Chronic pelvic pain is a common clinical syndrome that affects both the physical and emotional aspects of a woman's life. Pain in the lower abdomen is the most common complaint in gynecological practice, but sometimes doctors have to deal not with the concept of pain as a symptom, but with the concept of pain as a disease. Approximately 10% of all gynecological visits are associated with chronic pelvic pain, in 40% of cases this symptom is the reason for the performed laparoscopic interventions. In the population, about 15% of women suffer from chronic pelvic pain, and the trend towards this disease is rapidly increasing, due to the high prevalence of inflammatory gynecological diseases.

Causes of Chronic Pelvic Pain Syndrome

Chronic pelvic pain can be caused by various etiological factors and their combination. The most common causes of chronic pelvic pain include the following conditions:

  • gynecological diseases: endometriosis, inflammatory diseases, ovarian cysts and others;
  • pathologies of the vascular system of the pelvis;
  • bowel diseases: irritable bowel syndrome, ulcerative colitis and others;
  • urological diseases: chronic cystitis, nephrolithiasis and others;
  • myofascial pain syndrome;
  • neurological and psychiatric diseases;
  • somatic dysfunction.

It should be noted that the neurological factor plays a significant role in the development of chronic pelvic pain syndrome. During the collection of anamnesis, the practicing gynecologist should pay special attention to the emotional state of the patient, joint consultation with a neuropsychiatrist is possible.

Clinical presentation of chronic pelvic pain syndrome

In accordance with the causes of chronic pelvic pain syndrome, three types of such pain are distinguished in the classification of the disease: episodic recurrent pain, persistent pain and pain arising from psychophysiological disorders.

The very concept of chronic pelvic pain implies the presence of cyclic or acyclic pain, localized in the lower abdomen, lasting 6 or more months, not associated with either the menstrual cycle or sexual activity. Patients with chronic pelvic pain syndrome at the appointment with a gynecologist complain of dull, indistinctly localized pain in the lower abdomen, heavy menstruation and intermenstrual bleeding, painful sensations that occur during sexual intercourse, increased fatigue, mood changes such as irritability, constant fatigue and sleep disorders. It is noteworthy that the average age of all patients with chronic pelvic pain syndrome is 30 years.

Methods for diagnosing chronic pelvic pain syndrome

Diagnosis of chronic pelvic pain syndrome is based on physical data, as well as data from instrumental studies. Laboratory studies, often, do not detect any gynecological pathology. An objective examination and ultrasonography of the pelvic organs determine pain on palpation of the upper hypogastric plexus, a slightly enlarged uterus, a hypertrophied and cyanotic cervix, polycystic changes in the ovaries, varicose veins of the small pelvis and abundant watery discharge. Concomitant gynecological and extragenital pathologies may be detected. In the psychological state of the patient, attention is drawn to increased anxiety, irritability of the patient, sudden changes in mood, possibly emotional lability.

Treatment of chronic pelvic pain: pharmacotherapy

The main directions of pharmacological therapy for chronic pelvic pain syndrome are:

  • improvement of venous outflow from the uterus;
  • correction of microcirculatory disorders;
  • elimination of inflammatory processes;
  • stabilization of the psycho-emotional background;
  • correction of hormonal disorders, if any;
  • normalization of trophism in the pelvis.

It is recommended to start drug therapy for chronic pelvic pain syndrome with oral contraceptives and non-steroidal anti-inflammatory drugs. All drugs and dosages must be selected strictly individually! As an adjunct therapy for chronic pelvic pain, venotonic and antihomotoxic drugs, as well as tranquilizers, are used to stabilize the patient's emotional state. Treatment of chronic pelvic pain syndrome is carried out in several courses until the maximum effect is achieved. At the stage of rehabilitation, the use of balneotherapy is indicated.

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