Pelvic pain is a benign pain in the lower abdomen, pelvic organs, groin, lower back and sacrum. Over a period of time, they constantly make themselves felt and are repeated at regular intervals. Such repetitions are neither related to sexual life, nor to physical activity, nor to the menstrual cycle in women. Chronic pelvic pain syndrome occurs at different ages in different categories of people: whether it is an athlete or a housewife. With lesions of the motor apparatus, this syndrome is more common, as well as in people with low physical activity.
Syndrome concept
Chronic pelvic pain syndrome is manifested by painful symptoms and sensations in the lower abdomen, they can last at least six months. Pain can appear both on an ongoing basis and with some periodicity. The harm caused by it can have a very strong effect on the body as a whole, as well as on the performance of the usual daily operations for patients.
With injuries of ligaments, bones or cartilage of the small pelvis, acute pain can appear, which later becomes aching, and pain can also occur with intense physical exertion or with inflammation in the pelvic organs. In the cases described, it is very difficult to establish the cause of the pain, because it is not possible to determine the location.
According to medical research companies, more than 65% of women who come to see a gynecologist have a history of chronic pelvic pain when collecting an anamnesis. A fairly common situation is when the patient visits the urologist first and undergoes treatment with him, then the gynecologist also follows the treatment, and the pain does not go away. The reason is that the diagnosis is complicated by the fact that the localization of pain is very difficult to determine, respectively, examinations are prescribed that do not correspond to the true disease. You have to go for expensive treatment and complex examinations so that the disease is accurately determined.
In women and men, in connection with the ongoing pelvic pains, there is a panic fear of cancer, even the doctors themselves give directions to oncologists, so this pathology can also become the cause of psychological disorders.
Mandatory symptoms
It has been accepted by the International Association of Doctors that, in order to make a diagnosis of chronic pelvic pain syndrome in humans, all of the following characteristics should be manifested simultaneously. It:
- pain in the pelvic area is disturbed for six or more months;
- the patient’s sensation of the degree of pain does not correspond to the nature of damage to organs or bones;
- the therapy that is applied does not help;
- symptoms of depressive depression;
- symptoms of a behavior disorder;
- physical activity is limited.
Diagnostic symptoms
In addition to the mandatory symptoms of pelvic pain, there are signs that indirectly indicate this syndrome.
- Dull pain in the lower abdomen, discomfort in the groin, in the vagina in women, in the sacral zone and the coccyx. Such pain cannot be clearly localized, and the pain is not associated with diseases of the internal organs and spine. Usually, pains are felt in the gluteal region, in the femoral joints, in the external inguinal zones, are permanent. Soreness increases many times during urination, muscle tension, as well as when a person is lying and sitting for a long time, with hypothermia, exacerbation of chronic diseases of the pelvic organs, with gynecological manipulations.
- Menstruation in women with increased pain, pain in the premenstrual phase, menstrual bleeding become more abundant than usual. One of the symptoms of pelvic pain in women is bleeding between periods.
- During intercourse, signs of discomfort appear, a small amount of lubrication, acute pain when the male penis penetrates the vagina.
- Poor sleep, low ability to work, depressed state, depression, hypochondria and emotional instability. Such alarming symptoms further provoke the patient's inadequate response to pain. Nerve symptoms are especially pronounced in people with an unstable psyche, with a rapidly excitable character.
With such symptoms, a doctor's examination is prescribed, during which the following non-specific symptoms are usually revealed: abundant vaginal discharge, swollen enlarged uterine body, unhealthy color of the vaginal mucosa, cyanotic color of the cervix.
An ultrasound examination reveals varicose veins of the pelvis, the ovaries undergo the formation of small cysts. Often at the stage of a diagnostic study, myomatous nodes, endometriosis, inflammation in the tubes and ovaries are detected.
Pelvic pain stages
- The first stage is the organ. At this stage, pelvic pains in the lower body are weak, appear episodes. Pain is accompanied by impaired function of internal organs. Pain sensations correspond to the degree of circulatory disturbance of the pelvis and venous blood stasis. During gynecological examinations, taking a smear and ultrasound, the patient has unpleasant sensations, the cervix becomes sensitive and painful.
- The second stage is the organ. Here, in the process, nerve plexuses and nerves near the spine begin to participate, as a result of this, the pain intensifies and penetrates the upper abdomen. Pain during gynecological manipulations develop into acute pain. It is during this period that doctors can make the wrong diagnosis due to the movement of the focus of pain in the upper sections.
