Chronic Pelvic Pain
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- Chronic pelvic pain
- Chronic pelvic pain women
- Physical therapy chronic pelvic pain
- Chronic pelvic pain rehabilitation
Definition/Description
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Chronic pelvic pain (CPP) is commonly defined as nonmalignant intermittent or continuous pain in the lower abdomen, pelvis or intrapelvic structures, lasting at least 3–6 months.[1] If nonacute and central sensitization pain mechanisms are present, the condition is considered chronic, regardless of the time frame.[2] Central sensitization is characterized by amplification or increased sensory perception, where stimuli that are normally not painful are now perceived as painful.[3] CPP is in women not exclusively associated with the menstrual cycle, sexual intercourse or pregnancy[1], but is sufficiently severe to cause functional disability or to lead to medical care.[4]
Clinically Relevant Anatomy
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Epidemiologically CPP has a greater incidence in women than in men, and is mostly present between the ages of 36 and 50 years.[2] The etiology of CPP however is not clear. It can be difficult and complex to determine the cause of pain; in fact, no specific cause may be discovered. Many women are not able to identify a specific set of problems which can cause the problems and allowing for the diagnosis to be made.[5] CPP may originate from one or more organ systems or pathologies and may have multiple contributing factors. It usually involves an interaction between the gastrointestinal, urinary, gynecologic, musculoskeletal, neurologic and endocrine systems. It can also be influenced by psychological and sociocultural factors.[4]
Epidemiology /Etiology
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Characteristics/Clinical Presentation[edit | edit source]
Chronic pelvic pain has numerous presentations, and women with the same problem may exhibit different characteristics. Common symptoms include:
- constant severe pelvic pain
- intermittent pain
- sharp or cramping pain
- dull aching
- pressure
Many women miss work, have difficulty doing non strenuous exercises, and have difficulty sleeping. The level of pain can vary greatly and can contrast from mild to disabling.[5]
Differential Diagnosis
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| Gastrointestinal | Celiac disease, colitis, colon cancer, inflammatory bowel disease, irritable bowel syndrome |
| Gynecologic | Adhesions, adenomyosis, adnexal cysts, chronic endometritis, dysmenorrhea, endometriosis, gynecologic malignancies, leiomyomata pelvic congestion syndrome, pelvic inflammatory disease |
| Musculoskeletal | Degenerative disk disease, fibromyalgia, levator ani syndrome, myofascial pain, peripartum pelvic pain syndrome, stress fractures |
| Psychiatric/neurologic | Abdominal epilepsy, abdominal migraines, depression, nerve entrapment, neurologic dysfunction, sleep disturbances, somatization |
| Urologic | Bladder malignancy, chronic urinary tract infection, interstitial cystitis, radiation cystitis, urolithiasis |
| Other | Familial Mediterranean fever, herpes zoster, porphyria |
Diagnostic Procedures[edit | edit source]
Outcome Measures
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Examination
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Medical Management[edit | edit source]
Physical Therapy Management[edit | edit source]
Key Research
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Resources[edit | edit source]
Clinical Bottom Line[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 Díaz Mohedo E, Barón López FJ, Pineda Galán C, Dawid Milner MS, Suárez Serrano C, Medrano Sánchez E., Discriminating power of CPPQ-Mohedo: a new questionnaire for chronic pelvic pain, J Eval Clin Pract. 2011 Oct 26. doi: 10.1111/j.1365-2753.2011.01778.x. (Level of evidence : 2C)
- ↑ 2.0 2.1 Alappattu MJ, Bishop MD., Psychological factors in chronic pelvic pain in women: relevance and application of the fear-avoidance model of pain, Phys Ther. 2011 Oct;91(10):1542-50. doi: 10.2522/ptj.20100368. Epub 2011 Aug 11. (Level of evidence : 2C)
- ↑ Cambitzi J, Chronic pelvic pain: causes, mechanisms and effects, Nursing Standard, 25, 20, 35-38. Date of acceptance: March 26 2010 (Level of evidence : 2A)
- ↑ 4.0 4.1 Silva GP, Nascimento AL, Michelazzo D, Alves Junior FF, Rocha MG, Silva JC, Reis FJ, Nogueira AA, Poli Neto OB., High prevalence of chronic pelvic pain in women in Ribeira˜o Preto, Brazil and direct association with abdominal surgery, Clinics (Sao Paulo). 2011;66(8):1307-12. (Level of evidence : 2B)
- ↑ 5.0 5.1 John D. Paulson, MD, Joseph N. Paulson, Anterior Vaginal Wall Tenderness (AVWT) as a Physical Symptom in Chronic Pelvic Pain, JSLS. 2011 Jan-Mar;15(1):6-9. (Level of evidence : 2B)
- ↑ David D. Ortiz, MD, Chronic Pelvic Pain in Women, Am Fam Physician. 2008;77(11):1535-1542, 1544. (Level of evidence : 3A)
