Chronic Pelvic Pain

Question 1

Define chronic pelvic pain

Answer 1

Non cyclic pain of 6months
Localising to the pelvis,
Anterior abdominal wall below umbilicus
Lower back or buttocks
With enough severity to cause functional disability or lead to medical care

Question 2

List 5 gynae causes of chronic pain

Answer 2

Endometriosis
Adenomyosis
Adhesions
Chronic PID
PCS (PelvicCongestion Syndrome)

Question 3

List some of the GIT and Urology causes of chronic pelvic pain (3*2)

Answer 3

IBS
IBD
Chronic constipation

Interstitial Cystitis
Painful Bladder Syndrome
Urethral syndrome

Question 4

What neurological condition can cause chronic pelvic pain

Answer 4

Nerve entrapment

Question 5

List the top 5 causes of Chronic pelvic pain

Answer 5

Endometriosis
Pelvic adhesions
Pelvic congestion syndrome
Painful bladder syndrome
IBS

Question 6

What is Carnett’s sign

Answer 6

Carnets sign means abdominal pain get worse when the abdominal wall get more tense, suggesting a somatic type of pain. A negative Carnett sign suggests an intra abdominal cause of pain (visceral)

Question 7

Management of Adenomyosis

Answer 7

Medical:
GnRH analogues
Analgesia

Surgical: hysterectomy

Question 8

What do you expect to see on US in apt with Adenomyosis

Answer 8

Asymmetrical thickening
Myometrial cysts
Loss of endometrial boarder
Incr myometrial heterogeneity
Linear striations from endometrium

Question 9

What causes adhesions to cause chronic pelvic pain (2)

Answer 9

Pelvis organs are glued together, torsion on movement
Nerve tissue is present in adhesions

Question 10

What is pelvic congestion syndrome

Answer 10

Unclear aetiology
After pregnancy the veins dilate between ovarian varices and legs, through vagina and Vulva
Less to heaviness, dull ache and chronic pelvic discomfort
Worse on standing and after intercourse

Question 11

Discuss the management of pelvic congestion syndrome

Answer 11

Medical POI
Etonorgestril (implanon)
GnRHa
Dihydroergotamine (pain?)

Surgical
Sclerotherapy (therapy to shrink vessels)
Embolization
Clipping/Ligating
Hysterectomy + BSO (bilateral salpingoophorectomu)

Question 12

What is painful bladder syndrome or interstitial cystitis

Answer 12

DEFINITION(ESSIC): Sx pain associated with bladder accompanied by one other of daytime/nighttime frequency.
Pain related to filling and relief with voiding

Question 13

List management options for interstitial cystitis or painful bladder syndrome

Answer 13

Botox
Lazer
Surgery