{"id":176,"date":"2020-08-13T16:54:41","date_gmt":"2020-08-13T16:54:41","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=176"},"modified":"2021-05-09T20:50:53","modified_gmt":"2021-05-09T20:50:53","slug":"39-chronic-pelvic-pain","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/39-chronic-pelvic-pain\/","title":{"rendered":"39. Chronic Pelvic Pain"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/maH5Sqz8r_c\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 4:26<\/p>\n<input type='hidden' bg_collapse_expand='69e9c8eba239e9097298961' value='69e9c8eba239e9097298961'><input type='hidden' id='bg-show-more-text-69e9c8eba239e9097298961' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9c8eba239e9097298961' value='Hide Transcript'><button id='bg-showmore-action-69e9c8eba239e9097298961' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9c8eba239e9097298961' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 39<br \/>\n00:02<br \/>\nchronic pelvic pain chronic pelvic pain<br \/>\n00:05<br \/>\nis a common and significant disorder of<br \/>\n00:07<br \/>\nwomen that represent significant<br \/>\n00:09<br \/>\ndisability and represents 10% of all<br \/>\n00:11<br \/>\nreferrals to gynecologists the<br \/>\n00:13<br \/>\nobjectives of this video are to define<br \/>\n00:15<br \/>\nchronic pelvic pain to define the<br \/>\n00:17<br \/>\nprevalence and common ideologies of<br \/>\n00:19<br \/>\nchronic pelvic pain to describe the<br \/>\n00:21<br \/>\nsymptoms and physical exam findings in a<br \/>\n00:23<br \/>\npatient with chronic pelvic pain discuss<br \/>\n00:25<br \/>\nevaluation and management options for<br \/>\n00:27<br \/>\nchronic pelvic pain and to discuss the<br \/>\n00:29<br \/>\npsychosocial issues associated with<br \/>\n00:31<br \/>\nchronic pelvic pain let&#8217;s start with the<br \/>\n00:33<br \/>\nbasics with a definition there is no<br \/>\n00:35<br \/>\ngenerally accepted definition of chronic<br \/>\n00:37<br \/>\npelvic pain but one proposed definition<br \/>\n00:39<br \/>\nincludes non cyclic pain that lasts for<br \/>\n00:42<br \/>\ngreater than six months that localizes<br \/>\n00:45<br \/>\nto the anatomic pelvis the anterior<br \/>\n00:48<br \/>\nabdominal wall at or below the umbilicus<br \/>\n00:50<br \/>\nthe lumbosacral back or the buttocks and<br \/>\n00:53<br \/>\nis of sufficient severity to cause<br \/>\n00:55<br \/>\nfunctional disability or lead to medical<br \/>\n00:57<br \/>\ncare the prevalence of chronic pelvic<br \/>\n00:59<br \/>\npain is 3.8 percent of women aged 15 to<br \/>\n01:02<br \/>\n73 which is higher than the prevalence<br \/>\n01:04<br \/>\nof migraine 2.1% and asthma 3.7 percent<br \/>\n01:09<br \/>\nmoving now to etiology x&#8217; most often the<br \/>\n01:12<br \/>\npain is associated with several<br \/>\n01:13<br \/>\ndiagnoses including gynecologic and non<br \/>\n01:15<br \/>\ngynecologic conditions the list of<br \/>\n01:18<br \/>\ngynecological conditions is extensive<br \/>\n01:20<br \/>\nand includes endometriosis gynecologic<br \/>\n01:22<br \/>\nmalignancies ovarian retention syndrome<br \/>\n01:24<br \/>\npelvic inflammatory disease adhesions<br \/>\n01:27<br \/>\nleiomyoma &#8211; benign cystic mesothelioma<br \/>\n01:29<br \/>\nadenomyosis cervical stenosis and<br \/>\n01:32<br \/>\nchronic endometritis of all the<br \/>\n01:34<br \/>\ngynecologic conditions PID in particular<br \/>\n01:37<br \/>\nincreases the risk of developing chronic<br \/>\n01:38<br \/>\npelvic pain 18 to 35 percent of women<br \/>\n01:42<br \/>\nwho have had PID will develop chronic<br \/>\n01:43<br \/>\npelvic pain the mechanism is thought to<br \/>\n01:46<br \/>\ninvolve chronic inflammation adhesive<br \/>\n01:48<br \/>\ndisease and the coexistence of<br \/>\n01:49<br \/>\npsychosocial factors the list of non<br \/>\n01:51<br \/>\ngynecological conditions that can<br \/>\n01:53<br \/>\ncontribute to chronic pelvic pain is<br \/>\n01:55<br \/>\nextensive however there are two that are<br \/>\n01:57<br \/>\nworth noting irritable bowel syndrome<br \/>\n01:58<br \/>\nand interstitial cystitis irritable<br \/>\n02:01<br \/>\nbowel syndrome affects