Chronic Pelvic Pain
Chronic pelvic pain is
defined in a variety of ways. A useful clinical definition of chronic pelvic
pain is noncyclic pain that lasts six months or more; is localized to the
pelvis, the anterior abdominal wall at or below the umbilicus, or the buttocks;
and is of sufficient severity to cause functional disability or require medical
care. As a Women’s Health physical therapist I have quite a
bit of exposure to the diagnosis of chronic pelvic pain but I was quite shocked
at the numbers associated with this condition upon reading an article recently
while preparing for an in-service. Two to 10% of all
gynecologic office consultations are for chronic pelvic pain. Twenty percent of
all laparoscopies are performed for chronic pelvic pain. It is estimated that
10 million women suffer from this condition and that 7 million do not seek
help. Up to 61% of patients are found to have no explanation for their pain. The
economic impact of this condition is astonishing. The annual medical cost for
diagnosis and treatment of chronic pelvic pain is estimated to be about $1.2
billion annually. The cost of lost productivity in these patients is estimated
to be $15 billion annually. The most commonly made diagnosis in chronic pelvic
pain is endometriosis (31%). The majority are undiagnosed or improperly
diagnosed. (Ref. 1)
Initially the pelvic pain perception had been based on the
theory that the level of pain should be proportional to the degree of tissue
damage. So if your doctor could not see or palpate any masses or abnormal
tissue-then you shouldn’t be feeling any pain. That notion in the medical community is
changing. Studies show that at best only 60-70% of women undergoing
laparoscopic surgery for endometriosis experience pain relief, showing that
there is more to the story. (Ref. 2) More information is now showing the
presence of one or more other chronic pain disorders such as interstitial
cystitis, irritable bowel syndrome, TMJ disorder, migraines, pelvic congestion
syndrome, ovarian remnant, vulvodynia, or fibromyalgia suggesting that pelvic
pain should be treated as a disease rather than just as pathological changes.
Musculoskeletal dysfunction can be a driver for pelvic pain,
either as the primary problem or a secondary reaction to pelvic pain. Issues
such as overactive pelvic floor muscles or hip dysfunction can be contributors.
According to a Clinical Expert Series article on chronic pelvic pain from the
Journal of Obstetrics and Gynecology-
“The mainstay of treatment of muscular components of pelvic pain is
physical therapy, most commonly performed by a therapist with specialized
training in the treatment of female pelvic pain. This subspecialty of the field
has grown enormously over the pat 15 years in obvious response to growing
recognition of muscular elements to pelvic pain and in recognition that it
works.” (Ref. 2)
Hopefully attitudes towards chronic pelvic pain will
continue to change and the medical community will move even further away from
the “I can’t see it so you shouldn’t feel it” notion. It seems that more
credence is now being given to treating the whole body and giving consideration
to many factors such as anatomical, musculoskeletal, bowel and bladder
function, and psychological issues. The multi-disciplinarian approach appears
the best way to give women the support they need in dealing with this often
misunderstood condition.
References
1.
Scialli AR, Barbieri RL,
Glasser MH, Olive DL, Winkel CA. Association of Professors of Gynecology
and Obstetrics Educational Series on Women's Health Issues: chronic pelvic
pain: an integrated approach. January 2000; 1–9
2.
Steege
JF, Siedhoff MT. ACOG Clinical Expert Series, Chronic Pelvic Pain. September 2014; 616-629.
Resources
www.pelvicpain.org
International Pelvic Pain Society