2012 41 Chronic Pelvic Pain

Question 1

How is chronic pelvic pain defined?

Answer 1

Intermittent or constant pain
Lasting over 6 months

Question 2

** What are the possible aetiological factors in chronic pelvic pain? **

Answer 2

1. Central & peripheral nervous system
2. Endometriosis & adenomyosis
3. Adhesions
4. IBS & interstitial cystitis
5. Musculoskeletal
6. Nerve entrapment
7. Psychosocial issues

Question 3

What action should be taken for adhesions in chronic pelvic pain?

Answer 3

1. Fine adhesions: leave
2. Dense adhesions: consider dividing

Question 4

What features should be assessed for in an examination for chronic pelvic pain?

Answer 4

1. Local tenderness
2. Enlargement, distortion or tethering of pelvic organs
3. Prolapse
4. Trigger points
5. Sacroiliac or symphysis pubis joint tenderness

Question 5

What investigations should be undertaken in chronic pelvic pain?

Answer 5

1. STI screening
   2, TVUS for masses, adenomyosis, endometriosis, hydrosalpinx, fibroids
2. Diagnostic laparoscopy
3. Ca-125 if additional Sx

Question 6

What are the risks at diagnostic laparoscopy of a) death, b) injury to bowel, bladder or blood vessels

Answer 6

a) 1:10,000
b) 2:1000

Question 7

What therapeutic options are available if endometriosis is suspected?

Answer 7

Ovarian suppression for at least 3-6m:
1. COCP
2. Progestogens inc Mirena
3. Danazol
4. GnRH analogues

Question 8

What therapeutic options are recommended for IBS?

Answer 8

1. Antispasmodics
2. Diet amendment esp dairy & grains
3. Smooth muscle relaxants eg mebeverine
4. Bulking agents

Question 9

What analgesia is recommended for chronic pelvic pain?

Answer 9

1. NSAIDs
2. Paracetamol
3. Avoid opiates if possible
4. Amitriptyline or gabapentin
5. NOT LUNA

Question 10

What proportion of the UK adult female population is affected by chronic pelvic pain?

Answer 10

1:6

Question 11

What are the Rome III criteria for diagnosing IBS?
Abdo pain at least 3 days a month in last 3 months plus…

Answer 11

2/3 of:
Improvement with defecation
Onset associated with change in stool frequency
Onset associated with change in stool form

Question 12

What symptoms additional to Rome III criteria are suggestive of IBS?

Answer 12

1. Abdominal bloating
2. Passage of mucus
3. Lethargy
4. Back ache
5. Urinary frequency
6. Dyspareunia

Question 13

What are the red flag signs & symptoms in chronic pelvic pain?

Answer 13

1. PR bleeding
2. New bowel Sx > 50y old
3. New pain after menopause
4. Pelvic mass
5. Suicidal ideation
6. Excessive weight loss
7. Irregular PVB > 40y old
8. Postcoital bleeding