Pelvic pain is a benign pain in the lower abdomen, pelvic organs, groin, lumbar region and sacrum. For some period of time, they constantly make themselves felt and are repeated at regular intervals. Such repetitions are not associated with sexual life, nor with physical activity, nor with the menstrual cycle in women. Chronic pelvic pain syndrome occurs at different ages in different categories of people: be it an athlete or a housewife. With lesions of the locomotor system, this syndrome occurs more often, 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 impact on the body as a whole, as well as on the performance of the usual daily operations of patients.
In case of injuries of the ligaments, bones or cartilage of the small pelvis, acute pain may appear, which later becomes aching, and pain can also occur during intense physical exertion or during inflammation in the pelvic organs. In the described cases, it is very difficult to establish the cause of 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 symptoms of chronic pelvic pain during their medical history. A fairly common situation is when a patient first visits a urologist and undergoes treatment with him, then a gynecologist also with subsequent treatment, but the pain does not go away. The reason is that the diagnosis is complicated by the fact that it is very difficult to determine the localization of pain, respectively, examinations are prescribed that do not correspond to the true disease. You have to seek expensive treatment and complex examinations in order for the disease to be accurately determined.
In women and men, due to incessant pelvic pain, there is a panic fear of cancer, even doctors themselves give referrals to oncologists, so this pathology can also cause psychological disorders.
Required symptoms
It is accepted by the International Association of Doctors that a person must have all of the following characteristics at the same time to be diagnosed with chronic pelvic pain syndrome. This is:
- pelvic pain for six or moremonths;
- Patient's perception of the degree of pain does not correspond to the nature of damage to organs or bones;
- the therapy being applied is not helping;
- symptoms of depressive oppression;
- symptoms of conduct disorder;
- Physical activity is limited.
Diagnostic symptoms
In addition to the obligatory 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 area and the coccyx area. Such pain cannot be clearly localized, and the pain is not associated with diseases of the internal organs and the spine. Usually pains are felt in the gluteal zone, in the hip joints, in the external inguinal zones, they are permanent. Soreness increases many times during the process of urination, muscle tension, as well as when a person is in a lying and sitting position for a long time, with hypothermia, exacerbation of chronic diseases of the pelvic organs, during gynecological manipulations.
- Menstruation in women with increased pain, pain in the premenstrual phase, menstrual bleeding becomes more abundant than usual. Also one of the symptoms of pelvic pain in women is bleeding between periods.
- During sexual intercourse there are signs of discomfort, a small amount of lubrication, acute pain when the male penis penetrates the vagina.
- Bad sleep, poor performance, depression, depression, hypochondria and emotional instability. Such disturbing symptomsfurther provoke an inadequate response of the patient to pain. Nervous symptoms are especially pronounced in people with an unstable psyche, with a quickly excitable character.
With such symptoms, a doctor's examination is prescribed, during which the following non-specific symptoms are usually detected: abundant vaginal discharge, edematous enlarged uterine body, unhe althy color of the vaginal mucosa, bluish color of the cervix.
Ultrasound examination reveals varicose veins of the pelvis, the ovaries are subjected to the formation of small cysts. Often, at the stage of a diagnostic study, myomatous nodes, endometriosis, inflammation in the tubes and ovaries are detected.
Stages of pelvic pain formation
- First stage - organ. At this stage, pelvic pain in the lower part of the body is mild, appearing in episodes. Pain is accompanied by dysfunction of internal organs. Pain corresponds to the degree of circulatory disorders of the small pelvis and venous blood stasis. The patient experiences discomfort during gynecological examinations, taking a smear and ultrasound, the cervix becomes sensitive and painful.
- The second stage is over the organ. Here, the nerve plexuses and nerves near the spine begin to participate in the process, as a result of which the pain intensifies and penetrates into the upper abdomen. Painful sensations during gynecological manipulations develop into sharp pains. It is during this period that doctors can make an incorrect diagnosis due to the movement of the focus of pain to the upper sections.
