What Are the Different Causes of Posterior Pelvic Pain?

Chronic pelvic pain (CPP) refers to pelvic pain that is non-periodic and lasts for more than 6 months (some are considered to be more than 3 months) and is ineffective for non-opioid treatment. Chronic pelvic pain is one of the most common symptoms in women. There are acute and chronic pelvic pain. Chronic pelvic pain is characterized by a complex etiology, and sometimes no obvious cause can be found even after laparoscopy or laparotomy, and the degree of pain is not necessarily proportional to the degree of disease.

Basic Information

Visiting department

Obstetrics and Gynecology

Multiple groups

Women

Common causes

Organic lesions such as chronic pelvic inflammatory disease, endometriosis, adenomyosis, pelvic adhesions, etc.

Common symptoms

Lower abdominal pain or back pain, depression, severe pain, etc.

Causes of chronic pelvic pain

Organic lesions such as chronic pelvic inflammatory disease, endometriosis, adenomyosis, and pelvic adhesions can cause pain, but many patients have only mild pathological changes or no organic changes. Pelvic organ distortion caused by adhesions and endometriosis does not necessarily cause pain. Even if it causes pain, its location and degree may not be related to the location and severity of the lesion. It can be related to traumatic sexual experience, to marriage misfortune and sexual dysfunction.

Clinical manifestations of chronic pelvic pain

Chronic pelvic pain includes gynecological diseases that are easy to find on laparoscopy, such as endometriosis, pelvic inflammatory disease, pelvic adhesions, and pelvic vein congestion syndrome. ), Such as irritable bowel syndrome, also includes non-somatic (psychogenic) diseases.

Symptoms and signs

(1) Lower abdominal pain or back pain can be the entire lower abdomen, it can be bilateral or unilateral popliteal fossa, or there is no obvious localization, often accompanied by vaginal discomfort, persistent or intermittent dull pain or faint pain ; The patient can't tell what factors are associated with the increase in pain and relief.

(2) Depression Pain is caused or exacerbated by sexual intercourse, but does not affect sexual life. Patients have significant depressive symptoms, such as lack of appetite, tiredness, insomnia, loss of sexual desire or disinterest in anything, or impulse and poor self-control.

(3) Abnormal disease behavior There is a kind of physical prejudice, and I am convinced that I have a disease. The doctors do their best to treat it, but they still have pain.

2. Physical examination

(1) While instructing patients to relax their abdominal, thigh, and vaginal opening muscles to reduce discomfort during examinations, they can understand the extent to which patients control muscle tension. Anal diagnosis touches the levator anus and piriformis and causes pain, suggesting that the pelvic floor muscles are tense and painful. The feeling of discomfort usually manifests as pelvic pressure and radiating pain to the palate near the attachment point of the levator anus.
Attention should be paid to whether the attachment area is thickened, how active, whether there is pelvic floor relaxation, coccyx tenderness, and lesions that may cause sexual intercourse pain. Gentle palpation may detect sensitive areas that correspond to vaginal opening vestibitis or trigger points in the higher part of the vagina. Gentle palpation of the abdominal wall with the fingertips reveals tender points in the muscle tissue.

(2) Pelvic examination: No positive findings, but the pelvic cavity is overly sensitive, and even severe palpation can cause severe pain.

Chronic pelvic pain examination

Including vaginal discharge examination, hormone level detection, tumor marker examination, histopathological examination, imaging examination, endoscopy and laparoscopy.

Imaging examination

Ultrasound: As the most commonly used non-invasive imaging detection method in gynecology, ultrasound can find abnormal anatomy of the pelvic cavity, distinguish the nature of the mass (cystic or solid), and identify blood vessel characteristics by color Doppler. Whether it is transabdominal or vaginal ultrasound, preliminary pelvic organic lesions can be ruled out, which is helpful to relieve patients' ideological doubts. For patients with abdominal wall tension, unable to cooperate or not undergo pelvic examination, it has important diagnostic significance.

2. Endoscopy

(1) Cystoscopy When considering that the symptoms originate from the lower urinary tract, cystoscopy is necessary to exclude infection.

(2) Colonoscopy.

3. Laparoscopy

Laparoscopy, as a minimally invasive direct-view diagnostic tool, is regarded by gynecologists as an indispensable and important method for assessing CPP.

Chronic pelvic pain treatment

Medication principle

It is often difficult to achieve the desired results with a single medication, and more combined medications are used. Particular attention should be paid to drug interactions, and drug reactions are often checked to minimize the type and dose of drugs to reduce side effects and costs.

2. Commonly Used Drugs

(1) Analgesics include non-steroidal anti-inflammatory drugs (NSAIDs), complexes of NSAIDs and milder anesthetics, and pure anesthetics.

(2) Antidepressants Antidepressants not only fight depression, but also have analgesic effects of unknown mechanism. The efficacy of antidepressants for chronic pain is not very reliable, but it is widely used because it can be used as a substitute for anesthetics, and is not easy to be abused and has low dependence.

(3) Organ-specific drugs During the treatment of CPP, gastrointestinal symptoms, bladder irritation symptoms, and skeletal muscle pain can be targeted.

(4) Other drugs such as medroxyprogesterone acetate (progesterone acetate) can reduce pelvic congestion by inhibiting ovarian function to relieve related pain. GnRH-a has been suggested to distinguish pain from gynecological and non-gynecological causes.

3. Laparoscopy

Laparoscopic surgery for chronic pelvic pain should be based on its specific situation.

4. Psychotherapy

Psychotherapy should be performed for patients with no obvious organic lesions but with mental disorders. You can start with simple methods, such as starting with education and eliminating doubts, and gradually carry out special psychological treatment techniques, such as relaxation therapy, cognitive therapy, and supportive therapy.

5. Other therapies

Including physical therapy, massage and other therapies.