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BackTable / Urology / Topic / Condition
Pelvic Pain Syndrome
Pelvic pain syndrome is a relatively common form of chronic pain within the pelvis. Pelvic pain is centralized, regional pain that is experienced as hyperalgesia or allodynia. Pelvic pain syndrome is associated with physical and mental comorbidities such as irritable bowel syndrome and major depressive disorder. It is often related to a patient’s prior physical or emotional trauma and a functional somatic pain syndrome. Pelvic pain syndrome affects about one in seven women in the United States, and the most common comorbidity in these women is endometriosis.
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Pelvic Pain Syndrome Diagnosis
After three to six months of pelvic pain and a history and physical exam are completed, a pelvic pain syndrome diagnosis can be made. The comorbid chronic pain can be determined when reviewing the patient’s history. A medical, surgical, psychological, and gynecological history should be obtained. Additionally, the patient’s bowel movements, precipitating factors, alleviating factors, urination, and sexual activity should be assessed. The type of pain sensation, the consistency of pain, and activities associated with pain should be distinguished. The physical examination should include a gynecological, bimanual, and abdominal exam, as well as a physical evaluation of the pelvic floor for hypertonicity. The Carnett test and cotton swab test should be performed to evaluate abdominal wall pain and pelvic pain. Laboratory tests and diagnostic imaging are utilized when no alarm symptoms or comorbidity diagnosis has been made. Laboratory tests include a urine pregnancy test, complete blood count, erythrocyte sedimentation rate, and urinalysis. Pelvic ultrasonography and transvaginal ultrasonography are the most commonly used imaging tools for pelvic pain syndrome.
Pelvic Pain Syndrome Podcasts
Listen to leading physicians discuss pelvic pain syndrome on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
Episode #12
We talk with Dr. Yahir Santiago-Lastra, director of the Women's Pelvic Medicine Center at UC San Diego Health about the management of cystitis and pelvic pain syndromes. She shares her insights on genitourinary syndrome of menopause, pain evaluation and treatment, and procedural options including botox and sacral neuromodulation.
Pelvic Pain Syndrome Treatment
Evidence based treatments for pelvic pain syndrome are limited, and most treatments target the comorbidities of the patient such as neuropathy, uterine dysfunction, or mood disorders. When the source of chronic pelvic pain is unknown, over the counter analgesics are the first treatment option. Patients with cyclical pelvic pain , or patients that do not respond to over the counter analgesics, may try hormonal replacement therapy. If the pain is neuropathic or non-cyclical, antidepressant therapy may be an effective treatment option. In patients without an underlying mood disorder, tricyclic antidepressants, pregabalin, gabapentin, or SNRIs may be employed. If all other pharmaceutical treatments fail, an opioid analgesic trial may be used as a treatment option. Pelvic floor therapy, cognitive behavioral therapy, and mindfulness are integral to the management of pelvic pain syndrome. Patients with sacral nerve injury and pelvic pain syndrome may be candidates for a local steroid injection, radiofrequency ablation, peripheral nerve blocks, neuromodulation, botox injections, or trigger point injections.
References
[1] Dydyk, A. M., & Gupta, N. (2021, November 11). Chronic pelvic pain. StatPearls [Internet]. Retrieved January 26, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK554585/
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