- The third stage is polysystemic. This period is considered final in the process of formation of chronic pelvic pain syndrome. The process includes different parts of the pathways of nerve impulses, pain increases in depth and intensity, metabolic processes in the tissues of the pelvic organs are disturbed. Because of these changes, metabolic disturbances occur in the genital organs, the functioning of the intestines and the genitourinary system is disrupted. The pain syndrome develops on the rise, the increase occurs even due to minor causes, due to various irritants. It is difficult for a doctor to diagnose the disease, because as the clinical picture becomes unclear due to the numerous complaints of the patient, it becomes impossible to rely only on the patient's history.
Reasons
The difference between chronic and acute pelvic pain is that the location of the pain is difficult to determine. The body gradually adapts to constant pain, against this background, a person experiences 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, intrauterine device, endometriosis, adhesive processes, birth trauma of the sacral region, congenital anomalies of the genital organs.
- Chronic inflammation of the genitourinary system, kidney dystopia, kidney anomalies or urolithiasis.
- Anomalies of the osteochondral system, muscular apparatus and peripheral nerves: disc herniation of the spine, osteochondrosis,coccygodynia due to insufficient mobility of the body, coccyx injury with damaged nerve plexuses, plexitis, arthrosis of the femoral joint, neurinomas, tuberculous lesions of the spine, prolapse of the rectum, prolapse of the uterus.
- Diseases of the descending and ascending colon: proctitis, abdominal adhesions, ulcerative colitis, chronic colitis.
- Vascular anomalies: dilatation of the veins of the small pelvis, vasculitis in connective tissue diseases, varicose veins of the parauterine veins.
- Mental disorders: depression, chronic stress, epilepsy.
Each of the above diseases can be the cause on the basis of which there is a pelvic pain syndrome in women and men as a disease, as opposed to pain, which is a symptom of a specific disease. Here, doctors have a hard time: it can be very difficult to determine whether this is a symptom or a disease, 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 an erroneously 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.
Formation of a chronic process
Representations 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 unusualsymptoms and mechanisms. The muscles of the pelvis that support, contract and relax share 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 a stream of impulses going to the spinal cord, this increases the excitation of the corresponding sections of the spinal cord, the largest number of these impulses enters the sections that are responsible for muscle tone, this is a consequence of its increase;
- underestimated threshold for the reception of pain impulses, as a result of which simple physiological impulses from organs are considered by the body as pain sensations;
- violations of response impulses from the spinal cord and brain to the pelvic internal organs and muscle tissues are persistent.
Pain attacks 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 - deterioration of blood circulation in the uterus, this can cause swelling of the myometrium, 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 gointo a chronic form with low activity of the pathways coming out of the spinal cord and forming a pain signal to the brain, the main role here is assigned to pathological impulses that come out of the painful organs of the small pelvis.
Pathology in males
Pain in men is not as common as in women, however, it does occur. 90% of cases of pelvic pain in men are manifested by pain that accompanies prostatitis. There are types of prostatitis:
- Type one: acute prostatitis with bacterial etiology.
- Type two: chronic prostatitis.
- Type three: chronic non-bacterial prostatitis, which is chronic male pelvic pain syndrome.
- Type four: prostatitis that occurs against the background of inflammation.
Symptoms of the third type of prostatitis (pelvic pain syndrome in men):
- Retention of urination, acute pain during urination.
- Discomfort in the groin area, especially in the head of the male genital organ and testicles.
- Aching incessant pain in the lumbar region.
- Feeling uncomfortable in the anal area.
- Pain on intercourse.
- Pain when ejaculating.
- Detection of blood in semen fluid.
Chronic pelvic pain syndrome due to nerve pathology.
Pain in men can result from deformed nerves. During surgical operations or neuropathies, damage to the nerves that are located in the area of \u200b\u200borgans is possiblesmall pelvis - inguinal nerve, pudendal nerve.
With such lesions, pelvic pain syndrome in men is expressed by the following symptoms:
- Pain during intercourse.
- Pain when a man is in a sitting position.
- Pain in the lower back.
- Soreness in the groin.
