Materiały źródłowe

• #1 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  Chronic pelvic pain is a persistent or recurrent pain in the lower abdomen or pelvis lasting at least 3 to 6 months. […] Diagnosis is primarily clinical, based on history and physical examination, including a digital rectal exam and assessment for cutaneous allodynia. […] Although imaging and laboratory tests are often inconclusive, they can help identify comorbid conditions that contribute to chronic pelvic pain. […] Diagnosis is typically made after 3 to 6 months of persistent pelvic pain and is largely based on patient history and physical examination. […] Numerous symptoms or precipitating factors may support the diagnosis. […] Despite evaluation, an estimated 50% of cases remain undiagnosed. […] The clinical heterogeneity of chronic pelvic pain and its incompletely understood pathogenesis make treatment challenging.

• #2 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p380.html

  Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. […] Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is usually indicated in severe cases. […] In the absence of a clear etiology, chronic pelvic pain should be considered a regional pain syndrome or functional somatic syndrome, and a biopsychosocial approach to care is indicated. […] When chronic pelvic pain is severe, the patient should be referred for laparoscopy if the diagnosis remains unclear after the initial evaluation.

• #3 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p380.html

  Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. […] Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is usually indicated in severe cases. […] In the absence of a clear etiology, chronic pelvic pain should be considered a regional pain syndrome or functional somatic syndrome, and a biopsychosocial approach to care is indicated. […] When chronic pelvic pain is severe, the patient should be referred for laparoscopy if the diagnosis remains unclear after the initial evaluation.

• #4 Chronic pelvic pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/symptoms-causes/syc-20354368

  Chronic pelvic pain is pain in the area below the bellybutton and between the hips that lasts six months or longer. […] Chronic pelvic pain can have more than one cause. It may be a symptom of another disease, or it can be a condition in its own right. […] But tests may not be able to find a cause for chronic pelvic pain. In that case, the goal of treatment is to ease pain and other symptoms. That could make your quality of life better. […] Chronic pelvic pain is a complex health problem. Sometimes, tests may find that a single disease is the cause. In other cases, the pain may stem from more than one medical condition. For example, you might have endometriosis and interstitial cystitis, both of which play a role in chronic pelvic pain. […] Many conditions are linked to chronic pelvic pain. Having more than one condition that causes pelvic pain, such as endometriosis and fibroids, raises the risk. A history of sexual or physical abuse also may raise the risk.

• #5 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0601/p1535.html

  If the initial history and physical examination do not reveal a specific diagnosis, the initial diagnostic workup should include: a complete blood count, beta human chorionic gonadotropin levels, erythrocyte sedimentation rate, vaginal swabs for chlamydia and gonorrhea, urinalysis with urine culture, and a transvaginal pelvic ultrasound. […] The pathophysiology of chronic pelvic pain is not well understood. A definitive diagnosis is not made for 61 percent of women with chronic pelvic pain. Many patients and physicians incorrectly assume that all chronic pelvic pain results from a gynecologic source. […] When evaluating a patient with chronic pelvic pain, the history and physical examination can narrow the differential diagnosis and guide further laboratory and ancillary testing. […] Women with chronic pelvic pain usually want the following: to receive personalized care from their physicians; to be taken seriously; to receive an explanation for their condition (more so than a cure); and to be reassured.

• #6 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p380.html

  The history and physical examination are the most important components of the diagnostic evaluation. Limited laboratory testing and imaging are also indicated, with possible referral for laparoscopic or urologic evaluation as warranted by the clinical findings. […] Transvaginal ultrasonography is helpful to identify pelvic masses and adenomyosis. […] When the pain is severe, the patient should be referred for laparoscopy if the diagnosis remains unclear after the initial evaluation. […] Comprehensive guidelines for the diagnosis and treatment of chronic pelvic pain have been developed by the European Association of Urology.

• #7 Chronic pelvic pain – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371

  To figure out what’s causing your chronic pelvic pain, your healthcare team asks you about your symptoms. You’ll also answer questions about health conditions that you and your blood relatives, such as parents and siblings, have had over the years. […] Your care team may ask you to keep a journal of your pain and other symptoms. This can help you describe the effect that the pain has on your daily life. […] You also might need tests or exams such as: […] Pelvic exam. This can find symptoms of illnesses, unusual growths or tense pelvic floor muscles. Your healthcare professional checks for areas that feel tender. Speak up if you feel any pain during this exam, especially if it feels like the pain you’ve had lately. […] Lab tests. These can check for illnesses such as chlamydia or gonorrhea. You also may need a blood test to measure your blood cells or a urine test to check for a urinary tract infection.

• #8 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  Chronic pelvic pain is a persistent or recurrent pain in the lower abdomen or pelvis lasting at least 3 to 6 months. […] Diagnosis is primarily clinical, based on history and physical examination, including a digital rectal exam and assessment for cutaneous allodynia. […] Although imaging and laboratory tests are often inconclusive, they can help identify comorbid conditions that contribute to chronic pelvic pain. […] Diagnosis is typically made after 3 to 6 months of persistent pelvic pain and is largely based on patient history and physical examination. […] Numerous symptoms or precipitating factors may support the diagnosis. […] Despite evaluation, an estimated 50% of cases remain undiagnosed. […] The clinical heterogeneity of chronic pelvic pain and its incompletely understood pathogenesis make treatment challenging.

• #9 Diagnosing chronic pelvic pain

  https://www.contemporaryobgyn.net/view/diagnosing-chronic-pelvic-pain

  Chronic pelvic pain is common in women. The broad differential diagnosis for chronic pelvic pain and overlap in symptoms among etiologies makes diagnosis challenging but underscores the need to conduct a detailed history and careful examination that considers the full spectrum of cases, according to one expert. […] Medical history findings comprise about 90% of the diagnosis of chronic pelvic pain. The history should probe the specifics of the pain, including its location, nature, and radiation. However, because there is common innervation among urologic, gynecologic, gastrointestinal, and musculoskeletal structures, the report of pain location may be misleading in identifying the involved anatomy, Moldwin noted. […] Accurate diagnosis of chronic pelvic pain is the foundation for initiating effective management. However, there are no simple treatment algorithms, and a multimodal approach is often necessary. For the various diagnoses, well-defined therapy may not exist, and some interventions are aimed at the global aspect of pain. Depending on the cause of the pain, women may benefit from muscle relaxants, botulinum toxin injections, physical therapy, behavioral therapy, neurostimulation, biofeedback techniques, control of constipation, or lifestyle and dietary interventions aimed at minimizing inciting triggers. […] In patients without an apparent cause, we believe that centralized pain originating in the central nervous system may be involved.

• #10 Diagnosing Chronic Pelvic Pain | MDedge

  https://ma1.mdedge.com/content/diagnosing-chronic-pelvic-pain

  Too often, women with chronic pelvic pain will have a barium enema to rule out a gastrointestinal cause, an intravenous pyelogram to rule out urinary tract disease, and a host of other diagnostic tests that are neither efficient nor effective because they have not been driven specifically by the findings of a history and physical exam. Most gastrointestinal causes of pelvic pain, in fact, cannot be diagnosed by a barium enema, and most urologic causes cannot be determined through an IVP. The same holds true for other tests. […] Such a rule-out approach may seem appropriate up front, but it actually is much less efficient and quite often less accurate than a stepwise, deliberate approach to history-taking and physical examination. […] With the correct approach, we can successfully evaluate most patients with chronic pelvic pain in a 45-minute visit which is an achievement, considering that many disorders of the reproductive tract, gastrointestinal system, urologic organs, musculoskeletal system, and psychoneurologic system may be associated with the disorder.

• #11 Chronic pelvic pain – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371

  To figure out what’s causing your chronic pelvic pain, your healthcare team asks you about your symptoms. You’ll also answer questions about health conditions that you and your blood relatives, such as parents and siblings, have had over the years. […] Your care team may ask you to keep a journal of your pain and other symptoms. This can help you describe the effect that the pain has on your daily life. […] You also might need tests or exams such as: […] Pelvic exam. This can find symptoms of illnesses, unusual growths or tense pelvic floor muscles. Your healthcare professional checks for areas that feel tender. Speak up if you feel any pain during this exam, especially if it feels like the pain you’ve had lately. […] Lab tests. These can check for illnesses such as chlamydia or gonorrhea. You also may need a blood test to measure your blood cells or a urine test to check for a urinary tract infection.

• #12 Chronic Pelvic Pain: Diagnosis and Treatment – HealthyWomen

  https://www.healthywomen.org/content/article/chronic-pelvic-pain-diagnosis-and-treatment

  Trying to describe pain to someone is never easy. […] Thus, it’s not surprising that a survey from the Endometriosis Association found a 10-year delay from the time women start experiencing symptoms until they receive a diagnosis. […] Pelvic pain is inextricably linked to endometriosis—a medical condition in which tissue lining the uterus exists outside the uterus, where it grows and shrinks according to hormonal changes. […] An estimated 71 to 87 percent of women with chronic pelvic pain have endometriosis, which occurs in 7 to 10 percent of all women. […] One important thing to realize: Your pain is not normal, and you deserve a diagnosis and treatment. […] A good idea is to track your pain in a monthly diary, ranking the level of pain from 1 to 5, with 5 being so excruciating you can’t function and 1 being the level of mild menstrual cramps.

• #13 Chronic pelvic pain in women – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/722

  Chronic pelvic pain is a syndrome of pain arising from one or more pelvic organs, and can include any one or all pelvic viscera or muscles. […] A methodical, complete, criteria-based history is required to determine how many and which organ systems are involved and to uncover comorbid psychiatric conditions, particularly depression, or a history of abuse. […] The physical exam must be methodical and complete, searching for point tenderness in all individual pelvic muscles and organs, specifically including the vestibule, levator ani muscles, bladder, cervix and uterus, adnexa, and lower abdominal wall. […] Diagnostic tests are determined by the organ systems generating pain and may include urinalysis with culture, pelvic ultrasound, cystoscopy with hydrodistension, and diagnostic laparoscopy.

• #14 Chronic pelvic pain in women – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/722

  Chronic pelvic pain is a syndrome of pain arising from one or more pelvic organs, and can include any one or all pelvic viscera or muscles. […] A methodical, complete, criteria-based history is required to determine how many and which organ systems are involved and to uncover comorbid psychiatric conditions, particularly depression, or a history of abuse. […] The physical examination must be methodical and complete, searching for point tenderness in all individual pelvic muscles and organs, specifically including the vestibule, levator ani muscles, bladder, cervix and uterus, adnexa, and lower abdominal wall. […] Diagnostic tests are determined by the organ systems generating pain and may include urinalysis with culture, pelvic ultrasound, cystoscopy with hydrodistension, and diagnostic laparoscopy.