- The third stage is the polysystem one. This period is considered final in the process of the formation of chronic pelvic pain syndrome. The process includes different departments of the pathways of nerve impulses, pain increases in depth and intensity, metabolic processes in the tissues of the pelvic organs are disrupted. Due to these changes, metabolic processes in the genitals are disturbed, the functioning of the intestine and genitourinary system is disrupted. The pain syndrome develops on an increasing basis, amplification occurs even due to minor reasons, due to various irritants. It is difficult for the doctor to diagnose the disease, because the clinical picture becomes unclear due to the patient’s numerous complaints, it becomes impossible to rely solely on the patient’s history.
Causes
The difference between acute and chronic pelvic pain is that the location of the pain is difficult to determine. The body gradually adapts to constant pain, against the background of this, a person has a deterioration in the quality of life, problems in his personal life, intimate life and social sphere.
Causes of chronic pelvic pain in women:
- Anomalies of the internal genital organs: uterine fibroids, tumors, the intrauterine device, endometriosis, adhesions, birth trauma of the sacral region, congenital anomalies of the genital organs.
- Chronic inflammation of the urogenital system, renal dystopia, renal abnormalities, or urolithiasis.
- Anomalies of the skeletal-cartilaginous system, muscle system and peripheral nerves: disc hernia of the spine, osteochondrosis, coccygodynia due to lack of mobility of the body, tailbone injury with damaged nerve plexuses, plexitis, arthrosis of the femur joint, neuromas, tuberculous injuries of the spine, prolapse of the rectum prolapse of the uterus.
- Diseases of the descending and ascending parts of the colon: proctitis, adhesive processes in the abdominal cavity, ulcerative colitis, chronic colitis.
- Vascular anomalies: dilatation of the pelvic veins, vasculitis in connective tissue diseases, varicose veins of the genitals.
- Mental disorders: depression, prolonged stress, epilepsy.
Each of the aforementioned diseases can be the reason on the basis of which there will be a pelvic pain syndrome in women and men as a disease, in contrast to pain, which is a symptom of a certain disease. Here doctors have a hard time: determining a symptom or a disease can be very difficult, it is required to establish not only a functional cause, but also an organic one. But in more than 3% of cases, the etiology of pain remains unknown.
With a mistakenly chosen course of treatment (antibacterial drugs, monophasic contraceptives), the disease not only does not go away, but also causes other unpleasant causes of pelvic pain in women in the form of thrush, resistant ovary syndrome and others.
The formation of a chronic process
The ideas about the formation of pathology are based on the concept of functional somatic syndrome. Pelvic pain is one of the manifestations of this syndrome, which can be characterized by unusual symptoms and mechanisms. The pelvic muscles that support, contract, and relax have the same innervation: the nerve cells that control all of the above processes are located in the spinal cord.
Chronic pelvic pain in women includes the following pathologies:
- the emergence of a long source of flow of impulses reaching the spinal cord, this increases the excitation of the corresponding parts of the spinal cord, the largest number of these impulses goes to the departments that are responsible for muscle tone, this is a consequence of its increase;
- low threshold for the reception of pain impulses, as a result of which simple physiological impulses from organs are considered by the body as pain;
- disturbances in response impulses from the spinal cord and brain to the pelvic internal organs and muscle tissues are persistent.
Attacks of pain are caused by excessive physical and mental stress. The reason for their occurrence in the absence of pathological changes in the pelvic organs is contained in:
- altered states of the central nervous system;
- vegetative pathologies in some departments;
- slow outflow of venous blood fluid and lymph, as a result - worsening of blood circulation in the uterus, this can cause myometrial edema, the formation of cysts and adhesions;
- malnutrition of the pelvic organs;
- disorder of the hormonal background of the whole organism.
With a single occurrence of pelvic pain, it can become chronic with a low activity of the pathways emerging from the spinal cord and forming a pain signal to the brain, the main role here is given to pathological impulses that exit from the painful organs of the small pelvis.
Male pathology
Pain in men is not as common as in women, but it does occur. 90% of cases of pelvic pain in men are manifested by pain that accompany prostatitis. Types of prostatitis are distinguished:
- Type one: acute prostatitis with bacterial etiology.
- Type two: chronic prostatitis.
- Type three: chronic non-bacterial prostatitis, which is a chronic pelvic pain syndrome in men.
- Type four: prostatitis, which occurs against the background of inflammation.
Symptoms of the third type of prostatitis (pelvic pain syndrome in men):
- Urinary retention, acute pain during urination.
- Discomfort in the inguinal zone, especially in the area of ​​the head of the male genital organ and testicles.
- Aching, ongoing pain in the lumbar region.
- Discomfort in the anus.
- Pain during sexual contact.
- Pain during ejaculation.
- Detection of blood in sperm fluid.
Chronic pelvic pain syndrome with nerve pathology.
Pain in men can occur as a result of nerve deformation. During surgical operations or neuropathies, damage to the nerves that are located in the area of ​​the pelvic organs is possible - the inguinal nerve, the shameless nerve.
With such lesions, pelvic pain syndrome in men is expressed by the following symptoms:
- Pain during sexual contact.
