Chronic Pelvic Pain Flashcards
Definition of CPP
Non-cyclic pain of 6 months duration localiziing to the pelvix, anterior abdominal wall below the umbilicus, L/S back or buttocks with sufficient severity to cause functional disability or lead to medical care
Gynae causes of CPP
- endometriosis
- adenomyosis
- adhesions
- chronic PID
- PCS
GIT causes of CPP
- IBS
- IBD
- chronic constipation
Urology causes of CPP
- interstitial cystitis
- PBS
- urtheral syndrome
Musculoskeletal causes of CPP
- fibromyalgia
- trigger points
- pelvic floor abnormalities
- hernias
- SI joint dysfunction
- disc disease
Neurological cause of CPP
nerve entrapment
Top five causes of CPP
- endometiosis
- pelvic adhesions
- pevlci varicosities
- painful bladder syndrome
- IBS
What is carnetts sign?
If tenderness is unchanged or increased when abdominal muscles are tensed (positive Carnett’s sign), the abdominal wall is the likely origin of pain
Definition of adenomyosis
Endometrial tissue beyond the endomyometrial junction
Symptoms of adenomyosis
- pain
- dysmenorrhoea
- heavy menstrual bleeding
Diagnosis of adenomyosis
- histology
- MRI
- USS
Treatment of adenomyosis
- progestins
- GnRH a
- UAE
- hysterectomy
USS features of adenomyosis
- asymmetric thickening
- myometrial cysts
- linear striations radiating from endometrium
- loss of endomyometrial border
- increased myometrial heterogeneity
Symptoms of pelvic congestion syndrome
- chronic pelvic discomfort
- dull ache
- heaviness
- increased Sx perimenopausal
- worse on standing and after intercourse
Medical treatment of PCS
- progestin
- etonorgestril
- GnRHa
- dihydroergotamine
