Conclusion
Seema Chopra in Endometriosis, 2020
Endometriosis is a challenging medical condition with debilitating effects on the quality of life of women, as well as their mental and emotional health. More so, it remains a diagnostic dilemma as the symptoms are atypical or sometimes even asymptomatic. Endometriosis may have different clinical presentations depending on the primary location. Pelvic pain and infertility are two of the most common symptoms associated with it. Dysmenorrhea typically developing after years of pain-free menstrual cycle is suggestive of endometriosis. The pain most often begins 48 hours prior to the onset of menses and persists throughout the menstrual period. The pain may be unilateral or bilateral and is perceived as sensation of swelling of the internal organs or pelvic heaviness [1]. Cyclical pain soon progresses to noncyclical chronic pelvic pain severe enough to cause functional disability and to compromise day-to-day activities [2].
Chronic Pelvic Pain
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Very important to the delineation of pelvic pain is the pelvic exam. External genitalia should be inspected for any abnormal findings such as discharge, redness, excoriation, fissures, ulcerations, condylomata, atrophy, abscesses, or trauma. The vulva and introitus should then be examined for hyperalgesia and allodynia. This should be done with cotton tip localization of tender areas. After examination of the external genitalia, a speculum exam should be performed with close attention to not only the cervix but also the vaginal walls. The character of the discharge, lesions, erythema, whitened areas, or areas with atypical vascular patterns should be noted and cultured or biopsied accordingly. At this time cystocele, rectocele, and enterocele can be identified.
History and Examination
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
the pelvis And thus would be cAlled pelvic pAin. endometriosis on the blAdder mAy cAuse urethrAl pAin, which is present At certAin times in the menstruAl cycle. Pelvic inflAmmAtory diseAse mAy cAuse urethrAl pAin; however, the womAn will often hAve symptoms of vAginAl dischArge And pyrexiA. Loin PAin This pAin originAtes in the flAnk And rAdiAtes to the groin of the ipsilAterAl side. The pAin is referred from the sensory nerves innervAting the kidney And ureter, for which there Are mAny cAuses (tAble 28.6). Acute or chronic obstruction of the Urinary trAct cAn cAuse pAin. This becomes more Acute As the pressure generAted within the Urinary trAct is higher. Loin pAin during voiding And loin pAin AssociAted with urgency in women with detrusor overActivity mAy indicAte vesicoureteric reflux. DyspAreuniA This is the symptom of pAin during sexuAl intercourse. This cAn be subdivided into superficiAl And deep dyspAreuniA. superficiAl dyspAreuniA mAy be AssociAted with vAginAl dryness or following episiotomy or vAginAl wAll repAir. DyspAreuniA AssociAted with compression of the Anterior vAginAl wAll mAy reflect blAdder or urethrAl pAin syndromes. PerineAl pAin is felt between the posterior fourchette And the Anus And mAy be persistent or recurrent episodic. It mAy be relAted to the micturition cycle or AssociAted with symptoms suggestive of Urinary trAct or sexuAl dysfunction [1]. ProlApse Symptoms Pelvic orgAn prolApse often coexists with And mAy contribute to Luts. Women mAy describe the feeling of A lump, heAviness, A drAgging sensAtion in the vAginA, or lower bAck pAin. They mAy Also describe the leArned behAvior of using their fingers to reduce the bulge in order to successfully micturAte
Short and long-term effectiveness of external shock wave therapy for chronic pelvic pain syndrome in men
Published in Arab Journal of Urology, 2023
Kareim Khalafalla, Ahmed Albakr, Walid El Ansari, Ahmad Majzoub, Haitham Elbardisi, Khalid AlRumaihi, Mohamed Arafa
Men attending the chronic pelvic pain clinic for the first time are thoroughly evaluated with history and physical examination. Different aspects of chronic pelvic pain are assessed and characterized including pain location, description and triggering factors. In addition, pain-related psychosocial symptoms, e.g. stress, anxiety, and depression are appraised. For lower urinary tract symptoms (LUTS) evaluation and bladder and prostate assessment, expressed prostatic secretions and midstream urine samples are cultured. When needed, flexible cystoscopy is performed to exclude anatomical and pathological abnormalities. Depending on the findings, patients are offered pharmacological and/or non-pharmacological therapies, including alpha blockers, antibiotics, antidepressants, anticholinergics, neuroleptics, phytotherapy, physical therapy, mental health therapy and ESWT.
Comprehensive overview of the venous disorder known as pelvic congestion syndrome
Published in Annals of Medicine, 2022
Kamil Bałabuszek, Michał Toborek, Radosław Pietura
Pelvic Venous Disorders manifests in many clinical presentations. Pelvic Congestion Syndrome is a common condition occurring worldwide, in which a significant proportion of cases remain undiagnosed and symptoms reported by women are often underestimated, due to poor knowledge of the condition. It is an important cause of chronic pelvic pain in female patients. It can also present with superficial varicose veins as the only symptom as well as in combination with pain. Symptoms can be non-specific and difficult to distinguish from other diseases. Certain diagnosis of the PCS is very challenging, due to its multiformity. Determining which patients suffer from symptoms associated with PCS is hard, but also extremely important to implement appropriate and targeted treatment. Future randomised trials on embolisation management are needed. A common treatment algorithm for trials based on an understanding of the mechanisms leading to symptoms would be particularly helpful in objectively evaluating outcomes.
Which factors are associated with the recurrence of endometrioma after cystectomy?
Published in Journal of Obstetrics and Gynaecology, 2018
Mehmet Küçükbaş, Meryem Kurek Eken, Gülşah İlhan, Taylan Şenol, Dilşad Herkiloğlu, Bilge Kapudere
No correlation was found between the extent of disease and pelvic pain in previous studies (Fedele et al. 1992; Gruppo Italiano per lo Studio dell’Endometriosi 2001). But it should be noted that dyspareunia and chronic pelvic pain are typically associated with deep infiltrating endometriosis, which is also related to the presence and extent of pelvic adhesions (Porpora et al. 2010). These symptoms are often seen when the posterior cul-de-sac and rectovaginal septum are infiltrated (Chapron et al. 2005). Vignali et al. (2005) showed higher recurrence rates in patients with deep infiltrating endometriosis. Advanced stage of endometriosis and both advanced stage and deep infiltrating endometriosis are claimed to be risk factors for recurrence (Parazzini et al. 2005; Busacca et al. 2006). Non-cyclic pelvic pain may be an indirect sign of widespread disease and extent of pelvic adhesions. In our study, patients with preoperative dysmenorrhoea and non-cyclic pelvic pain had higher rates of recurrence. We also found a higher rate of recurrence in patients who had extensive pelvic adhesion. In a previous study, they concluded there was a higher rate of recurrence in patients with extensive pelvic adhesions. It may be that indirect signs of more aggressive disease and adhesion formation cause small endometriotic lesions to be overlooked and lead to incomplete surgery (Busacca et al. 1999; Porpora et al. 2010).
Related Knowledge Centers
- Adhesion
- Chronic Pain
- Interstitial Cystitis
- Irritable Bowel Syndrome
- Pelvis
- Pain
- Endometriosis
- Acute
- Urologic Chronic Pelvic Pain Syndrome
- Chronic Prostatitis/Chronic Pelvic Pain Syndrome