• #15 Chronic pelvic pain – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371

  To figure out what’s causing your chronic pelvic pain, your healthcare team asks you about your symptoms. You’ll also answer questions about health conditions that you and your blood relatives, such as parents and siblings, have had over the years. […] Your care team may ask you to keep a journal of your pain and other symptoms. This can help you describe the effect that the pain has on your daily life. […] You also might need tests or exams such as: […] Pelvic exam. This can find symptoms of illnesses, unusual growths or tense pelvic floor muscles. Your healthcare professional checks for areas that feel tender. Speak up if you feel any pain during this exam, especially if it feels like the pain you’ve had lately. […] Lab tests. These can check for illnesses such as chlamydia or gonorrhea. You also may need a blood test to measure your blood cells or a urine test to check for a urinary tract infection.

• #16 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0601/p1535.html

  The physical examination can identify areas of tenderness and the presence of masses or other anatomical findings that aid in the diagnosis. However, a lack of findings during the physical examination does not rule out intra-abdominal pathology because many patients with a normal examination will have pathologic findings on subsequent laparoscopy. […] If the history and physical examination do not lead to a diagnosis, then cancer screenings appropriate to the patient’s age and associated risk factors should be performed. […] Treatment should be directed at the underlying cause of the pelvic pain. […] A recent Cochrane analysis of treatments for chronic pelvic pain found that only the following treatments have shown benefit: oral medroxyprogesterone acetate (Provera), 50 mg daily; goserelin (Zoladex), an injectable gonadotropin-releasing hormone (GnRH) agonist; a multidisciplinary approach; counseling after a negative ultrasound; and lysis of deep adhesions.

• #17 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0601/p1535.html

  The physical examination can identify areas of tenderness and the presence of masses or other anatomical findings that aid in the diagnosis. However, a lack of findings during the physical examination does not rule out intra-abdominal pathology because many patients with a normal examination will have pathologic findings on subsequent laparoscopy. […] If the history and physical examination do not lead to a diagnosis, then cancer screenings appropriate to the patient’s age and associated risk factors should be performed. […] Treatment should be directed at the underlying cause of the pelvic pain. […] A recent Cochrane analysis of treatments for chronic pelvic pain found that only the following treatments have shown benefit: oral medroxyprogesterone acetate (Provera), 50 mg daily; goserelin (Zoladex), an injectable gonadotropin-releasing hormone (GnRH) agonist; a multidisciplinary approach; counseling after a negative ultrasound; and lysis of deep adhesions.

• #18 Recent Trends in Chronic Pelvic Pain Diagnosis

  https://www.kosinmedj.org/journal/view.php?number=5

  Chronic pelvic pain is defined in 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. Other definitions do not require that the pain be noncyclic. […] When evaluating a patient with chronic pelvic pain, the history and physical examination can narrow the differential diagnosis and guide further laboratory and ancillary testing. As many as 40 percent of women who present to primary care practices with chronic pelvic pain have more than one diagnosis. […] The physical examination can identify areas of tenderness and the presence of masses or other anatomical findings that aid in the diagnosis. However, a lack of findings during the physical examination does not rule out intra-abdominal pathology because many patients with a normal examination will have pathologic findings on subsequent laparoscopy.

• #19 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0601/p1535.html

  If the initial history and physical examination do not reveal a specific diagnosis, the initial diagnostic workup should include: a complete blood count, beta human chorionic gonadotropin levels, erythrocyte sedimentation rate, vaginal swabs for chlamydia and gonorrhea, urinalysis with urine culture, and a transvaginal pelvic ultrasound. […] The pathophysiology of chronic pelvic pain is not well understood. A definitive diagnosis is not made for 61 percent of women with chronic pelvic pain. Many patients and physicians incorrectly assume that all chronic pelvic pain results from a gynecologic source. […] When evaluating a patient with chronic pelvic pain, the history and physical examination can narrow the differential diagnosis and guide further laboratory and ancillary testing. […] Women with chronic pelvic pain usually want the following: to receive personalized care from their physicians; to be taken seriously; to receive an explanation for their condition (more so than a cure); and to be reassured.

• #20 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Diagnosis is based on the findings from the history and physical examination. […] If the underlying cause of chronic pelvic pain is identified, it should be confirmed and managed appropriately. […] The first step in evaluating suspected chronic pelvic pain is to assess for alarm symptoms, signs of an acute abdomen, or potential malignancy. […] Initial lab work should include a complete blood count, erythrocyte sedimentation rate, urinalysis, urine pregnancy test, and testing for gonorrhea and chlamydia. […] Transvaginal ultrasonography is a crucial component of the initial workup for chronic pelvic pain. […] If abnormalities are identified, magnetic resonance imaging (MRI) may be necessary for further evaluation. […] Diagnosis is based on the findings from the history and physical examination.

• #21 Pelvic Pain: Causes, Symptoms, Treatment & Relief

  https://my.clevelandclinic.org/health/symptoms/12106-pelvic-pain

  Pelvic pain can happen in all sexes and might stem from infections, abnormalities in internal organs or pain from your pelvic bones. Treatment depends on the cause. […] Pelvic pain might be a symptom of infection or arise from pain in your pelvic bone or nonreproductive internal organs. But in women, pelvic pain can very well be an indication that there might be a problem with one of the reproductive organs in your pelvic area (uterus, ovaries, fallopian tubes, cervix and vagina). […] When diagnosing the cause of pelvic pain, a healthcare provider will review your symptoms and medical history. A physical exam or other tests might also help in determining the cause of pelvic pain. […] Some diagnostic tools might include: Blood and urine tests. Pregnancy tests. Vaginal or penile cultures to check for sexually transmitted infections like gonorrhea and chlamydia. Abdominal and pelvic X-rays. Laparoscopy (a procedure allowing a direct look at the structures in your pelvis and abdomen). Hysteroscopy (a procedure to examine your uterus). Stool sample to check for signs of blood in your poop. Lower endoscopy (insertion of a lighted tube to examine the inside of your rectum and colon). Ultrasound (a test that uses sound waves to provide images of internal organs). CT scan of your abdomen and pelvis (a scan that uses X-rays and computers to produce cross-sectional images of your body). […] Your healthcare provider can help determine the cause of your pelvic pain so you can receive the treatment you need to feel better.

• #22 Chronic pelvic pain – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371

  To figure out what’s causing your chronic pelvic pain, your healthcare team asks you about your symptoms. You’ll also answer questions about health conditions that you and your blood relatives, such as parents and siblings, have had over the years. […] Your care team may ask you to keep a journal of your pain and other symptoms. This can help you describe the effect that the pain has on your daily life. […] You also might need tests or exams such as: […] Pelvic exam. This can find symptoms of illnesses, unusual growths or tense pelvic floor muscles. Your healthcare professional checks for areas that feel tender. Speak up if you feel any pain during this exam, especially if it feels like the pain you’ve had lately. […] Lab tests. These can check for illnesses such as chlamydia or gonorrhea. You also may need a blood test to measure your blood cells or a urine test to check for a urinary tract infection.

• #23 Chronic Pelvic Pain in Women Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/258334-workup

  The decision to perform laboratory or imaging evaluations in patients with chronic pelvic pain (CPP) is based on the need for confirmation of the diagnosis and to help rule out other potentially life-threatening illnesses. Certain investigations sometimes are needed to provide appropriate and safe medical or surgical treatment. […] Testing for sexually transmitted diseases in women with chronic pelvic pain includes cervical cultures or smears, syphilis serology (rapid plasma reagent, microhemagglutination-Treponema pallidum), hepatitis B screening, chlamydial polymerase chain reaction, and HIV testing. […] More than 40% of laparoscopies are performed for the diagnosis of chronic pelvic pain. […] More then 60% of women with chronic pelvic pain have at least one condition detectable by laparoscopy.

• #24 Chronic pelvic pain in women – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/722

  Because chronic pain is sometimes a disorder of pain perception, minimal if any pathological change may be found. […] Treatment is targeted at each organ system involved in pain production. […] Patients typically present with one or more of several common pain-related diagnoses: interstitial cystitis, irritable bowel syndrome, fibromyalgia, levator ani syndrome (pelvic floor tension myalgia), endometriosis, adenomyosis, leiomyoma, or vulvodynia. […] Common comorbid conditions include depression, anxiety, and traumatic stress disorder. […] Key diagnostic factors include presence of risk factors, dysuria, dyspareunia, dysmenorrhoea, abdominal trigger points, levator ani tenderness, cervical motion tenderness, uterine tenderness, abdominal tenderness, vestibular tenderness, rectal tenderness, adnexal tenderness, bladder tenderness, and urethral tenderness. […] 1st investigations to order include urinalysis, urine culture, nucleic acid amplification test, pelvic ultrasound, and alkalinised lidocaine instillation into bladder. […] Investigations to consider include pelvic CT, pelvic MRI, laparoscopic biopsy, and cystoscopy with hydrodistension.

• #25 Chronic Pelvic Pain in Women Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/258334-workup

  Most commonly, diagnoses made via laparoscopy include endometriosis, pelvic adhesions, and chronic pelvic inflammatory disease. Other diagnoses include ovarian cysts, hernias, pelvic congestion syndrome, ovarian remnant syndrome, ovarian retention syndrome, postoperative peritoneal cysts, and endosalpingiosis. […] Urodynamic testing can be performed if chronic urethral syndrome or interstitial cystitis is suggested in a patient with chronic pelvic pain. […] Cancer antigen 125 (CA-125), used as a diagnostic test, has low sensitivity and specificity. It may be elevated with diseases associated with pelvic pain, such as endometriosis or leiomyomata. CA-125 levels also are elevated with malignancy (eg, ovarian, endometrial, colon, or breast cancer), pelvic inflammatory disease, pregnancy, and menses.

• #26 Pelvic Pain: Causes, Symptoms, Treatment & Relief

  https://my.clevelandclinic.org/health/symptoms/12106-pelvic-pain

  Pelvic pain can happen in all sexes and might stem from infections, abnormalities in internal organs or pain from your pelvic bones. Treatment depends on the cause. […] Pelvic pain might be a symptom of infection or arise from pain in your pelvic bone or nonreproductive internal organs. But in women, pelvic pain can very well be an indication that there might be a problem with one of the reproductive organs in your pelvic area (uterus, ovaries, fallopian tubes, cervix and vagina). […] When diagnosing the cause of pelvic pain, a healthcare provider will review your symptoms and medical history. A physical exam or other tests might also help in determining the cause of pelvic pain. […] Some diagnostic tools might include: Blood and urine tests. Pregnancy tests. Vaginal or penile cultures to check for sexually transmitted infections like gonorrhea and chlamydia. Abdominal and pelvic X-rays. Laparoscopy (a procedure allowing a direct look at the structures in your pelvis and abdomen). Hysteroscopy (a procedure to examine your uterus). Stool sample to check for signs of blood in your poop. Lower endoscopy (insertion of a lighted tube to examine the inside of your rectum and colon). Ultrasound (a test that uses sound waves to provide images of internal organs). CT scan of your abdomen and pelvis (a scan that uses X-rays and computers to produce cross-sectional images of your body). […] Your healthcare provider can help determine the cause of your pelvic pain so you can receive the treatment you need to feel better.

