Chronic Pelvic Pain (CPP)

Chronic Pelvic Pain (CPP)

·        = Pelvis pain present for 6 months or longer. Can be intermittent (eg related to menses or intercourse) or continuous

·        Differential:

o   Gynaecological: dysmenorrhoea, endometriosis, adenomyosis, pelvic adhesions, PID, uterine prolapse, vaginitis, pelvic congestion (engorgement of pelvic vasculature – ie varicose veins), pelvic relaxation (trauma of pregnancy etc) 

o   Non-gynaecologic: UTI, interstitial cystitis, IBS, diverticular disease, musculo-skeletal disorders

o   Psychosocial: psychosomatic, abuse/rape, drug seeking, attention seeking

·        Exam: 

o   External genitalia, mono-manual (eg evidence of spasm), bi-manual, recto-vaginal (nodularity over uterosacral ligaments Þ endometriosis), speculum (eg discharge, cervical erythema)

o   Musculo-skeletal exam: tenderness over lumbar, lower thoracic muscles, strength

·        Investigations:

o   Always: cultures, FBC, urine culture and analysis, US, pap smear 

o   If indicated: pregnancy, GI and GU workup, psych evaluation, laproscopy (if suspicious masses, other physical findings, acute abdomen, if for reassurance then wait a while first)

·        Treatment:

o   Drugs: NSAIDs, PG-inhibitors, ?antibiotics, OCP for at least 3 months

o   GI: diet changes, stool softeners, bulking agents

o   Exercise