5: Pelvic Pain Flashcards
What is the definition of pelvic pain?
Pain experienced between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joint. The pain can radiate into the posterior thigh and can occur in conjunction with pain in the symphysis
What are causes of acute pelvic girdle pain?
Trauma, tumor, infection, physiologic process
What are causes of chronic pelvic girdle pain?
Central sensitization, peripheral stimulus, lacking infection or neoplastic disease
What is the definition of chronic pelvic pain?
Persistent pain perceived in structures related to the pelvis of men and women
What consequences are associated with chronic pelvic pain?
Negative cognitive, behavioral, sexual, and emotional consequences
What are chronic pelvic pain symptoms suggestive of?
LUT, sexual, bowel, pelvic floor, gynecologic function
What is the timeframe to be diagnosed with chronic pelvic pain?
Continuous or recurring pain lasting 6 months of longer with the absence of infection
When are females likely to develop pelvic pain?
Mostly in the reproductive years
What conditions lead males to experience pelvic pain?
Chronic prostate and bladder pain syndrome
What are the 5 risk factors of pelvic girdle pain?
- History of lumbar pain
- History of pelvic pain or pelvic pain during pregnancy
- History of multiparity
- Increased BMI
- Hip and LE dysfunction
What are the five components of the clinical paradigm for chronic pelvic pain.
- Referred pain
- Hyperalgesia in somatic tissues
- Visceral hyperalgesia
- Allodynia
- Trigger points and muscle pain
What is hyperalgesia?
Increased sensitivity to normally painful stimuli
What is allodynia?
Normal stimulus causes extreme pain
What parts of the history are relevant with pelvic pain?
Site and duration, onset, pain characteristics, response to activity
What is central sensitization?
Development and maintenance of chronic pain - persistent state of hyperactivity
What are the symptoms of central sensitization?
Allodynia, hyperalgesia, non-mechanical pain, poor sleep, fear avoidance, catastrophizing
What are you visually inspecting when examining the perineum?
Genital hiatus may be reduced in size or displaced anterior
What are you looking for when observing contraction, relaxation, and bearing down?
Absent movement, timing, incomplete relaxation, no bearing down, fatigue
How do you assess sensation and neurologic integrity?
Anal wink reflex - may be absent or decreased
Describe the external tissue exam
Palpation assessing tissue quality, sensation, temperature, tenderness, trigger points, discoloration
Describe the internal exam
One digit used to determine presence of pain. Assessed with relaxation and contraction
What if there are no positive findings with the internal exam?
Assess for referred pain
Describe conservative treatment for pelvic pain
Education, lifestyle modification, CBT, exercise
What types of manual therapy can be beneficial for pelvic pain?
MFR, SCS, stretching, scar mobilization, local massage
What are treatments for voiding retraining?
Postural mechanics, awareness and function in position and simulated action
What are adjunct therapies for pelvic pain?
Biofeedback, e-stim, dry needling, laser, dilators, heat, cold
What are the key three pain management strategies?
- Multidisciplinary
- Pain education
- Goal setting