• #27 Diagnosing Pelvic Pain | NYU Langone Health

  https://nyulangone.org/conditions/pelvic-pain/diagnosis

  Laparoscopy is a minimally invasive surgical procedure that can help your doctor diagnose endometriosis or adenomyosis. […] If your doctor finds endometrial growths or internal scar tissue called adhesions, he or she removes them during surgery. […] If your pain is severe and accompanied by heavy menstruation and bleeding between periods, your doctor may order an MRI scan to check for adenomyosis, endometriosis, or fibroids. […] Ultrasound, which uses sound waves to create images of the pelvic organs on a computer monitor, may be useful in identifying growths such as fibroids or ovarian cysts, pelvic organ prolapse, or scar tissue caused by pelvic inflammatory disease. […] Your doctor may ask you to provide a urine sample that may reveal a bladder or urinary tract infection, which can cause pelvic pain.

• #28 Chronic pelvic pain – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371

  Ultrasound. This test uses sound waves to make pictures of tissues, organs and other parts inside the body. It can help find growths or cysts in the ovaries, uterus or fallopian tubes. […] Other imaging tests. You might need computerized tomography (CT) scans or magnetic resonance imaging (MRI). These imaging tests can help find growths or other unusual structures inside the body. […] Laparoscopy. During this surgery, a small cut is made in the stomach area. A thin tube with a small camera is placed through the cut. The camera lets your surgeon look at your pelvic organs and check for unusual tissues or infections. This procedure can help find and treat problems such as endometriosis and chronic pelvic inflammatory disease. […] Finding the cause of chronic pelvic pain can take time. A clear reason for the pain may never be found. Talk openly with your healthcare team during this process. Work together to find a treatment plan that helps you live well with as little pain as possible.

• #29 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p380.html

  The history and physical examination are the most important components of the diagnostic evaluation. Limited laboratory testing and imaging are also indicated, with possible referral for laparoscopic or urologic evaluation as warranted by the clinical findings. […] Transvaginal ultrasonography is helpful to identify pelvic masses and adenomyosis. […] When the pain is severe, the patient should be referred for laparoscopy if the diagnosis remains unclear after the initial evaluation. […] Comprehensive guidelines for the diagnosis and treatment of chronic pelvic pain have been developed by the European Association of Urology.

• #30 Chronic pelvic pain – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371

  Ultrasound. This test uses sound waves to make pictures of tissues, organs and other parts inside the body. It can help find growths or cysts in the ovaries, uterus or fallopian tubes. […] Other imaging tests. You might need computerized tomography (CT) scans or magnetic resonance imaging (MRI). These imaging tests can help find growths or other unusual structures inside the body. […] Laparoscopy. During this surgery, a small cut is made in the stomach area. A thin tube with a small camera is placed through the cut. The camera lets your surgeon look at your pelvic organs and check for unusual tissues or infections. This procedure can help find and treat problems such as endometriosis and chronic pelvic inflammatory disease. […] Finding the cause of chronic pelvic pain can take time. A clear reason for the pain may never be found. Talk openly with your healthcare team during this process. Work together to find a treatment plan that helps you live well with as little pain as possible.

• #31 Patient education: Chronic pelvic pain in females (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-pelvic-pain-in-females-beyond-the-basics

  A pelvic ultrasound can help your provider look for certain causes of pelvic pain, including ovarian cysts (sometimes caused by ovarian endometriosis), adenomyosis, and uterine fibroids. […] A surgical procedure called a laparoscopy may be helpful in diagnosing some causes of chronic pelvic pain such as endometriosis. […] Laparoscopy should be performed by a gynecologic surgeon who is qualified to correctly diagnose and surgically remove endometriosis.

• #32 Diagnosing Pelvic Pain | NYU Langone Health

  https://nyulangone.org/conditions/pelvic-pain/diagnosis

  Laparoscopy is a minimally invasive surgical procedure that can help your doctor diagnose endometriosis or adenomyosis. […] If your doctor finds endometrial growths or internal scar tissue called adhesions, he or she removes them during surgery. […] If your pain is severe and accompanied by heavy menstruation and bleeding between periods, your doctor may order an MRI scan to check for adenomyosis, endometriosis, or fibroids. […] Ultrasound, which uses sound waves to create images of the pelvic organs on a computer monitor, may be useful in identifying growths such as fibroids or ovarian cysts, pelvic organ prolapse, or scar tissue caused by pelvic inflammatory disease. […] Your doctor may ask you to provide a urine sample that may reveal a bladder or urinary tract infection, which can cause pelvic pain.

• #33 Diagnosing Pelvic Pain | NYU Langone Health

  https://nyulangone.org/conditions/pelvic-pain/diagnosis

  Laparoscopy is a minimally invasive surgical procedure that can help your doctor diagnose endometriosis or adenomyosis. […] If your doctor finds endometrial growths or internal scar tissue called adhesions, he or she removes them during surgery. […] If your pain is severe and accompanied by heavy menstruation and bleeding between periods, your doctor may order an MRI scan to check for adenomyosis, endometriosis, or fibroids. […] Ultrasound, which uses sound waves to create images of the pelvic organs on a computer monitor, may be useful in identifying growths such as fibroids or ovarian cysts, pelvic organ prolapse, or scar tissue caused by pelvic inflammatory disease. […] Your doctor may ask you to provide a urine sample that may reveal a bladder or urinary tract infection, which can cause pelvic pain.

• #34 Chronic pelvic pain – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371

  Ultrasound. This test uses sound waves to make pictures of tissues, organs and other parts inside the body. It can help find growths or cysts in the ovaries, uterus or fallopian tubes. […] Other imaging tests. You might need computerized tomography (CT) scans or magnetic resonance imaging (MRI). These imaging tests can help find growths or other unusual structures inside the body. […] Laparoscopy. During this surgery, a small cut is made in the stomach area. A thin tube with a small camera is placed through the cut. The camera lets your surgeon look at your pelvic organs and check for unusual tissues or infections. This procedure can help find and treat problems such as endometriosis and chronic pelvic inflammatory disease. […] Finding the cause of chronic pelvic pain can take time. A clear reason for the pain may never be found. Talk openly with your healthcare team during this process. Work together to find a treatment plan that helps you live well with as little pain as possible.

• #35 The Diagnosis of Chronic Pelvic Pain: How Can We Detect Urological Pain?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9260328/

  Chronic pelvic pain (CPP) refers to pain perceived in the pelvic region for over 6 months. The diagnosis and classification of CPP are not easy because of the vague diagnostic criteria, variety of presenting symptoms, absence of diagnostic tools, and coexisting symptoms due to accompanying other diseases. […] CPP is diagnosed based on the patients symptoms, physical examination findings, diagnostic tests, and special studies of each organ. The location of the pain is determined by a clinical history and physical examination. Special studies of each organ determine the etiology of the pain within the involved organ. If a patient is diagnosed with a well-known treatable disease or a disease with a similar presentation, appropriate treatment is required. […] Recommended diagnostic tests vary across guidelines, but all include urine analysis, culture, and cytology. Pelvic imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) are recommended by East Asian guidelines and the Canadian Urological Association (CUA).

• #36 Diagnosing Pelvic Pain | NYU Langone Health

  https://nyulangone.org/conditions/pelvic-pain/diagnosis

  Laparoscopy is a minimally invasive surgical procedure that can help your doctor diagnose endometriosis or adenomyosis. […] If your doctor finds endometrial growths or internal scar tissue called adhesions, he or she removes them during surgery. […] If your pain is severe and accompanied by heavy menstruation and bleeding between periods, your doctor may order an MRI scan to check for adenomyosis, endometriosis, or fibroids. […] Ultrasound, which uses sound waves to create images of the pelvic organs on a computer monitor, may be useful in identifying growths such as fibroids or ovarian cysts, pelvic organ prolapse, or scar tissue caused by pelvic inflammatory disease. […] Your doctor may ask you to provide a urine sample that may reveal a bladder or urinary tract infection, which can cause pelvic pain.

• #37 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p380.html

  Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. […] Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is usually indicated in severe cases. […] In the absence of a clear etiology, chronic pelvic pain should be considered a regional pain syndrome or functional somatic syndrome, and a biopsychosocial approach to care is indicated. […] When chronic pelvic pain is severe, the patient should be referred for laparoscopy if the diagnosis remains unclear after the initial evaluation.

• #38 Recent Trends in Chronic Pelvic Pain Diagnosis

  https://www.kosinmedj.org/journal/view.php?number=5

  Laparoscopy is an important diagnostic study in the evaluation of pelvic pain-over 40% of gynecologic diagnostic laparoscopies are done for chronic pelvic pain. Endometriosis and adhesions account for at least 85% of all laparoscopic diagnoses. It is important to remember that a negative laparoscopy is not synonymous with no diagnosis or no disease and does not mean that a woman has no physical basis for her pain. More discriminative use of laparoscopy, carefully based on the patient’s history, physical examination, laboratory, and imaging findings, might decrease the rate of negative laparoscopies from 39% to 4%. […] Chronic pelvic pain is a serious problem. Women who suffer from chronic pelvic pain are a heterogeneous group, and the possible diagnoses and contributing factors are varied and numerous. Diagnosis can be complex, and the goals of treatment must be realistic. Sometimes these consist only of treatment of one or more specific diseases, such as endometriosis and irritable bowel syndrome, but often must include treatment of pain itself as a diagnosis.

• #39 Chronic Pelvic Pain in Women Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/258334-workup

  The decision to perform laboratory or imaging evaluations in patients with chronic pelvic pain (CPP) is based on the need for confirmation of the diagnosis and to help rule out other potentially life-threatening illnesses. Certain investigations sometimes are needed to provide appropriate and safe medical or surgical treatment. […] Testing for sexually transmitted diseases in women with chronic pelvic pain includes cervical cultures or smears, syphilis serology (rapid plasma reagent, microhemagglutination-Treponema pallidum), hepatitis B screening, chlamydial polymerase chain reaction, and HIV testing. […] More than 40% of laparoscopies are performed for the diagnosis of chronic pelvic pain. […] More then 60% of women with chronic pelvic pain have at least one condition detectable by laparoscopy.

