1. Chronic pelvic pain
By Dr. Dalya Muthefer

2. Chronic pelvic pain:
Chronic pelvic pain refers to pain in the region between the hips, below the bellybutton. In order to be considered chronic, the pain must last for at least six months or longer.
Chronic pelvic pain syndrome: chronic pelvic pain causing emotional and behavioral changes.

3. Types of pain:- Visceral pain Referred Pain Somatic Pain Myalgia
Hyperalgesia
Neuroinflammation

4. Sources of chronic pelvic pain :-
Gynecological
Urological
Gastrointestinal
Musculoskeletal
Neuropathic
Others

5. Incidence:- 14 – 24% of women b/w 18 and 50 years.
1/3 do not consult doctor.
60% who consult are not referred to tertiary centre.
Population studies: GI (37%), Urinary (31%), Gynae (20%).
Laparoscopic findings: No pathology (35%), Endometriosis (33%), Adhesions (24%).

6. Causes:

7. Signs and Symptoms:- Pain during intercourse Cramping or sharp pains
Heaviness or a feeling of pressure inside the pelvis
Extreme and constant pain
Intermittent pain
A dull ache
Pain during bowel movements .

8. General Examination:-
Gait- Musculoskeletal
Check  Abdominal Wall – Point trigger, Ovarian point tenderness
Inspection of Vulva & introitus- Vestibulitis
Check for Pelvic Floor Myalgia
Single Digit Pelvic Exam
Bimanual exam
Rectovaginal exam

9. Investigations:- WCC, ESR CA – 125 HVS / Endocervical swabs USS
Laproscopy

10. Differential Diagnosis for Chronic Pelvic Pain:-

11. Differential Diagnosis for Chronic Pelvic Pain:-

12. Treatment:- Possible treatments for chronic pelvic pain include:
Birth control pills to stop menstruation
Progestogen (medroxy progesterone acetate (MPA)) was
effective after 4 months’ treatment
Over the counter pain relief medications, such as ibuprofen or aspirin
Relaxation exercises, massage or physical therapy
Antibiotics
Psychological counseling
Surgery to correct pelvic abnormalities
Antibiotics if infection is the source of the pain
Antidepressants
Trigger point injections

13. Surgical management:-
Adhesion release. beware of prolapse and bladder. Presacral neurectomy: beware of vessel injury, bladder/bowel. Hysterectomy with BSO Surgical mx of non gynae causes.

14. Thank you