- Pain when a man is in a sitting position.
- Pain in the lower back.
- Soreness in the inguinal region.
- Severe pain during urination.
Chronic pelvic pain syndrome in men with irritable bowel pathology.
An irritated bowel is a frequent signal of the pathology of the pelvic organs in men. The following symptoms are most pronounced:
- Spasm and colic in the lower abdomen on the left side.
- Dysfunction of the intestinal system, manifested by constipation, flatulence and diarrhea.
- Pain sensations become most severe after eating.
- Pain during sexual interaction.
- Pain syndrome is aggravated by stress, depression and anxiety.
Chronic pelvic pain syndrome with pathologies in the genitourinary system.
Pain syndrome that occurs with tumors of the bladder or ureter, with cystitis in men, manifests itself in the following symptoms:
- Soreness after urination and when the bladder is full of fluid.
- Urinary incontinence.
- Frequent trips to the toilet.
- Pain during sex.
- Soreness in the inguinal zone.
Chronic pelvic pain syndrome in the inflammatory process of the pubic bone.
Pain sensations arising from inflammation of the pubic bone can be diagnosed not only in men with weakened immunity, but also in physically healthy and strong representatives of the stronger sex. Symptoms are as follows:
- Soreness of the inguinal zone, may increase with physical exertion.
- Soreness when mixing legs.
- Pain when squatting or when a man climbs a ladder.
Symptoms of chronic pelvic pain vary depending on the cause and depending on the inborn characteristics of the patient. If you suspect that you have this difficult disease, do not postpone the visit to the doctor. Chronic pelvic pain syndrome can manifest as a single symptom or as a whole.
What is the prevalence of pain in the pelvic organs?
Not everyone has a hearing syndrome in the pelvic bone, but it occurs quite regularly, according to statistics, every eighth woman and every second man. Prolonged pain can provoke long physical discomforts, psychological discomfort, as well as growing problems in intimate life.
Diagnostics
The pathogenesis of the disease includes many factors, therefore, a single set of measures for the diagnosis of pain in the pelvic bone is currently missing, examination of the patient is quite problematic and includes a huge number of studies, individual for each case.
Diagnosis should be carried out in several different stages, it begins with collecting a patient’s medical history, then clinical tests and special gynecological studies are prescribed, and pain sensitivity thresholds are determined using an algesimeter device. Also, the attending physician may schedule consultations with a surgeon, urologist, gynecologist and neurologist.
The next stage of diagnostic studies includes examinations that are prescribed by narrow-profile specialists, these can be: smears of vaginal discharge in women, cervical swab, urethral swab in men. These tests are prescribed to detect chlamydia, mycoplasma infections, herpes viruses, since these pathogens are often the causes of lesions of the nerve nodes and plexuses of the pelvic organs.
Mandatory is an ultrasound examination of the pelvic organs with dopplerometry of the pelvic vessels, an X-ray examination, magnetic resonance imaging, computed tomography of the spine and pelvic bones are prescribed. Also a frequent study is absorption densitometry for the diagnosis of bone abnormalities.
At the third stage of diagnostic studies, material is collected for examination for the presence of tumors, inflammation in the body, endometriosis, adhesions, as well as varicose enlargements of the walls of the pelvic organs. Methods of examination: hysteroscopy, hysterosalpingography, laparoscopy (material for cytological examination).
Only after a comprehensive and complete examination of the pelvic organs can bone diseases, internal organs and others be excluded. Many of these studies identify other serious illnesses that cause pelvic pain.
Treatment
There are a lot of reasons and symptoms of such a pathology, therefore it is important to identify the main and indirect ones and prescribe the right treatment. As a rule, the treatment is long and complicated, because many factors and parallel diseases in the body affect pains in the pelvic area. Only an individual approach to a specific case can guarantee the successful completion of a course of procedures. Self-medication for such pain is pointless and dangerous, so it is very important to trust the hands of a professional doctor.
Chronic pelvic pain syndrome requires a thorough examination. A diagnosis and selection of a treatment regimen are impossible without a comprehensive and correct understanding of the mechanisms of development of this anomaly, namely, as a disease and its differentiation from pain, which is just a symptom of some disease or congenital state of the organ or system as a whole.
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This method of treatment is carried out using the complete elimination or temporary reduction of the degree of intensity of the flow of pathological pain impulses. Doctors prescribe non-steroidal anti-inflammatory drugs: Ibuprofen, Nurofen, Nimesil and others. Combined analgesic drugs and antispasmodic drugs are also used. In the fight against chronic pelvic pains, acupuncture and acupressure are used.
The latest neurosurgical laser techniques allow you to achieve quick results. If external endometriosis of the genitals is detected, drugs are used to restore the hormonal background, as a rule, combined oral contraceptives are used.