• #40 Chronic pelvic pain – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371

  Ultrasound. This test uses sound waves to make pictures of tissues, organs and other parts inside the body. It can help find growths or cysts in the ovaries, uterus or fallopian tubes. […] Other imaging tests. You might need computerized tomography (CT) scans or magnetic resonance imaging (MRI). These imaging tests can help find growths or other unusual structures inside the body. […] Laparoscopy. During this surgery, a small cut is made in the stomach area. A thin tube with a small camera is placed through the cut. The camera lets your surgeon look at your pelvic organs and check for unusual tissues or infections. This procedure can help find and treat problems such as endometriosis and chronic pelvic inflammatory disease. […] Finding the cause of chronic pelvic pain can take time. A clear reason for the pain may never be found. Talk openly with your healthcare team during this process. Work together to find a treatment plan that helps you live well with as little pain as possible.

• #41 Chronic Pelvic Pain in Women Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/258334-workup

  Most commonly, diagnoses made via laparoscopy include endometriosis, pelvic adhesions, and chronic pelvic inflammatory disease. Other diagnoses include ovarian cysts, hernias, pelvic congestion syndrome, ovarian remnant syndrome, ovarian retention syndrome, postoperative peritoneal cysts, and endosalpingiosis. […] Urodynamic testing can be performed if chronic urethral syndrome or interstitial cystitis is suggested in a patient with chronic pelvic pain. […] Cancer antigen 125 (CA-125), used as a diagnostic test, has low sensitivity and specificity. It may be elevated with diseases associated with pelvic pain, such as endometriosis or leiomyomata. CA-125 levels also are elevated with malignancy (eg, ovarian, endometrial, colon, or breast cancer), pelvic inflammatory disease, pregnancy, and menses.

• #42 Chronic pelvic pain and the role of exploratory laparoscopy as diagnostic and therapeutic tool: a retrospective observational study | Gynecological Surgery | Full Text

  https://gynecolsurg.springeropen.com/articles/10.1186/s10397-018-1045-5

  Forty percent of exploratory laparoscopies are performed for chronic pelvic pain (CPP). However, a final diagnosis is still unreported in 35% of the patients. […] Exploratory laparoscopy is reasonable in patients complaining of CPP, allowing a final diagnosis in a high percentage of patients and a significant improvement in pain symptom in 59% of the cases. […] The present study aims to establish if exploratory laparoscopy demonstrates the presence of pathological lesions in patients with normal physical and complementary examinations complaining of CPP and to evaluate the improvement of pain after the surgical procedures. […] In summary, exploratory laparoscopy demonstrated the presence of pelvic anomalies not previously detected in 98% of patients. […] The surgical treatment of these lesions improves painful symptomatology in 59% of women with a total disappearance of pain in 44% of cases (VAS 0) and significant improvement in 15% of cases (VAS 5). […] We believe that the exploratory laparoscopy is therefore justified in patients complaining of significant CPP.

• #43 Recent Trends in Chronic Pelvic Pain Diagnosis

  https://www.kosinmedj.org/journal/view.php?number=5

  Laparoscopy is an important diagnostic study in the evaluation of pelvic pain-over 40% of gynecologic diagnostic laparoscopies are done for chronic pelvic pain. Endometriosis and adhesions account for at least 85% of all laparoscopic diagnoses. It is important to remember that a negative laparoscopy is not synonymous with no diagnosis or no disease and does not mean that a woman has no physical basis for her pain. More discriminative use of laparoscopy, carefully based on the patient’s history, physical examination, laboratory, and imaging findings, might decrease the rate of negative laparoscopies from 39% to 4%. […] Chronic pelvic pain is a serious problem. Women who suffer from chronic pelvic pain are a heterogeneous group, and the possible diagnoses and contributing factors are varied and numerous. Diagnosis can be complex, and the goals of treatment must be realistic. Sometimes these consist only of treatment of one or more specific diseases, such as endometriosis and irritable bowel syndrome, but often must include treatment of pain itself as a diagnosis.

• #44 Diagnosing Pelvic Pain | NYU Langone Health

  https://nyulangone.org/conditions/pelvic-pain/diagnosis

  Laparoscopy is a minimally invasive surgical procedure that can help your doctor diagnose endometriosis or adenomyosis. […] If your doctor finds endometrial growths or internal scar tissue called adhesions, he or she removes them during surgery. […] If your pain is severe and accompanied by heavy menstruation and bleeding between periods, your doctor may order an MRI scan to check for adenomyosis, endometriosis, or fibroids. […] Ultrasound, which uses sound waves to create images of the pelvic organs on a computer monitor, may be useful in identifying growths such as fibroids or ovarian cysts, pelvic organ prolapse, or scar tissue caused by pelvic inflammatory disease. […] Your doctor may ask you to provide a urine sample that may reveal a bladder or urinary tract infection, which can cause pelvic pain.

• #45 Chronic pelvic pain – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371

  Ultrasound. This test uses sound waves to make pictures of tissues, organs and other parts inside the body. It can help find growths or cysts in the ovaries, uterus or fallopian tubes. […] Other imaging tests. You might need computerized tomography (CT) scans or magnetic resonance imaging (MRI). These imaging tests can help find growths or other unusual structures inside the body. […] Laparoscopy. During this surgery, a small cut is made in the stomach area. A thin tube with a small camera is placed through the cut. The camera lets your surgeon look at your pelvic organs and check for unusual tissues or infections. This procedure can help find and treat problems such as endometriosis and chronic pelvic inflammatory disease. […] Finding the cause of chronic pelvic pain can take time. A clear reason for the pain may never be found. Talk openly with your healthcare team during this process. Work together to find a treatment plan that helps you live well with as little pain as possible.

• #46 Chronic Pelvic Pain | ACOG

  https://www.acog.org/womens-health/faqs/chronic-pelvic-pain

  The tests you need depend on your symptoms and the results of the pelvic exam. You may have lab tests, such as tests of your blood or other tissue. Some of the following imaging tests may be performed: Ultrasound exam, Laparoscopy, Cystoscopy, Colonoscopy, Sigmoidoscopy. […] If the cause of the pain is found, it can be treated. If a cause is not known, treatment focuses on pain relief. Its important to not give up on treatment if a cause is not found. There are many ways to lessen or relieve pain or to avoid making it worse. […] Chronic pelvic pain that is caused by a specific condition is treated with medication or surgery. […] Several pain-relief measures can be used to treat chronic pelvic pain. They include medications, physical therapy, nutritional therapy, and surgery. […] A type of therapy called cognitive behavioral therapy (CBT) may be helpful. Sex therapy may be helpful too. Sex therapy can help you have sex without pain, feel pleasure from sex, and relieve pelvic pain in general.

• #47 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/diagnostic-evaluation

  Diagnostic criteria for primary chronic anal pain syndrome (chronic proctalgia) according to the Rome IV criteria are as follows and must include all of the following: chronic or recurrent rectal pain or aching, episodes last at least thirty minutes and exclusion of other causes of rectal pain such as ischaemia, inflammatory bowel disease, cryptitis, intramuscular abscess and fissure, haemorrhoids, prostatitis, and Coccyx Pain Syndrome. […] An injection of local anaesthetic and steroid at the site of nerve injury may be diagnostic. […] Ultrasound has limited value but may reassure patients. However, over-investigating may be detrimental. […] Laparoscopy is perhaps the most useful invasive investigation to exclude gynaecological pathology and to assist in the differential diagnosis of CPPPS in women. […] Assess primary prostate pain syndrome-associated negative cognitive, behavioural, sexual, or emotional consequences, as well as symptoms of lower urinary tract and sexual dysfunctions. […] Assess PBPS-associated negative cognitive, behavioural, sexual, or emotional consequences.

• #48 Pelvic Pain: Causes, Symptoms, Treatment & Relief

  https://my.clevelandclinic.org/health/symptoms/12106-pelvic-pain

  Pelvic pain can happen in all sexes and might stem from infections, abnormalities in internal organs or pain from your pelvic bones. Treatment depends on the cause. […] Pelvic pain might be a symptom of infection or arise from pain in your pelvic bone or nonreproductive internal organs. But in women, pelvic pain can very well be an indication that there might be a problem with one of the reproductive organs in your pelvic area (uterus, ovaries, fallopian tubes, cervix and vagina). […] When diagnosing the cause of pelvic pain, a healthcare provider will review your symptoms and medical history. A physical exam or other tests might also help in determining the cause of pelvic pain. […] Some diagnostic tools might include: Blood and urine tests. Pregnancy tests. Vaginal or penile cultures to check for sexually transmitted infections like gonorrhea and chlamydia. Abdominal and pelvic X-rays. Laparoscopy (a procedure allowing a direct look at the structures in your pelvis and abdomen). Hysteroscopy (a procedure to examine your uterus). Stool sample to check for signs of blood in your poop. Lower endoscopy (insertion of a lighted tube to examine the inside of your rectum and colon). Ultrasound (a test that uses sound waves to provide images of internal organs). CT scan of your abdomen and pelvis (a scan that uses X-rays and computers to produce cross-sectional images of your body). […] Your healthcare provider can help determine the cause of your pelvic pain so you can receive the treatment you need to feel better.

• #49 Diagnosing Pelvic Pain | NYU Langone Health

  https://nyulangone.org/conditions/pelvic-pain/diagnosis

  Pelvic pain occurs in the lowest part of the abdomen, below your navel. […] After conducting physical and pelvic exams and taking a medical history, your NYU Langone doctor may order one or more tests to help determine the cause of your pelvic pain. […] Laboratory tests allow your doctor to check for certain conditions that can lead to pelvic pain, such as pelvic inflammatory disease (PID), which often results from a sexually transmitted infection. […] Your doctor may also conduct a pregnancy test, because an ectopic pregnancy in which a fertilized egg implants in the fallopian tube instead of the uterus may cause pelvic pain. […] Doctors may perform a cystoscopy to check inside the bladder for conditions that can lead to pain. […] If your doctor suspects that interstitial cystitis or pelvic organ prolapse are causing your pelvic pain, he or she may refer you to an NYU Langone urogynecologist a doctor who specializes in urinary tract and pelvic conditions.

• #50 The Diagnosis of Chronic Pelvic Pain: How Can We Detect Urological Pain?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9260328/

  Urological pelvic pain can be diagnosed based on the location and nature of the pain and tenderness on physical examination. Bladder pain should be accompanied by LUTS and pain related to voiding. However, LUTS may be a symptom of another disease or syndrome, such as OAB or BPH. Thus, the possibility of other etiologies of pelvic pain should be excluded in order to diagnose bladder pain. Urologists can diagnose urological pelvic pain, if it is located in the urological organs, patients have urologic organ-specific symptoms, and the possibility of the pain originating in other organs is excluded.

