Lecture 7: Pelvic pain

Chronic pelvic pain

-Intermittent or constant pain in the lower abdomen or pelvis in women. -Lasting for at least six months. -Not occurring exclusively with menstruation or sexual intercourse. -Not being associated with pregnancy.

Renal pain

-The kidney (loin pain) -The ureter (ureteric colic may radiate from loin to groin) -The bladder (supra-pubic pain or pain on passing urine)

Recommendations are that women with ovarian cancer can get four key symptoms:

1.Persistentstomach or pelvic pain 2.Persistent bloating or increased stomach size (not the kind that comes on after a big meal and settles within a couple of hours) 3.Feeling full quickly after eating, or having problems eating 4.Needing to pass water more often

Cervical cancer etiology and clinical presentation

Aetiology •Human papilloma virus (HPV infection)/sexually transmitted •Smoking Clinical presentation •Screening. •Excessive vaginal discharge •Abnormal Bleeding unrelated to menstruation •Vaginal discomfort/urinary symptoms •It often presents in the advanced stages to a chiropractor and may present with back pain and ascites.

OVARIAN CYSTS

Common symptoms include: -pelvic pain -irregular menstruation -pelvic pressure -pain after intercourse. -low back pain. -swollen abdomen Complications include: Increasing size : pressure symptoms twisting, infarction or haemorrhage rupture

Problems with pregnancy causing pelvic pain

Early on: Miscarriage Ectopic pregnancy In later pregnancy: Premature labour Placental abruption

mittelschmerz

Short-term pelvic pain that occurs during ovulation This pain is related to the stretching of the membrane that covers the ovary as it releases the egg.

endometriosis

chronic oestrogen-dependent condition characterised by the growth of endometrial tissue in sites other than the uterine cavity most commonly the pelvic cavity. Cardinal symptoms are: •Dysmenorrhoe •Dyspareunia/pain with intercourse •Cyclical or chronic pelvic pain •Subfertility •Other symptoms may include bloating, lethargy, constipation and low back pain

Pelvic inflammatory disease

complication of a sexually transmitted disease (STD) eg.gonorrheaor chlamydia. Can cause damage to the Fallopian tubes, ovaries, and the uterus. Common symptoms; pain that radiates to the abdomen, an abnormal vaginal discharge, pain during intercourse or urination

fibroids

•Benign tumours within the uterine wall. •Common and usually asymptomatic •Can cause heavy periods, abdominal swelling and urinary problems.

Pelvic pain: What to ask in the history

•Bladder and bowel symptoms •Previous gynecological problems •The effect of movement and posture •Any association with periods

Red flag symptoms and signs for chronic pelvic pain

•Bleeding from the rectum. •New bowel symptoms in patients over 50 years old •New pain after the menopause. •Bleeding after the menopause •Pelvic mass. •Unintentional weight loss. •Irregular vaginal bleeding in patients over 40 years old. •Postcoital bleeding.

Causes of chronic pelvic pain

•Endometriosis •Fibroids. •Chronic PID •Adhesions •Gastrointestinal, egirritable bowel syndrome, diverticular disease. •Urological •Musculoskeletal pain •Psychological and social issues commonly occur in association with chronic pelvic pain

Acute pelvic pain

•Pelvic inflammatory disease (PID) •Urinary tract infection (UTI) •Miscarriage •Ectopic pregnancy •Torsion or rupture of ovarian cysts.

Dysmenorrhoea

•Pelvic pain that occurs when the uterus contracts to remove the blood and endometrial lining that accumulates monthly when an embryo is not implanted in the uterus. •The pain is often mild but, in about 1 in 10 women, it can be debilitating

Ectopic pregnancy

•Symptoms develop anytime between 4 and 10 weeks of pregnancy. •Pain on one side of the lower abdomen. It may develop suddenly or slowly get worse over several days. •Vaginal bleeding often occurs, but not always.

Pelvic prolapse

•a condition where a pelvic organ such as the bladder or uterus drops into a lower than normal position and can in some instances protrude into the vaginal canal. •Can produce a 'pressure-like' pain and may include back pain. •Tends to occur in older women •Treatments include exercises to strengthen pelvic musculature or surgery.

Endometrial Cancer

•postmenopausal bleeding (PMB) •Before the menopause it can present with irregularities of the menstrual cycle.