Pelvic Pain: An Overview

Chronic pelvic pain is defined as pain below the level of the umbilicus of 6 months or longer duration that significantly interferes with function or requires medical treatment. Various studies have estimated its prevalence as between 4 and 25%. Chronic pelvic pain accounts for approximately 10% of all visits to a gynecologist although studies suggest that as much as two thirds of cases go untreated. This syndrome is also felt to be responsible for at least 40% of gynecological laparoscopies and about 20% of al hysterectomies and a significant percentage of the patients continue to have pain.

The causes of chronic pelvic pain are many and varied as can be seen from the table below. What is of interest is the number of disorders on the list which are primarily function rather than anatomic in nature and the large degree of overlap between the different sections of the list. In addition the fact that many of these conditions may be mediated through the autonomic nervous system offers the hope for finding similar treatments for this bewildering set of conditions.

Causes of Chronic Pelvic Pain

Gynecologic

  • Endometriosis
  • Chronic Pelvic Inflammatory Disease
  • Pelvic Adhesions
  • Pelvic Congestion Syndrome
  • Adenomyosis
  • Ovarian Remnant Syndrome
  • Residual Ovary Syndrome
  • Leiomyoma
  • Endosalginiosis
  • Neoplasia
  • Fallopian Tubal Prolapse
  • Tuberculous Salpingitis
  • Benign Cystic Mesothelioma
  • Postoperative Peritoneal Cysts

Mental Health Issues

  • Somatization
  • Substance Abuse
  • Physical & Sexual Abuse
  • Depression
  • Sleep Disorders

Urinary Tract

  • Interstitial Cystitis
  • Recurrent Urinary Tract Infection
  • Urethral Diverticulum
  • Chronic Urethral Syndrome
  • Neoplasia
  • Radiation Cystitis

Gastrointestinal Tract

  • Irritable Bowel Syndrome
  • Inflammatory Bowel Disease
  • Diverticular Colitis
  • Chronic Intermittent Bowel Obstruction
  • Neoplasia
  • Chronic Constipation
  • Celiac Disease

Musculoskeletal Disorders

  • Pelvic Floor Myalgia
  • Myofascial Pain Syndrome
  • Coccydynia
  • Piriformis Syndrome
  • Hernia
  • Fibromyalgia
  • Peripartum Pelvic Pain Syndrome

Neurological Diseases

  • Neuralgia (ilioinguinal, iliohypogastric, genitofemoral or pudendal)
  • Neoplasia
  • Neuropathic Pain
  • Abdominal Epilepsy
  • Abdominal Migraine

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