• #51 The Diagnosis of Chronic Pelvic Pain: How Can We Detect Urological Pain?

  https://einj.org/journal/view.php?number=998&viewtype=pubreader

  Urological pelvic pain can be diagnosed based on the location and nature of the pain and tenderness on physical examination. Bladder pain should be accompanied by LUTS and pain related to voiding. However, LUTS may be a symptom of another disease or syndrome, such as OAB or BPH. Thus, the possibility of other etiologies of pelvic pain should be excluded in order to diagnose bladder pain. Urologists can diagnose urological pelvic pain, if it is located in the urological organs, patients have urologic organ-specific symptoms, and the possibility of the pain originating in other organs is excluded.

• #52 The Diagnosis of Chronic Pelvic Pain: How Can We Detect Urological Pain?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9260328/

  Urological pelvic pain can be diagnosed based on the location and nature of the pain and tenderness on physical examination. Bladder pain should be accompanied by LUTS and pain related to voiding. However, LUTS may be a symptom of another disease or syndrome, such as OAB or BPH. Thus, the possibility of other etiologies of pelvic pain should be excluded in order to diagnose bladder pain. Urologists can diagnose urological pelvic pain, if it is located in the urological organs, patients have urologic organ-specific symptoms, and the possibility of the pain originating in other organs is excluded.

• #53 The Diagnosis of Chronic Pelvic Pain: How Can We Detect Urological Pain?

  https://einj.org/journal/view.php?number=998&viewtype=pubreader

  Urological pelvic pain can be diagnosed based on the location and nature of the pain and tenderness on physical examination. Bladder pain should be accompanied by LUTS and pain related to voiding. However, LUTS may be a symptom of another disease or syndrome, such as OAB or BPH. Thus, the possibility of other etiologies of pelvic pain should be excluded in order to diagnose bladder pain. Urologists can diagnose urological pelvic pain, if it is located in the urological organs, patients have urologic organ-specific symptoms, and the possibility of the pain originating in other organs is excluded.

• #54 The Diagnosis of Chronic Pelvic Pain: How Can We Detect Urological Pain?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9260328/

  Chronic pelvic pain (CPP) refers to pain perceived in the pelvic region for over 6 months. The diagnosis and classification of CPP are not easy because of the vague diagnostic criteria, variety of presenting symptoms, absence of diagnostic tools, and coexisting symptoms due to accompanying other diseases. […] CPP is diagnosed based on the patients symptoms, physical examination findings, diagnostic tests, and special studies of each organ. The location of the pain is determined by a clinical history and physical examination. Special studies of each organ determine the etiology of the pain within the involved organ. If a patient is diagnosed with a well-known treatable disease or a disease with a similar presentation, appropriate treatment is required. […] Recommended diagnostic tests vary across guidelines, but all include urine analysis, culture, and cytology. Pelvic imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) are recommended by East Asian guidelines and the Canadian Urological Association (CUA).

• #55 Causes and Diagnosis | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/urology/chronic-pelvic-pain-syndromes/causes-and-diagnosis

  Chronic pelvic pain may be caused by interstitial cystitis, prostatitis or other conditions. The cause of the chronic pain depends on the condition. […] A questionnaire called the Chronic Pelvic Symptom Index (CPSI) is used to assess your symptoms and to guide treatment decisions. Your physician will review your medical history and CPSI, and then perform a physical exam. […] Other tests may include: Urinalysis: This test checks for blood cells, germs (like bacteria) or excess protein in the urine. Urine culture: This test will rule out a urinary tract infection (UTI), as symptoms of chronic pelvic pain syndromes are similar to UTI symptoms. Cystourethroscopy: Also known as a cystoscopy, this test examines the inside of your bladder and urethra. CT scan: This test uses X-rays and a computer to make detailed images of the urinary tract.

• #56 Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain

  In the initial evaluation of patients with chronic pelvic pain, clinicians should include a comprehensive history, complete review of symptoms, physical examination, and laboratory studies to document symptoms and signs of chronic pelvic pain. Clinicians should screen for concurrent pelvic pathology and exclude other confusable disorders that could be the cause of patient symptoms as part of the initial assessment for pelvic pain. (Clinical Principle) […] Clinicians should consider the diagnosis of IC/BPS in male chronic pelvic pain patients who experience an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes. (Expert Opinion)

• #57 Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain

  Clinicians should consider the diagnosis of CP/CPPS in patients who experience chronic perineal pain, bilateral scrotal content pain, penile pain, suprapubic pain, dysuria, or pain with ejaculation. (Expert Opinion) […] Clinicians should consider the diagnosis of CSCP in patients who experienced unilateral chronic scrotal pain in the absence of other pelvic sites of pain or urinary symptoms. (Expert Opinion) […] Treatment decisions should be made based on shared decision-making between the patient and clinician, with the patient informed of the risks, potential benefits, and treatment alternatives. Initial treatment should typically be nonsurgical. (Clinical Principle) […] Clinicians should periodically reassess efficacy of treatment and discontinue ineffective treatments. The clinical diagnosis should be reconsidered if no improvement occurs after multiple treatment approaches. (Clinical Principle)

• #58 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  Effective treatment requires a coordinated, interprofessional team approach, as collaboration across multiple specialties is crucial for achieving adequate pain relief. […] Diagnosis is based on the findings from the history and physical examination. […] If the underlying cause of chronic pelvic pain is identified, it should be confirmed and managed appropriately. […] The first step in evaluating suspected chronic pelvic pain is to assess for alarm symptoms, signs of an acute abdomen, or potential malignancy. […] If none are present and no definitive diagnosis is established, laboratory testing and imaging are necessary. […] A thorough diagnostic approach is essential to identify the underlying causes of chronic pelvic pain in men and guide individualized treatment strategies effectively.

• #59 Primary care management of chronic pelvic pain in women | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/85/3/215

  The ideal care-delivery model is the patient-centered medical home, whereby a primary care physician coordinates comprehensive care with the help of an interdisciplinary team. […] Because the differential diagnosis of chronic pelvic pain is broad, the diagnostic workup and testing should be based on findings of the history and physical examination. […] A holistic approach ensures that the treatment plan adequately addresses the physical, social, and psychological aspects of chronic pelvic pain. […] The main goals of medical therapy are to improve function and quality of life while minimizing adverse effects. […] Pelvic pain that significantly fluctuates with the menstrual cycle may be caused by endometriosis, the most common gynecologic cause of chronic pelvic pain. […] Recognizing that chronic pelvic pain may have more than one cause is important when developing a comprehensive care plan.

• #60 Chronic pelvic pain in women – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/722

  Because chronic pain is sometimes a disorder of pain perception, minimal if any pathologic change may be found. […] Patients typically present with one or more of several common pain-related diagnoses: interstitial cystitis, irritable bowel syndrome, fibromyalgia, levator ani syndrome (pelvic floor tension myalgia), endometriosis, adenomyosis, leiomyoma, or vulvodynia. […] Common comorbid conditions include depression, anxiety, and traumatic stress disorder. […] 1st tests to order include urinalysis, urine culture, nucleic acid amplification test, pelvic ultrasound, and alkalinized lidocaine instillation into bladder. […] Tests to consider include pelvic CT, pelvic MRI, laparoscopic biopsy, and cystoscopy with hydrodistension.

• #61 Chronic pelvic pain in women – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/722

  Because chronic pain is sometimes a disorder of pain perception, minimal if any pathological change may be found. […] Treatment is targeted at each organ system involved in pain production. […] Patients typically present with one or more of several common pain-related diagnoses: interstitial cystitis, irritable bowel syndrome, fibromyalgia, levator ani syndrome (pelvic floor tension myalgia), endometriosis, adenomyosis, leiomyoma, or vulvodynia. […] Common comorbid conditions include depression, anxiety, and traumatic stress disorder. […] Key diagnostic factors include presence of risk factors, dysuria, dyspareunia, dysmenorrhoea, abdominal trigger points, levator ani tenderness, cervical motion tenderness, uterine tenderness, abdominal tenderness, vestibular tenderness, rectal tenderness, adnexal tenderness, bladder tenderness, and urethral tenderness. […] 1st investigations to order include urinalysis, urine culture, nucleic acid amplification test, pelvic ultrasound, and alkalinised lidocaine instillation into bladder. […] Investigations to consider include pelvic CT, pelvic MRI, laparoscopic biopsy, and cystoscopy with hydrodistension.

• #62 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  Chronic pelvic pain is a persistent or recurrent pain in the lower abdomen or pelvis lasting at least 3 to 6 months. […] Diagnosis is primarily clinical, based on history and physical examination, including a digital rectal exam and assessment for cutaneous allodynia. […] Although imaging and laboratory tests are often inconclusive, they can help identify comorbid conditions that contribute to chronic pelvic pain. […] Diagnosis is typically made after 3 to 6 months of persistent pelvic pain and is largely based on patient history and physical examination. […] Numerous symptoms or precipitating factors may support the diagnosis. […] Despite evaluation, an estimated 50% of cases remain undiagnosed. […] The clinical heterogeneity of chronic pelvic pain and its incompletely understood pathogenesis make treatment challenging.

• #63 Primary care management of chronic pelvic pain in women | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/85/3/215

  The ideal care-delivery model is the patient-centered medical home, whereby a primary care physician coordinates comprehensive care with the help of an interdisciplinary team. […] Because the differential diagnosis of chronic pelvic pain is broad, the diagnostic workup and testing should be based on findings of the history and physical examination. […] A holistic approach ensures that the treatment plan adequately addresses the physical, social, and psychological aspects of chronic pelvic pain. […] The main goals of medical therapy are to improve function and quality of life while minimizing adverse effects. […] Pelvic pain that significantly fluctuates with the menstrual cycle may be caused by endometriosis, the most common gynecologic cause of chronic pelvic pain. […] Recognizing that chronic pelvic pain may have more than one cause is important when developing a comprehensive care plan.

• #64 Chronic pelvic pain in women – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/722

  Because chronic pain is sometimes a disorder of pain perception, minimal if any pathologic change may be found. […] Patients typically present with one or more of several common pain-related diagnoses: interstitial cystitis, irritable bowel syndrome, fibromyalgia, levator ani syndrome (pelvic floor tension myalgia), endometriosis, adenomyosis, leiomyoma, or vulvodynia. […] Common comorbid conditions include depression, anxiety, and traumatic stress disorder. […] 1st tests to order include urinalysis, urine culture, nucleic acid amplification test, pelvic ultrasound, and alkalinized lidocaine instillation into bladder. […] Tests to consider include pelvic CT, pelvic MRI, laparoscopic biopsy, and cystoscopy with hydrodistension.