- Severe pain during urination.
Chronic pelvic pain syndrome in men with irritable bowel pathology.
Irritable bowel is a frequent signal of the pathology of the pelvic organs in men. The most pronounced symptoms are:
- Spasm and colic in the lower abdomen on the left side.
- Intestinal system dysfunction, manifested by constipation, flatulence and diarrhea.
- Pain is most intense after eating.
- Pain during sexual intercourse.
- Pain syndrome increases with stress, depression and anxiety.
Chronic pelvic pain syndrome in 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 fills with fluid.
- Urinary incontinence.
- Frequent trips to the toilet.
- Pain during sex.
- Pain in the groin.
Chronic pelvic pain syndrome due to inflammation of the pubic bone.
Painfulthe sensations that occur during inflammation of the pubic bone can be diagnosed not only in men with a weakened immune system, but also in physically he althy and strong representatives of the stronger sex. Symptoms are as follows:
- Soreness in the groin, may increase with physical activity.
- Soreness when bringing legs together.
- Pain while doing squats or climbing stairs.
The symptoms of chronic pelvic pain vary depending on the cause and depending on the congenital characteristics of the patient. If you suspect that you have this difficult disease, you should not postpone a visit to the doctor. Chronic pelvic pain syndrome can manifest as one symptom or a complex.
What is the prevalence of pelvic pain?
Pelvic bone pain syndrome is not heard by everyone, but it occurs quite regularly, according to statistics, in every eighth woman and every second man. Prolonged pain can provoke long-term physical inconvenience, psychological discomfort, as well as growing problems in intimate life.
Diagnosis
The pathogenesis of the disease includes many factors, so there is currently no unified set of measures for diagnosing pain in the pelvic bone, the 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 the collection of an anamnesis from the patient, after which clinical tests and special gynecological examinations are prescribed, pain sensitivity thresholds are determined using an algesimeter device. Also, the attending physician can appoint consultations with a surgeon, urologist, gynecologist and neurologist.
The next stage of diagnostic studies includes examinations that are prescribed by highly specialized specialists, these can be: swabs of vaginal discharge in women, a smear of the cervix, a smear from the urethra in men. These tests are prescribed to detect chlamydia, mycoplasma infections, herpes viruses, since these pathogens are often the causes of damage to 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 not uncommon is absorption densitometry for the diagnosis of bone anomalies.
At the third stage of diagnostic studies, material is taken for examination for the presence of tumors, inflammation in the body, endometriosis, adhesions, and varicose veins of the walls of the pelvic organs. Examination methods: hysteroscopy, hysterosalpingography, laparoscopy (material for cytological examination).
Only after a comprehensive and complete examination of the pelvic organs, diseases of the bones, internal organs and others can be excluded. Many of these studiesidentify other serious diseases that are the causes of pelvic pain.
Treatment
There are a lot of causes and symptoms of such a pathology, so it is important to identify the main and indirect ones and prescribe the right treatment. As a rule, treatment is long and complicated, because pain in the pelvic region is affected by many factors and parallel diseases in the body. 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. Diagnosis and selection of a treatment regimen are impossible without a comprehensive and correct understanding of the mechanisms of development of this anomaly precisely as a disease and its differentiation with pain, which is just a symptom of some disease or congenital condition of an organ or system as a whole.
Comprehensive treatment of pelvic pain in women and men includes many measures and solutions, consider the possible.
Surgical intervention.
This type of pathology treatment is the most conservative. When identifying a disease with a chronic course, it is important to eliminate the source of pain. With surgical treatment, this can be done as quickly and efficiently as possible.
Fighting chronic pain.
This method of treatment is carried out with the help of the complete elimination or temporary decrease in the degree of intensity of the flow of pathologicalpain impulses. Doctors prescribe anti-inflammatory drugs without steroids: Ibuprofen, Nurofen, Nimesil and others. Combined analgesic drugs and antispasmodic drugs are also used. In the fight against chronic pelvic pain, acupuncture is used, as well as acupressure.
