Chronic pelvic pain: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Chronic pelvic pain can be a cause of great discomfort in women of reproductive age. There is usually a history of chronic chronic pelvic pain with secondary dysmenorrhea and deep dyspareunia. Pain can be either a cause or a consequence of emotional problems. The patient may be depressed.
With laparoscopy, it is possible to identify the most probable cause: chronic pelvic infection, endometriosis, adenomyosis, adhesions or congestion in the pelvic veins. If this does not happen (or if all gynecological causes are "excluded" by surgery), the cause may be a disease of the gastrointestinal tract: irritable bowel syndrome.
Stagnation in the pelvic veins. Painful stagnation of the blood is observed in the "weakened" veins of the pelvis. The pain increases in the patient's standing position, with walking (gravity filling of the veins) and in the premenstrual period. Characteristic typical variability of the place and intensity of pain, as well as pain after sexual intercourse. Palpation the greatest soreness is revealed with deep palpation of the ovary region. As a result of stagnation, cyanosis of the vagina and cervix can be observed, as well as varicose veins of the lower extremities - as a result or in combination. Dilated veins can be visualized with venography or laparoscopy.
Treatment of chronic pain is complex, although subjectively the patient's condition can improve if she explains the cause of the pain ("pelvic migraine"). Pain decreases with medroxyprogesterone acetate at a dose of 30 mg every 24 hours inside for 3 months (side effects: amenorrhea, weight gain, bloating); you can try to prescribe drugs used for migraines and antispasmodics. When extreme symptoms of chronic pelvic pain are resorted to bilateral ligation of the ovaries.
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