• #65 Is chronic pelvic pain a comfortable diagnosis for primary care practitioners: a qualitative study | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/1471-2296-11-7

  Chronic pelvic pain (CPP) has a prevalence similar to asthma and chronic back pain, but little is known about how general practitioners (GPs) and practice nurses manage women with this problem. […] Analysis suggests that women who present with CPP pose a challenge to GPs and practice nurses. CPP is not necessarily recognized as a diagnostic label and making the diagnosis was achieved only by exclusion. […] GPs expressed elements of therapeutic nihilism about the condition. […] The study demonstrates an educational/training need for both GPs and practice nurses. GPs described a number of skills and clinical competencies which could be harnessed to develop a more targeted management strategy. […] Chronic pelvic pain (CPP) is a common condition amongst women of reproductive age, but the underlying patho-physiology remains poorly understood.

• #66 Diagnosing Chronic Pelvic Pain: A Holistic Framework

  https://www.backtable.com/shows/obgyn/articles/chronic-pelvic-pain-diagnosis-holistic-framework

  Many patients live with chronic pelvic pain, yet it is frequently underdiagnosed. […] Chronic pelvic pain should be assessed using a biopsychosocial approach, considering biological, psychological, and social factors. […] The PAPS framework (Pain Characteristics, Associated Organs, Psychological Factors, and Central Sensitization) provides a structured method for evaluating chronic pelvic pain. […] A comprehensive assessment of chronic pelvic pain considers the many factors that can contribute to pain. […] Dr. Carillo’s PAPS method offers a comprehensive framework for clinical evaluation. The „Pain Characteristics” component examines the type, intensity, duration, and pattern of pain, distinguishing between acute and chronic pain and identifying fluctuations. […] The PAPS framework ensures a holistic approach to diagnosis and treatment, leading to more targeted and individualized care.

• #67 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/diagnostic-evaluation

  Diagnostic criteria for primary chronic anal pain syndrome (chronic proctalgia) according to the Rome IV criteria are as follows and must include all of the following: chronic or recurrent rectal pain or aching, episodes last at least thirty minutes and exclusion of other causes of rectal pain such as ischaemia, inflammatory bowel disease, cryptitis, intramuscular abscess and fissure, haemorrhoids, prostatitis, and Coccyx Pain Syndrome. […] An injection of local anaesthetic and steroid at the site of nerve injury may be diagnostic. […] Ultrasound has limited value but may reassure patients. However, over-investigating may be detrimental. […] Laparoscopy is perhaps the most useful invasive investigation to exclude gynaecological pathology and to assist in the differential diagnosis of CPPPS in women. […] Assess primary prostate pain syndrome-associated negative cognitive, behavioural, sexual, or emotional consequences, as well as symptoms of lower urinary tract and sexual dysfunctions. […] Assess PBPS-associated negative cognitive, behavioural, sexual, or emotional consequences.

• #68 Chronic pelvic pain: from correct diagnosis to adequate therapy | Rachin | Neurology, Neuropsychiatry, Psychosomatics

  https://nnp.ima-press.net/nnp/article/view/1298?locale=en_US

  Management of patients with chronic pelvic pain (CPP) is an actual interdisciplinary problem of modern clinical medicine. CPP is chronic or persistent pain lasting more than 6 months, which is located in the structures related to the male or female pelvis and is associated with negative cognitive, behavioral, and emotional consequences, as well as with lower urinary tract, bowel, and pelvic floor symptoms, and reproductive and sexual dysfunction. […] When diagnosing CPP, it is most acceptable to phenotype patients according to the UPOINTS classification. […] Cognitive behavioral therapy (CBT) occupies an important place in the treatment of CPP. There is clinical and neurophysiological evidence of the efficiency of CBT in patients with CPP, a protocol has been developed for the combined use of CBT and physical therapy. CBT is recommended to be included in a comprehensive treatment and rehabilitation program for patients with CPP.

• #69 Diagnosing Chronic Pelvic Pain: A Holistic Framework

  https://www.backtable.com/shows/obgyn/articles/chronic-pelvic-pain-diagnosis-holistic-framework

  Many patients live with chronic pelvic pain, yet it is frequently underdiagnosed. […] Chronic pelvic pain should be assessed using a biopsychosocial approach, considering biological, psychological, and social factors. […] The PAPS framework (Pain Characteristics, Associated Organs, Psychological Factors, and Central Sensitization) provides a structured method for evaluating chronic pelvic pain. […] A comprehensive assessment of chronic pelvic pain considers the many factors that can contribute to pain. […] Dr. Carillo’s PAPS method offers a comprehensive framework for clinical evaluation. The „Pain Characteristics” component examines the type, intensity, duration, and pattern of pain, distinguishing between acute and chronic pain and identifying fluctuations. […] The PAPS framework ensures a holistic approach to diagnosis and treatment, leading to more targeted and individualized care.

• #70 Is chronic pelvic pain a comfortable diagnosis for primary care practitioners: a qualitative study | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/1471-2296-11-7

  Approximately 38 per 1000 women present to primary care each year with chronic pelvic pain, a rate comparable to that of asthma and back pain. […] Managing women with CPP has been reported to be frustrating for both general practitioners (GPs) and patients: this group of women has been described by GPs as 'heartsink’ patients, being considered difficult to manage and treat. […] Complex conditions, like CPP, where in a substantial number of cases the cause of the pain remains medically unexplained, provide an ongoing challenge to current management strategies in primary care. […] Not all GPs were comfortable applying the diagnostic label of CPP to a woman, preferring only to use this term when underlying physical pathology had been excluded, or were confident that the problem was largely due to psychological phenomenon.

• #71 Is chronic pelvic pain a comfortable diagnosis for primary care practitioners: a qualitative study | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/1471-2296-11-7

  The lack of cohesion between GPs’ and practice nurses’ understanding of CPP was reflected in the adoption of different management styles, and level of involvement with this patient group. […] GPs described referral of some women with chronic pain mainly to gynaecology, gastroenterology, pain clinics and psychological services, but respondents described a lack of availability of the latter two services and questioned the usefulness of any referral. […] GPs and practice nurses acknowledged that CPP was a difficult problem to manage both for themselves, and for the women who presented to them with this condition. […] A sense of failure and frustration permeated the GP and practice nurse interviews. […] GPs suspected that some women probably discontinue the route of seeking help and treatment from their GP.

• #72 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  Chronic pelvic pain is a persistent or recurrent pain in the lower abdomen or pelvis lasting at least 3 to 6 months. […] Diagnosis is primarily clinical, based on history and physical examination, including a digital rectal exam and assessment for cutaneous allodynia. […] Although imaging and laboratory tests are often inconclusive, they can help identify comorbid conditions that contribute to chronic pelvic pain. […] Diagnosis is typically made after 3 to 6 months of persistent pelvic pain and is largely based on patient history and physical examination. […] Numerous symptoms or precipitating factors may support the diagnosis. […] Despite evaluation, an estimated 50% of cases remain undiagnosed. […] The clinical heterogeneity of chronic pelvic pain and its incompletely understood pathogenesis make treatment challenging.

• #73 Is chronic pelvic pain a comfortable diagnosis for primary care practitioners: a qualitative study | BMC Primary Care | Full Text

  https://bmcprimcare.biomedcentral.com/articles/10.1186/1471-2296-11-7

  The lack of cohesion between GPs’ and practice nurses’ understanding of CPP was reflected in the adoption of different management styles, and level of involvement with this patient group. […] GPs described referral of some women with chronic pain mainly to gynaecology, gastroenterology, pain clinics and psychological services, but respondents described a lack of availability of the latter two services and questioned the usefulness of any referral. […] GPs and practice nurses acknowledged that CPP was a difficult problem to manage both for themselves, and for the women who presented to them with this condition. […] A sense of failure and frustration permeated the GP and practice nurse interviews. […] GPs suspected that some women probably discontinue the route of seeking help and treatment from their GP.

• #74 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0601/p1535.html

  If the initial history and physical examination do not reveal a specific diagnosis, the initial diagnostic workup should include: a complete blood count, beta human chorionic gonadotropin levels, erythrocyte sedimentation rate, vaginal swabs for chlamydia and gonorrhea, urinalysis with urine culture, and a transvaginal pelvic ultrasound. […] The pathophysiology of chronic pelvic pain is not well understood. A definitive diagnosis is not made for 61 percent of women with chronic pelvic pain. Many patients and physicians incorrectly assume that all chronic pelvic pain results from a gynecologic source. […] When evaluating a patient with chronic pelvic pain, the history and physical examination can narrow the differential diagnosis and guide further laboratory and ancillary testing. […] Women with chronic pelvic pain usually want the following: to receive personalized care from their physicians; to be taken seriously; to receive an explanation for their condition (more so than a cure); and to be reassured.

• #75 Recent Trends in Chronic Pelvic Pain Diagnosis

  https://www.kosinmedj.org/journal/view.php?number=5

  Chronic pelvic pain is defined in 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. Other definitions do not require that the pain be noncyclic. […] When evaluating a patient with chronic pelvic pain, the history and physical examination can narrow the differential diagnosis and guide further laboratory and ancillary testing. As many as 40 percent of women who present to primary care practices with chronic pelvic pain have more than one diagnosis. […] The physical examination can identify areas of tenderness and the presence of masses or other anatomical findings that aid in the diagnosis. However, a lack of findings during the physical examination does not rule out intra-abdominal pathology because many patients with a normal examination will have pathologic findings on subsequent laparoscopy.

• #76 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  Chronic pelvic pain is a persistent or recurrent pain in the lower abdomen or pelvis lasting at least 3 to 6 months. […] Diagnosis is primarily clinical, based on history and physical examination, including a digital rectal exam and assessment for cutaneous allodynia. […] Although imaging and laboratory tests are often inconclusive, they can help identify comorbid conditions that contribute to chronic pelvic pain. […] Diagnosis is typically made after 3 to 6 months of persistent pelvic pain and is largely based on patient history and physical examination. […] Numerous symptoms or precipitating factors may support the diagnosis. […] Despite evaluation, an estimated 50% of cases remain undiagnosed. […] The clinical heterogeneity of chronic pelvic pain and its incompletely understood pathogenesis make treatment challenging.

• #77 Long-term pelvic pain | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/long-term-pelvic-pain/

  After you have described your symptoms you may be offered: an examination of your abdomen, a vaginal examination. […] You may also be offered a laparoscopy, particularly if your doctor thinks you may have endometriosis, adhesions or pelvic infection. […] In a third to a half of laparoscopies done to investigate chronic pelvic pain, no obvious cause is found. […] If your doctor thinks that your pain is due to a particular cause then you should be offered treatment for that condition. […] Many women find that they can cope better with the pain if they have been listened to, taken seriously, have a full explanation of their test results and agree a plan of action. […] Whatever your situation, you should be offered pain relief. […] Chronic pelvic pain can be very difficult to live with and can cause emotional, social and economic difficulties.

