nerve plexus deep in the lower abdomen is pulled and the deep pelvis occurs, and the pain and pain accompanying the posterior iliac crest.

(5) Intra-pelvic lesions: intrauterine endometriosis stimulation, tumor compression or malignant tumor metastases can cause pain.

(6) Sexual stimuli disorders: Sexual stimuli are unbalanced, such as excessive estrogen, progesterone deficiency can also cause pain in the basin. Excessive estrogen often causes tissue edema, blood vessels and lymphatic filling cause swelling of the tissue inside the basin, and compression of the surrounding pelvic nerve fibers causes bulging pelvic pain. More associated with premenstrual tension and increased aldosterone.

(7) Non-organic pelvic pain: Unexplained or non-organic pelvic pain does exist.

1 is related to the state of mind. More common in sensitive women, introverted or impetuous. Subject to certain mental effects, there are potential concerns about genital diseases.

2 There are hidden ligaments or fascia or muscles in the pelvic cavity. Occasionally, if you are touched or involved (such as forced bowel movements, cough, vomiting, etc.), you will feel severe pain in the pelvic cavity.

3 phantom pain. Surgical resection of the pelvic genital organs, after the family planning, often caused by pelvic pain due to ideological concerns.

In addition, there are other pelvic pains that are willing to cause, such as young women undergoing uterine attachment resection or vaginal atrophy after senile menopause, dryness, resulting in discomfort or dryness; sexual intercourse discomfort or dryness caused by perineal or vaginal scar contracture, Causes pain in the pelvic cavity and soreness in the lumbosacral region.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.