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Reproductive Health (Y4) > 3- Pelvic pain (chronic pain) > Flashcards

3- Pelvic pain (chronic pain) Flashcards

1
Q

define chronic pelvic paion

A

‘intermittent or constant pain in the lower abdomen or pelvis of a women of at least 6 months in duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy’
- Social and psychological issues such as physical or sexual abuse are key risk factors

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2
Q

examples of chronic pelvic pain

A
  • Endometriosis
  • Adenomyosis
  • Adhesions
  • Trauma during childbirth
  • Interstitial cystitis
  • Social and psychological
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3
Q

non-gynaecological causes of chronic pelvic pain

A
  • MSK pain
  • Nerve entrapment
  • IBS/ IBD
  • Chronic inflammatory condition of the bladder
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4
Q

pathophysiology of acute vs chronic pelvic pai n

A
  • Acute pain- resolves when tissue heals
  • Chronic pain- additional factors contribute hence pain persists longer
    o Chemokines and TNF alpha affecting peripheral nerves
    o Visceral hyperalgesia
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5
Q

endometriosis background

A

Presence of endometrial glands and stroma outside of the uterus.
- Responds to cyclical hormonal changes and bleeds at menstruation

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6
Q

pathophysiology of endometriosis

A
  • Unknown
  • Retrograde menstruation
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7
Q

presentation of endometriosis

A
  • Painful periods
  • Painful intercourse
  • Painful defecation
  • Painful urination
  • Heavy periods
  • Persisting abdominal pain
  • Rectal bleeding
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8
Q

on examination: endometriosis

A
  • Thickened uterosacral ligaments
  • Retroverted uterus
  • Uterine/ovarian enlargement
  • Uterine tenderness
  • Endometrial tissue visible on speculum exam, esp in posterior fornix
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9
Q

investigations for endometriosis

A
  • Pelvic US- endometriomas and chocolate cysts
  • Laparoscopic surgery- gold standard
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10
Q

management of endometriosis

A

Treatment depends on:
- Fertility issues
- Severity of symptoms
- Therapies tried and failed

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11
Q

medical management of endometriosis

A
  • COCP
  • Continuous progestogen therapy
  • GnRH analogues
  • Danazol
  • Mefenamic acid
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12
Q

medical management of endometriosis

A
  • COCP
  • Continuous progestogen therapy
  • GnRH analogues
  • Danazol
  • Mefenamic acid
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13
Q

surgical management of endometriosis

A
  • Laparoscopic- diathermy, laser
  • TAH + BSO (hysterectomy and bilateral salpingo-oophorectomy )
    o Risk of bladder, ureteric, bowel injury
    o Risk of subtotal hysterectomy
    o Role of HRT
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14
Q

Adenomyosis background

A

Presence of endometrial tissue within the myometrium (muscle layer of the myometrium)

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15
Q

RF for adenomyosis

A
  • Multiparous
  • Seem to resolve after menopause
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16
Q

cause of adenomyosis

A
  • Not fully understood
  • Multiple factors
    o Sex hormones
    o Trauma
    o Inflammation
17
Q

presentation of adenomyosis

A
  • Dysmenorrhoea
  • Menorrhagia
  • Pain during intercourse
  • infertility
18
Q

investigations for adenomyosis

A
  • Transvaginal US
  • Gold standard- Diagnosis by histology after hysterectomy
19
Q

management of adenomyosis

A
  • Mirena coil or COCP or cyclical oral progestogens

Others:
- GnRH analogues to induce menopause like state
- Endometrial ablation
- Uterine artery embolization
- Hysterectomy

Non-contraceptive methods
- Tranexamic acid – if not painful
- Mefenamic acid- if painful (NSAID)

20
Q

IBS background

A

“Functional bowel disorder”. This means that there is no identifiable organic disease underlying the symptoms. The symptoms are a result of the abnormal functioning of an otherwise normal bowel.

21
Q

IBS RF

A
  • Female
  • Younger adults
22
Q

presentation of IBS

A
  • Diarrhoea
  • Constipation
  • Abdominal pain
  • Bloating
  • Worse after eating
  • Improved by opening bowels
23
Q

rome III criteria for IBS

A
  • Continuous or recurrent abdominal pain or discomfort on at least 3 days a month in the last 3 months
  • Onset at least 6 months previously

Associated with at least two of the following:
* Improvement with defecation
* Onset associated with a change in frequency of stool
* Onset associated with a change in the form of stool.

24
Q

treatment of IBCS

A

General healthy diet and exercise
o Adequate fluid intake
o Regular small meals
o Limit caffeine and alcohol
o FODMAP
o Probiotic supplements for 4 weeks
First line medication
o Loperamide for diarrhea
o Laxatives for constipation
o Antispasmodic e.g. buscopan
Second line medication
o Tricyclic antidepressants
Third line
o SSRIs
o CBT

25
Q

Interstitial cystitis background

A

A chronic condition causing inflammation in the bladder, resulting in lower urinary tract symptoms and suprapubic pain. It is also called bladder pain syndrome and hypersensitive bladder syndrome.

26
Q

presentation of interstitial cystitis

A
  • Suprapubic pain
  • Frequency
  • Urgency
  • Worse on menstruation
27
Q

investigations for interstitial cystitis

A
  • Urinalysis
  • Swabs for STI
  • Cystoscopy for bladder cancer
  • Prostate exam
28
Q

findings of cystoscopy for bladder cancer

A

o Hunner lesion
o Granulations

29
Q

management of interstitial cystitis

A

Supportive
- Diet e.g. caffeine and alcohol
- Stop smoking
- PFMT
- Bladder retraining
Oral medication
- Analgesia
- Antihistamine
- Anticholinergic medication e.g. oxybutynin
- Mirabegron
Intravesical medication
- Lidocaine
- Hydrodistension-
Surgical
- Cauterisation of Hunner lesions
- Botulinum toxin injection
- Electrical nerve stimulator
- Cystectomy

30
Q

hydrodistension

A

involves filling bladder with water, to high pressure, during cystoscopy (requires general anaesthetic)- can give temporary improvement of symptoms

31
Q

MSK pain

A
  • Joints in the pelvis
  • Damage to the muscles in the abdominal wall or pelvic floor
  • Pelvic organ prolapse may also be a source of pain.
  • Trigger points-localized areas of deep tenderness – chronic muscle contraction
  • Treatment- Analgesia, Physiotherapy, Nerve modulation and Antidepressant
32
Q

nerve entrapment

A
  • Joints in the pelvis
  • Damage to the muscles in the abdominal wall or pelvic floor
  • Pelvic organ prolapse may also be a source of pain.
  • Trigger points-localised areas of deep tenderness – chronic muscle contraction
  • Treatment- Analgesia, Physiotherapy, Nerve modulation and Antidepressant

Reproductive Health (Y4) (34 decks)

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