• #78 Chronic pelvic pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/symptoms-causes/syc-20354368

  Chronic pelvic pain is pain in the area below the bellybutton and between the hips that lasts six months or longer. […] Chronic pelvic pain can have more than one cause. It may be a symptom of another disease, or it can be a condition in its own right. […] But tests may not be able to find a cause for chronic pelvic pain. In that case, the goal of treatment is to ease pain and other symptoms. That could make your quality of life better. […] Chronic pelvic pain is a complex health problem. Sometimes, tests may find that a single disease is the cause. In other cases, the pain may stem from more than one medical condition. For example, you might have endometriosis and interstitial cystitis, both of which play a role in chronic pelvic pain. […] Many conditions are linked to chronic pelvic pain. Having more than one condition that causes pelvic pain, such as endometriosis and fibroids, raises the risk. A history of sexual or physical abuse also may raise the risk.

• #79 Diagnosing Chronic Pelvic Pain | MDedge

  https://ma1.mdedge.com/content/diagnosing-chronic-pelvic-pain

  In general, we should be guided in our differential diagnosis by seeking those diagnoses for which we have the best evidence of causal or associative roles in chronic pelvic pain. […] We must not be surprised, moreover, when our patients have more than one diagnosis. In fact, we should anticipate and expect more than one. And more often than not, the pain itself will be a diagnosis and not just a symptom. […] Chronic pelvic pain is a staggering problem. […] Despite this, we as physicians do a poor job of diagnosing and managing chronic pelvic pain. […] Once a diagnosis has been made, physicians have a tendency to stay with the diagnosis; they do not reinvestigate for other causes. Unfortunately, chronic pelvic pain can have multiple etiologies. […] Expect common diagnoses that have level A evidence of association with CPP: Irritable bowel syndrome, Interstitial cystitis, Myofascial trigger points, Depression, Endometriosis, Chronic pain syndrome. […] Do not assume that laparoscopy is essential; it is usually not needed for a diagnosis.

• #80 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  Effective treatment requires a coordinated, interprofessional team approach, as collaboration across multiple specialties is crucial for achieving adequate pain relief. […] Diagnosis is based on the findings from the history and physical examination. […] If the underlying cause of chronic pelvic pain is identified, it should be confirmed and managed appropriately. […] The first step in evaluating suspected chronic pelvic pain is to assess for alarm symptoms, signs of an acute abdomen, or potential malignancy. […] If none are present and no definitive diagnosis is established, laboratory testing and imaging are necessary. […] A thorough diagnostic approach is essential to identify the underlying causes of chronic pelvic pain in men and guide individualized treatment strategies effectively.

• #81 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Effective evaluation and management of chronic pelvic pain require a broad differential diagnosis and an interprofessional approach. […] Managing chronic pelvic pain requires a coordinated interprofessional healthcare team, including physical therapists, psychologists, pharmacists, and clinicians from multiple specialties. […] The primary clinician typically coordinates the diagnosis and management of the underlying cause of chronic pelvic pain.

• #82 Diagnosing Pelvic Pain | NYU Langone Health

  https://nyulangone.org/conditions/pelvic-pain/diagnosis

  Pelvic pain occurs in the lowest part of the abdomen, below your navel. […] After conducting physical and pelvic exams and taking a medical history, your NYU Langone doctor may order one or more tests to help determine the cause of your pelvic pain. […] Laboratory tests allow your doctor to check for certain conditions that can lead to pelvic pain, such as pelvic inflammatory disease (PID), which often results from a sexually transmitted infection. […] Your doctor may also conduct a pregnancy test, because an ectopic pregnancy in which a fertilized egg implants in the fallopian tube instead of the uterus may cause pelvic pain. […] Doctors may perform a cystoscopy to check inside the bladder for conditions that can lead to pain. […] If your doctor suspects that interstitial cystitis or pelvic organ prolapse are causing your pelvic pain, he or she may refer you to an NYU Langone urogynecologist a doctor who specializes in urinary tract and pelvic conditions.

• #83 Primary care management of chronic pelvic pain in women | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/85/3/215

  The ideal care-delivery model is the patient-centered medical home, whereby a primary care physician coordinates comprehensive care with the help of an interdisciplinary team. […] Because the differential diagnosis of chronic pelvic pain is broad, the diagnostic workup and testing should be based on findings of the history and physical examination. […] A holistic approach ensures that the treatment plan adequately addresses the physical, social, and psychological aspects of chronic pelvic pain. […] The main goals of medical therapy are to improve function and quality of life while minimizing adverse effects. […] Pelvic pain that significantly fluctuates with the menstrual cycle may be caused by endometriosis, the most common gynecologic cause of chronic pelvic pain. […] Recognizing that chronic pelvic pain may have more than one cause is important when developing a comprehensive care plan.

• #84 Primary care management of chronic pelvic pain in women | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/85/3/215

  The ideal care-delivery model is the patient-centered medical home, whereby a primary care physician coordinates comprehensive care with the help of an interdisciplinary team. […] Because the differential diagnosis of chronic pelvic pain is broad, the diagnostic workup and testing should be based on findings of the history and physical examination. […] A holistic approach ensures that the treatment plan adequately addresses the physical, social, and psychological aspects of chronic pelvic pain. […] The main goals of medical therapy are to improve function and quality of life while minimizing adverse effects. […] Pelvic pain that significantly fluctuates with the menstrual cycle may be caused by endometriosis, the most common gynecologic cause of chronic pelvic pain. […] Recognizing that chronic pelvic pain may have more than one cause is important when developing a comprehensive care plan.

• #85 Chronic Pelvic Pain Program | Women’s Health | Loyola Medicine

  https://www.loyolamedicine.org/services/womens-health/programs/chronic-pelvic-pain-program

  As a patient in our chronic pelvic pain program, you will receive care from urogynecologists and female pelvic medicine and reconstructive surgeons who will collaborate on the evaluation, diagnosis and plan of care for your pelvic pain over the course of several visits. […] In addition to taking your medical and family history and providing a pelvic exam, your healthcare team may request testing in order to make an informed diagnosis, which may include: Abdominal X-ray, Blood tests, CT scan (computed tomography), Lab cultures, Laparoscopic discovery, MRI (magnetic resonance imaging), Pregnancy test, Stool tests, Ultrasound, Urine test. […] The goal of Loyolas chronic pelvic pain program is to provide an accurate diagnosis for your condition and develop a plan of treatment that will improve your quality of life.

• #86 Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey | Scientific Reports

  https://www.nature.com/articles/s41598-020-73389-2

  Chronic pelvic pain (CPP) affects a significant number of women worldwide. […] We aimed to use an online survey using the EndoCost tool to determine if there was any difference in the impact of CPP in those with vs. those without a confirmed diagnosis of endometriosis, and if there was any change in diagnostic delay since the introduction of clinical guidelines in 2005. […] In the endometriosis cohort there was a mean diagnostic delay of eight years, however there was a reduction in both the diagnostic delay (p0.001) and number of doctors seen before diagnosis (p0.001) in those presenting more recently. […] Both endometriosis and CPP have significant negative impact. […] It has been repeatedly demonstrated internationally that endometriosis has a long diagnostic delay, impacts peoples health and wellbeing, including social activities, mental and emotional health, work/finances, and sexual relationships; and those with endometriosis report physical quality of life similar to that of cancer patients.

• #87 Chronic Pelvic Pain: Diagnosis and Treatment – HealthyWomen

  https://www.healthywomen.org/content/article/chronic-pelvic-pain-diagnosis-and-treatment

  Trying to describe pain to someone is never easy. […] Thus, it’s not surprising that a survey from the Endometriosis Association found a 10-year delay from the time women start experiencing symptoms until they receive a diagnosis. […] Pelvic pain is inextricably linked to endometriosis—a medical condition in which tissue lining the uterus exists outside the uterus, where it grows and shrinks according to hormonal changes. […] An estimated 71 to 87 percent of women with chronic pelvic pain have endometriosis, which occurs in 7 to 10 percent of all women. […] One important thing to realize: Your pain is not normal, and you deserve a diagnosis and treatment. […] A good idea is to track your pain in a monthly diary, ranking the level of pain from 1 to 5, with 5 being so excruciating you can’t function and 1 being the level of mild menstrual cramps.

• #88 Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey | Scientific Reports

  https://www.nature.com/articles/s41598-020-73389-2

  Chronic pelvic pain (CPP) affects a significant number of women worldwide. […] We aimed to use an online survey using the EndoCost tool to determine if there was any difference in the impact of CPP in those with vs. those without a confirmed diagnosis of endometriosis, and if there was any change in diagnostic delay since the introduction of clinical guidelines in 2005. […] In the endometriosis cohort there was a mean diagnostic delay of eight years, however there was a reduction in both the diagnostic delay (p0.001) and number of doctors seen before diagnosis (p0.001) in those presenting more recently. […] Both endometriosis and CPP have significant negative impact. […] It has been repeatedly demonstrated internationally that endometriosis has a long diagnostic delay, impacts peoples health and wellbeing, including social activities, mental and emotional health, work/finances, and sexual relationships; and those with endometriosis report physical quality of life similar to that of cancer patients.

• #89 Discoveries in Medicine – Chronic Pelvic Pain: A Paradigm for Diagnosis and Treatment

  https://discoveries.vanderbilthealth.com/2020/04/chronic-pelvic-pain-a-paradigm-for-diagnosis-and-treatment/

  Blood tests can help diagnose some conditions. However, if the pains cause cannot be determined through basic testing, diagnostic laparoscopy is often recommended. […] A wide range of therapeutic interventions may be used to treat CPP, dependent on the etiology. […] CPP can significantly impact quality of life, causing depression, fatigue, sexual dysfunction and physical limitations. […] Taking a more comprehensive approach can help physicians identify causes of the pain early and get the patient in treatment before CPP becomes a burden. […] The key is collaboration, Yunker said. We have to listen to our patients and partner with them.

• #90 Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey | Scientific Reports

  https://www.nature.com/articles/s41598-020-73389-2

  Chronic pelvic pain (CPP) affects a significant number of women worldwide. […] We aimed to use an online survey using the EndoCost tool to determine if there was any difference in the impact of CPP in those with vs. those without a confirmed diagnosis of endometriosis, and if there was any change in diagnostic delay since the introduction of clinical guidelines in 2005. […] In the endometriosis cohort there was a mean diagnostic delay of eight years, however there was a reduction in both the diagnostic delay (p0.001) and number of doctors seen before diagnosis (p0.001) in those presenting more recently. […] Both endometriosis and CPP have significant negative impact. […] It has been repeatedly demonstrated internationally that endometriosis has a long diagnostic delay, impacts peoples health and wellbeing, including social activities, mental and emotional health, work/finances, and sexual relationships; and those with endometriosis report physical quality of life similar to that of cancer patients.