Vascular and tissue therapy.
The purpose of this type of treatment are:
- elimination of inflammation in the walls of veins and tissues of the pelvic organs;
- correction of pathologies of microcirculation processes;
- activation of the outflow of venous blood from the pelvic organs by increasing the tone of the venous walls;
- increased permeability of the walls of small capillaries;
- increased fluidity;
- correction of the general hormonal background.
In order to improve the microcirculation processes, the following drugs are prescribed: Trental, Curantil, Pentoxifylline and others. Gels for external use Troxevasin and Cyclo 3 Fort are excellent remedies. They increase the tone of the venous walls, improve the stability of small capillaries, and also improve blood circulation. If the funds do not have the desired effect, then endoscopic treatment of varicose vessels and veins of the pelvic organs is performed.
To improve metabolism and normalize the flow of biochemical reactions in them, folic acid, vitamin preparations (B vitamins, ascorbic acid), antioxidant drugs (Wobenzym, Solcoseryl) are used.
Correction of biomechanical disturbances.
A very important method of treating pelvic pain is physical exposure, in other words physiotherapy exercises. This is a set of physical exercises to relax and restore muscles, to reduce the muscles of the inguinal region. Combine such exercises with holding your breath in inhale and exhale for a few seconds. Also, the patient is prescribed exercises for a reflex increase in the tone of the muscles of the buttocks, they relax the ligaments of the pelvis and help reduce pain.
To correct degenerative changes in joints and reflex pathologies of muscle tone, reduce saturation of pain, eliminate pathologies of the motor apparatus, manual therapy, massaging of the sacral zone, physiotherapy exercises, and physiotherapy are widely used.
In order to eliminate muscle spasm in therapy, muscle relaxants of central action ("Midokalm") in tablets are used. An effective and promising in terms of stopping the detection of increased tone is a comprehensive method of injecting botulinum toxin "A" into the muscles of the pelvic floor. This method can help in the elimination of severe pain.
An excellent effect in the treatment of pelvic pain syndrome is brought by the hemosiniatric treatment, it consists of ten procedures in which homeopathic preparations are administered under the skin to the patient in the corresponding points of the pelvic area. Physiotherapeutic manipulations are performed using dynamic currents and sinus-modeled currents for electrical stimulation of nerve flows. In addition to all this, relaxing massages are widely used.
Correction of psychological health.
As mentioned earlier, one of the causes of severe pelvic pain is nervous disorders and stress. Specialists have developed a whole system of treatment of the disease for psychological reasons, consider it below.
To improve the patient’s mental health, training programs are conducted for psychological techniques and techniques to reduce the saturation of pelvic pain, these programs include: the rules of autogenic training, emotional and psychological relaxation, and sessions of suggestive therapy.
The attending physician prescribes sedatives (tincture of hawthorn, valerian root, motherwort root, Corvalol, Novo-Passit), as well as synthetic pharmaceutical drugs and tranquilizers (Relium, Diazepam). To improve sleep and fight insomnia, light sleeping pills and antidepressants are used (Phenazepam).
To improve overall psychological well-being, the patient undergoes a course of iontophoresis and massage to obtain a relaxing effect.
Chronic pelvic pain syndrome involves a thorough study of all the symptoms, a detailed study of each organ. No doctor will be able to make a correct diagnosis without a deep understanding of the mechanism of origin of this anomaly, therefore it is so important to pay attention to each complaint, to fix the anamnesis. Complaints can clarify the causes of pelvic pain syndrome, and can also reveal other equally serious diseases of the pelvic organs.
Prevention
The best preventative method in preventing pain is a healthy lifestyle. A correct lifestyle will not only prevent chronic pelvic pain, but also other concomitant diseases of the body. It is important not to abuse alcohol and tobacco, because it is these bad habits that provoke stagnation of blood and lymph in the vessels.
Also, one must not forget about proper nutrition: it is necessary to adhere to the principle of frequency in eating food, and also not to eat too heavy and fatty foods. Fatty foods contribute to poor vascular permeability, because of this, blood circulation is disturbed, and these are all direct causes of chronic pelvic pain syndrome. Excessive consumption of carbonated drinks can cause an increase in blood sugar, which can also indirectly affect the onset of an unpleasant syndrome.
An active lifestyle promotes good muscle tone, regular exercise helps the blood circulate more actively throughout the body.
And the most important thing in the prevention of pelvic pain syndrome is regular examinations by a specialist. After all, this syndrome can provoke viruses or infections, which is why it is important to take tests and undergo examinations by a gynecologist and urologist.
If you experience primary symptoms and pain, you should immediately contact a medical institution for a diagnosis, because the treatment of chronic pelvic pain will be most effective and quick at the initial stage. Such a disease is not subject to self-medication or treatment with traditional medicine.