The latest neurosurgical laser techniques allow you to achieve fast results. If external endometriosis of the genitals is detected, drugs are used to restore hormonal levels, as a rule, combined oral contraceptives are used.
Vascular and tissue therapy.
The purpose of this type of treatment is:
- eliminate the process of inflammation in the walls of the 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;
- increasing the permeability of the walls of small capillaries;
- increased fluidity of blood fluid;
- correction of the general hormonal background.
In order to improve microcirculation processes, the following drugs are prescribed: Trental, Curantil, Pentoxifylline and others. Excellent means are gels for external use "Troxevasin" and "Cyclo 3 Fort", they increase the tone of the venous walls, improve the stability of small capillaries, and also improve blood circulation. If the funds do not provide adequateeffect, then endoscopic treatment of varicose veins and walls of the veins of the pelvic organs is carried out.
To improve metabolism and normalize the course of biochemical reactions in them, folic acid, vitamin preparations (group B vitamins, ascorbic acid), antioxidant preparations (Wobenzym, Solcoseryl) are used.
Correction of biomechanical disorders.
A very important method of treating pelvic pain is the physical impact, in other words, physical therapy. This is a set of physical exercises for relaxing and restoring muscles, for contracting the muscles of the inguinal region. Combine such exercises with holding your breath while inhaling and exhaling 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 the joints and reflex pathologies of muscle tissue tone, reduce the saturation of pain, eliminate pathologies of the motor apparatus, manual therapy, massage of the sacral zone, physiotherapy exercises, physiotherapy procedures are widely used.
To eliminate muscle spasm in therapy, muscle relaxants of central action ("Mydocalm") in tablets are used. Effective and promising in terms of stopping the manifestations of increased tone is a complex method of injections of botulinum toxin "A" into the muscles of the pelvic floor. This method can help eliminate severe pain.
An excellent effect in the treatment of pelvic pain syndrome is brought by hemosyniatric treatment, it consists of ten procedures in which homeopathic preparations are injected under the skin of the patient at the appropriate points of the pelvic region. Physiotherapeutic manipulations are carried out by using dynamic currents and sinus-modeled currents for electrical stimulation of nerve flows. In addition to all this, relaxing massage sessions are widely used.
Correction of mental he alth.
As mentioned earlier, one of the causes of severe pelvic pain is nervous disorders and stress. Specialists have developed a whole system of treating a disease for psychological reasons, we will consider it below.
To improve the mental he alth of the patient, training programs are conducted on psychological techniques and techniques to reduce the saturation of pelvic pain, these programs include: the rules of autogenic training, emotional and psychological relaxation, 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). Light sleeping pills and antidepressants (Phenazepam) are used to improve sleep and fight insomnia.
To improve the overall psychological well-being, the patient undergoes a course of iontophoresis and massage to get the effectrelaxation.
Chronic pelvic pain syndrome involves a thorough study of all 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 the origin of this anomaly, which is why it is so important to pay attention to each complaint and record an anamnesis. Complaints may shed light on the causes of pelvic pain syndrome and may also reveal other equally serious pelvic disorders.
Prevention
The best preventive method in preventing pain is a he althy lifestyle. The right lifestyle will not only prevent chronic pelvic pain, but also other concomitant diseases of the body. It is important not to abuse alcohol and smoking, because it is these bad habits that provoke stagnation of blood and lymph in the vessels.
Also, one should not forget about proper nutrition: it is necessary to adhere to the principle of periodicity in eating food, and also not to eat too heavy and fatty foods. Fatty food contributes to weak vascular permeability, in view 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 blood circulate more actively throughout the body.
And the most important thing in the prevention of pelvic pain syndrome is regular check-ups inspecialist. After all, this syndrome can be provoked by viruses or infections, which is why it is important to take tests and undergo examinations by a gynecologist and urologist.
If primary symptoms and pain occur, you should immediately contact a medical institution for a diagnosis, because the treatment of chronic pelvic pain will be most effective and fastest at the initial stage. Such a disease is not subject to self-treatment or treatment by traditional medicine.
