17- Chronic Pelvic Pain

Question 1

What is chronic pelvic pain?

Answer 1

Usually non cyclic of 6 months duration interfering with normal activities or lead to medical care

Question 2

What are some causes of chronic pelvic pain?

Answer 2

Gynecologic causes (endometriosis)
Ovarian or non ovarian causes
IBS
Interstitial cystitis

Question 3

What are the characteristics of primary dysmenorrhea ?

Answer 3

Uncommon in first 3-6 menstrual cycles
Most common in late teens or 20s
Decreases with age
Not affected by childbearing
Due to excess of prostaglandins F2-alpha
Symptoms often co occurring with menstrual pain including nausea and vomiting

Question 4

What are the goals of treatment of chronic pelvic pain?

Answer 4

After meds, surgery need multi disciplinary approach to develop coping mechanisms
Increase quality of life and control pain
Evaluate patient on regular basis not only in pain

Question 5

What are the treatments of chronic pelvic pain?

Answer 5

May require bed rest
NSAIDs
Heat
OMT
Exercise
Oral contraceptives 
Supportive care/ counseling
Presacral neurectomy for severe cases

Question 6

What are the causes of secondary dysmenorrhea ?

Answer 6

Specific cause to be determined by underlying abnormality or findings noted on history and clinical exam. Causes:
Imtrrauterine contraceptive device
PCOS
Morbid obesisty
Steroid therapy
Hypothyroidism 
Clotting disorders

Question 7

What is adenomyosis?

Answer 7

Used to be called endometriosis interna
Islands of endometrial tissue in the myometrium
Diagnosed most often at time of hysterectomy