1. Dr. Ahmed jasim Ass.Prof. MBChB-DOG-FICMS COSULTANT OF GYN. & OBST.
Chronic pelvic pain
Dr. Ahmed jasim
Ass.Prof.
MBChB-DOG-FICMS
COSULTANT OF GYN. & OBST.

2. Def.
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. Type of pain Visceral pain Referred Pain Somatic Pain Myalgia
Hyperalgesia
Neuroinflammation

4. Sources of chronic pelvic pain
Gynecological
Urological
Gastrointestinal
Musculoskeletal
Neuropathic
Other

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. Differential Diagnosis for Chronic Pelvic Pain
Gynecologic Gastrointestinal
Endometriosis syndrome Irritable bowel
Adhesions (chronic pelvic Chronic Appendicitis inflammatory disease)
Leiomyomata Inflammatory bowel disease
Adenomyosis Diverticulosis
Pelvic congestion syndrome Diverticulitis
Meckel’s diverticulum

7. Differential Diagnosis
Urologic Psychological
Abnormal bladder function Depression (detrusor instability)
Urethral syndrome Somatization (chronic urethritis)
Interstitial cystitis
Psychosexual dysfunction/ Personality disorder abuse

8. Differential Diagnosis
Musculoskeletal Surgical
Nerve entrapment (neuritis) Chronic appendicitis
Fasciitis Hernia
Scoliosis Bowel disease
Disc disease Adhesive disease
Spondylolisthesis
Osteitis pubis

9. 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

10. 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

11. Investigations WCC, ESR CA – 125 HVS / Endocervical swabs USS
Laparoscopy.

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.