• #91 Relief From Chronic Pelvic Pain

  https://www.webmd.com/women/features/relief-from-chronic-pelvic-pain

  A woman can experience severe pain even after physical exams and tests show that their risk factor for chronic pelvic pain, such as endometriosis, has lessened or disappeared. […] He says chronic pain causes what’s called CNS upregulation, or an increasing sensitivity of cells that transmit pain sensation. […] „We want to educate health care providers so patients get proper treatment and avoid going into chronic pelvic pain syndrome.” […] „Treat the inflammation, and a lot of the pain goes away,” she says. […] „It’s more than periods, menopause, and having babies,” she says. „The true picture of women’s health involves all the problems that are predominantly female, including IBS, chronic fatigue syndrome, fibromyalgia, depression, allergies and asthma, autoimmune disease, and thyroid disorders.”

• #92 Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey | Scientific Reports

  https://www.nature.com/articles/s41598-020-73389-2

  Our findings indicate that this delay in presentation to a medical professional is reducing over time, with those reporting their symptoms that have started more recently showing a shorter time delay in seeking medical attention. […] Since the introduction of the ESHRE guideline on endometriosis in 2005, there appears to be a significant reduction in both the number of doctors seen before diagnosis and the time between seeking medical help and a diagnosis of endometriosis. […] Our study demonstrates similar negative impacts across many domains irrespective of diagnosis. […] It is therefore necessary to identify and have a treatment plan for pelvic pain symptoms, regardless of the current or future diagnosis. […] Our findings suggest that there has been a significant decrease in diagnostic delay for people with endometriosis over time, possibly due to improved guidelines and advocacy. However, the diagnostic delay still exists and still carries a significant burden to those suffering CPP.

• #93 Diagnosing chronic pelvic pain

  https://www.contemporaryobgyn.net/view/diagnosing-chronic-pelvic-pain

  Chronic pelvic pain is common in women. The broad differential diagnosis for chronic pelvic pain and overlap in symptoms among etiologies makes diagnosis challenging but underscores the need to conduct a detailed history and careful examination that considers the full spectrum of cases, according to one expert. […] Medical history findings comprise about 90% of the diagnosis of chronic pelvic pain. The history should probe the specifics of the pain, including its location, nature, and radiation. However, because there is common innervation among urologic, gynecologic, gastrointestinal, and musculoskeletal structures, the report of pain location may be misleading in identifying the involved anatomy, Moldwin noted. […] Accurate diagnosis of chronic pelvic pain is the foundation for initiating effective management. However, there are no simple treatment algorithms, and a multimodal approach is often necessary. For the various diagnoses, well-defined therapy may not exist, and some interventions are aimed at the global aspect of pain. Depending on the cause of the pain, women may benefit from muscle relaxants, botulinum toxin injections, physical therapy, behavioral therapy, neurostimulation, biofeedback techniques, control of constipation, or lifestyle and dietary interventions aimed at minimizing inciting triggers. […] In patients without an apparent cause, we believe that centralized pain originating in the central nervous system may be involved.

• #94 Chronic pelvic pain in women – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/722

  Chronic pelvic pain is a syndrome of pain arising from one or more pelvic organs, and can include any one or all pelvic viscera or muscles. […] A methodical, complete, criteria-based history is required to determine how many and which organ systems are involved and to uncover comorbid psychiatric conditions, particularly depression, or a history of abuse. […] The physical examination must be methodical and complete, searching for point tenderness in all individual pelvic muscles and organs, specifically including the vestibule, levator ani muscles, bladder, cervix and uterus, adnexa, and lower abdominal wall. […] Diagnostic tests are determined by the organ systems generating pain and may include urinalysis with culture, pelvic ultrasound, cystoscopy with hydrodistension, and diagnostic laparoscopy.

• #95 Chronic pelvic pain in women – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/722

  Chronic pelvic pain is a syndrome of pain arising from one or more pelvic organs, and can include any one or all pelvic viscera or muscles. […] A methodical, complete, criteria-based history is required to determine how many and which organ systems are involved and to uncover comorbid psychiatric conditions, particularly depression, or a history of abuse. […] The physical exam must be methodical and complete, searching for point tenderness in all individual pelvic muscles and organs, specifically including the vestibule, levator ani muscles, bladder, cervix and uterus, adnexa, and lower abdominal wall. […] Diagnostic tests are determined by the organ systems generating pain and may include urinalysis with culture, pelvic ultrasound, cystoscopy with hydrodistension, and diagnostic laparoscopy.

• #96 Diagnosing Chronic Pelvic Pain: A Holistic Framework

  https://www.backtable.com/shows/obgyn/articles/chronic-pelvic-pain-diagnosis-holistic-framework

  Many patients live with chronic pelvic pain, yet it is frequently underdiagnosed. […] Chronic pelvic pain should be assessed using a biopsychosocial approach, considering biological, psychological, and social factors. […] The PAPS framework (Pain Characteristics, Associated Organs, Psychological Factors, and Central Sensitization) provides a structured method for evaluating chronic pelvic pain. […] A comprehensive assessment of chronic pelvic pain considers the many factors that can contribute to pain. […] Dr. Carillo’s PAPS method offers a comprehensive framework for clinical evaluation. The „Pain Characteristics” component examines the type, intensity, duration, and pattern of pain, distinguishing between acute and chronic pain and identifying fluctuations. […] The PAPS framework ensures a holistic approach to diagnosis and treatment, leading to more targeted and individualized care.

• #97 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0601/p1535.html

  If the initial history and physical examination do not reveal a specific diagnosis, the initial diagnostic workup should include: a complete blood count, beta human chorionic gonadotropin levels, erythrocyte sedimentation rate, vaginal swabs for chlamydia and gonorrhea, urinalysis with urine culture, and a transvaginal pelvic ultrasound. […] The pathophysiology of chronic pelvic pain is not well understood. A definitive diagnosis is not made for 61 percent of women with chronic pelvic pain. Many patients and physicians incorrectly assume that all chronic pelvic pain results from a gynecologic source. […] When evaluating a patient with chronic pelvic pain, the history and physical examination can narrow the differential diagnosis and guide further laboratory and ancillary testing. […] Women with chronic pelvic pain usually want the following: to receive personalized care from their physicians; to be taken seriously; to receive an explanation for their condition (more so than a cure); and to be reassured.

• #98 Chronic pelvic pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/symptoms-causes/syc-20354368

  Chronic pelvic pain is pain in the area below the bellybutton and between the hips that lasts six months or longer. […] Chronic pelvic pain can have more than one cause. It may be a symptom of another disease, or it can be a condition in its own right. […] But tests may not be able to find a cause for chronic pelvic pain. In that case, the goal of treatment is to ease pain and other symptoms. That could make your quality of life better. […] Chronic pelvic pain is a complex health problem. Sometimes, tests may find that a single disease is the cause. In other cases, the pain may stem from more than one medical condition. For example, you might have endometriosis and interstitial cystitis, both of which play a role in chronic pelvic pain. […] Many conditions are linked to chronic pelvic pain. Having more than one condition that causes pelvic pain, such as endometriosis and fibroids, raises the risk. A history of sexual or physical abuse also may raise the risk.

• #99 Long-term pelvic pain | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/long-term-pelvic-pain/

  After you have described your symptoms you may be offered: an examination of your abdomen, a vaginal examination. […] You may also be offered a laparoscopy, particularly if your doctor thinks you may have endometriosis, adhesions or pelvic infection. […] In a third to a half of laparoscopies done to investigate chronic pelvic pain, no obvious cause is found. […] If your doctor thinks that your pain is due to a particular cause then you should be offered treatment for that condition. […] Many women find that they can cope better with the pain if they have been listened to, taken seriously, have a full explanation of their test results and agree a plan of action. […] Whatever your situation, you should be offered pain relief. […] Chronic pelvic pain can be very difficult to live with and can cause emotional, social and economic difficulties.

• #100 Long-term pelvic pain | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/long-term-pelvic-pain/

  After you have described your symptoms you may be offered: an examination of your abdomen, a vaginal examination. […] You may also be offered a laparoscopy, particularly if your doctor thinks you may have endometriosis, adhesions or pelvic infection. […] In a third to a half of laparoscopies done to investigate chronic pelvic pain, no obvious cause is found. […] If your doctor thinks that your pain is due to a particular cause then you should be offered treatment for that condition. […] Many women find that they can cope better with the pain if they have been listened to, taken seriously, have a full explanation of their test results and agree a plan of action. […] Whatever your situation, you should be offered pain relief. […] Chronic pelvic pain can be very difficult to live with and can cause emotional, social and economic difficulties.

• #101 Chronic pelvic pain: Expert insight on diagnosis and management

  https://www.topdoctors.co.uk/medical-articles/chronic-pelvic-pain-expert-insight-on-diagnosis-and-management

  Some patients are also offered a laparoscopy, particularly if your doctor suspects endometriosis, adhesions or pelvic infection may be present. […] This allows a narrow telescope (called a laparoscope) to be inserted through the abdominal wall so your pelvis can be examined. […] Many women are empowered by their consultations with a specialist, where they are listened to and their pain is taken seriously. […] Receiving a full explanation from a doctor and with a good understanding of test results, allows patients to work together with their specialist to agree a plan of action and cope with their pain better. […] If your pelvic pain is determined to be related to your periods, hormone treatment, such as the contraceptive pill, injections or the Mirena IUS (hormone coil) may be offered as an alternative to laparoscopy. […] Whatever the specifics of your individual case, you should be offered pain relief. […] If this does not resolve your pain, you may be referred to a pain management team or a specialist pain clinic.

• #102 Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey | Scientific Reports

  https://www.nature.com/articles/s41598-020-73389-2

  Our findings indicate that this delay in presentation to a medical professional is reducing over time, with those reporting their symptoms that have started more recently showing a shorter time delay in seeking medical attention. […] Since the introduction of the ESHRE guideline on endometriosis in 2005, there appears to be a significant reduction in both the number of doctors seen before diagnosis and the time between seeking medical help and a diagnosis of endometriosis. […] Our study demonstrates similar negative impacts across many domains irrespective of diagnosis. […] It is therefore necessary to identify and have a treatment plan for pelvic pain symptoms, regardless of the current or future diagnosis. […] Our findings suggest that there has been a significant decrease in diagnostic delay for people with endometriosis over time, possibly due to improved guidelines and advocacy. However, the diagnostic delay still exists and still carries a significant burden to those suffering CPP.

• #103 Management of persistent pelvic pain in girls and women

  https://www.racgp.org.au/afp/2015/july/management-of-persistent-pelvic-pain-in-girls-and

  Laparoscopy is an excellent tool for removing endometriosis, or for hysterectomy in older women with dysmenorrhoea. […] Pelvic pain has been estimated to cost Australians more than $6 billion annually in direct costs. […] A GP with an interest in this area is in a good position to manage the majority of PPP symptoms.

Zobacz więcej