fifty to eighty<br \/>\n02:03<br \/>\npercent of women with chronic pelvic<br \/>\n02:04<br \/>\npain it is defined as recurrent<br \/>\n02:06<br \/>\nabdominal pain or discomfort with a<br \/>\n02:08<br \/>\nmarked change in bowel habit for at<br \/>\n02:10<br \/>\nleast six months with symptoms<br \/>\n02:12<br \/>\nexperienced on Atlee<br \/>\n02:13<br \/>\nthree days of the last three months<br \/>\n02:16<br \/>\ninterstitial cystitis is a chronic<br \/>\n02:18<br \/>\ninflammatory condition of the bladder<br \/>\n02:19<br \/>\noften characterized by pelvic pain<br \/>\n02:21<br \/>\nurinary urgency frequency and<br \/>\n02:24<br \/>\ndyspareunia let&#8217;s move now to evaluation<br \/>\n02:27<br \/>\nit is important to note that the<br \/>\n02:28<br \/>\nsuccessful evaluation and treatment of a<br \/>\n02:30<br \/>\npatient with chronic pelvic pain<br \/>\n02:32<br \/>\nrequires a patient and caring physician<br \/>\n02:34<br \/>\nthe history and physical is an important<br \/>\n02:36<br \/>\ntime in which the physician can both<br \/>\n02:37<br \/>\ngather information and establish a<br \/>\n02:39<br \/>\ntrusting rapport remember that there is<br \/>\n02:41<br \/>\na significant correlation between a<br \/>\n02:43<br \/>\nhistory of abuse and chronic pain during<br \/>\n02:46<br \/>\nyour history asked for a description and<br \/>\n02:48<br \/>\ntiming of the symptoms perform a<br \/>\n02:50<br \/>\nthorough medical surgical menstrual and<br \/>\n02:53<br \/>\nsexual history and obtain a psychosocial<br \/>\n02:55<br \/>\nhistory and especially ask about<br \/>\n02:57<br \/>\ndepression depression is one of the<br \/>\n03:00<br \/>\nseveral predictors of pain severity and<br \/>\n03:02<br \/>\nis a significant indicator of<br \/>\n03:03<br \/>\nresponsiveness to treatment the physical<br \/>\n03:06<br \/>\nexamination should be directed towards<br \/>\n03:08<br \/>\ntrying to uncover possible causative<br \/>\n03:10<br \/>\npathologies of the pain the carnot sign<br \/>\n03:12<br \/>\nis a tensing of the abdominal wall while<br \/>\n03:14<br \/>\nraising the leg or chin which points to<br \/>\n03:17<br \/>\na myofascial component to pain also<br \/>\n03:19<br \/>\ndon&#8217;t forget to obtain cervical cultures<br \/>\n03:21<br \/>\nthe management often involves a<br \/>\n03:24<br \/>\nmultidisciplinary approach which may<br \/>\n03:25<br \/>\ninclude psychiatric evaluation physical<br \/>\n03:28<br \/>\ntherapy gastroenterology urology and\/or<br \/>\n03:31<br \/>\nanesthesia if the cause of the pain is<br \/>\n03:34<br \/>\nknown then it should be treated if the<br \/>\n03:36<br \/>\ncause of the pain is unknown then<br \/>\n03:38<br \/>\ntherapy will focus on pain relief<br \/>\n03:40<br \/>\nmedical therapy options to consider<br \/>\n03:42<br \/>\nwould be suppression of ovulation with<br \/>\n03:44<br \/>\noral contraception or a gnrh agonist may<br \/>\n03:47<br \/>\nbe useful also possible referral to GI<br \/>\n03:49<br \/>\nfor IBS or urology for interstitial<br \/>\n03:52<br \/>\ncystitis surgical therapies such as<br \/>\n03:54<br \/>\nhysterectomy should only be used after<br \/>\n03:56<br \/>\nnon gynecological causes have been ruled<br \/>\n03:58<br \/>\nout this concludes the aapko video on<br \/>\n04:01<br \/>\nchronic pelvic pain we have defined the<br \/>\n04:03<br \/>\nprevalence comedy ology symptoms and<br \/>\n04:05<br \/>\nphysical exam findings as well as<br \/>\n04:07<br \/>\nevaluation and management options for<br \/>\n04:09<br \/>\nthis common disease process<\/p>\n<p><\/div>\n<hr \/>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 4:26<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":39,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-176","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/176","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=176"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/176\/revisions"}],"predecessor-version":[{"id":2853,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/176\/revisions\/2853"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=176"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}