Pelvic painDr Felicia Molokoane

Chronic pelvic pain is a complex disorder associated with multiple and often overlapping conditions.

Accounts for 10% of outpatient referrals to gynaecologist.

Important to distinguish gynaecological causes from non-gynaecological causes.

Introduction

Many women present because they want an explanation of their pain.

Often they have a theory or concern about the origin of the pain.

Allow time for initial assessment.

Introduction

Causes

Gynaecological

Endometriosis Gynaecological

malignancies Ovarian remnant

syndrome PID Pelvic congestion

syndrome

Gastrointestinal

Irritable bowel syndrome Inflammatory bowel

syndrome Constipation Colon cancer

Causes

Urological

Interstitial cystitis Urethral syndrome Bladder malignancy

Musculoskeletal

Fibromyalgia Poor posture Chronic coccygeal pain Neuralgia Pelvic floor dysfunction

pain

Causes

Other

Depression Physical or sexual abuse Somatization disorder

Ask questions about the pattern of pain Associated factors

Psychological Bladder Bowel symptoms Effects of movements or posture on pain

History

General examination Abdominal examination

Bimanual examination Screen for infections, particularly chlamydia

or gonorrhoea if suspect PID

Examination

Diagnostic laparoscopy: Gold standard Diagnose and treat peritoneal endometriosis

and adhesions

TVS: Screen and assess for adnexal masses

MRI scan: Adenomyosis

Investigations

Cyclical pain Therapeutic trial of COCs for 3 – 6 months

before diagnostic laparoscopic Mirena

Irritable bowel syndrome Antispasmodics Diet control

Treatment

Analgesia NSAIDs

Treatment

Pelvic pain is common

Affect 1 in 6 adult female population

Majority are unclear of the aetiology

Pain diary may be helpful in tracking symptoms and activities associated with pain

Summary