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CHRONIC PELVIC PAIN SYNDROME |
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Medically speaking
Chronic Pelvic Pain syndrome is defined as a
“Non-menstrual pain of six or more months duration that
localizes to the anatomic pelvis and is severe enough to cause
functional disability and require medical or surgical
treatment”.
In simple terms however, Chronic Pelvic Pain is a pain of
various severity and characteristics located between the level of
umbilicus and the upper portion of the legs
Chronic Pelvic Pain, depending on the patient, can be the symptom or the illness itself. The pelvic region constitutes the “crossroad” of many organic systems, mainly the urinary, genital, peptic, musculoskeletal and nervous system, which because of the standing position and the frequent utilisation of these, they often interact for pain creation, for which it is often difficult to isolate the cause. The cluster of illnesses causing Chronic Pelvic Pain is wide and complex. The diagnosis of causes of Pelvic Pain is without doubt one of the most difficult subjects in the Medicine. Some of the main causes of Chronic Pelvic Pain syndrome are summarized here. Some times the cause cannot be found. This probability has inverse relationship with the doctor’s experience, and his/her interest for the syndrome of Chronic Pelvic Pain. When the illness causing the pain can be found, then the treatment is directed on this, but when the cause cannot be found then the physician has to focus to the treatment of the pain itself, in order to improve the patient's quality of life. Chronic Pelvic Pain Syndrome can present as a pain during the sexual contact, during bowel evacuation, or simply when the patient is seated. The pain can become intense when the patient standing for long period of time, and remit in sitting position. The characteristics of pain of Chronic Pelvic Pain Syndrome can range from intense and devastating for the patient, to mild and simply annoying sense in genitalia. Sometimes the pain severity leads to patient's insomnia, inability for work or everyday activities. The etiologic diagnosis of Chronic Pelvic Pain Syndrome could be difficult and challenging, and it is a process of progressive exclusion of many illnesses that can be the cause. The type of pain, the duration, the time that happens, its intensity, and what worsens or alleviate it, are fundamental questions that should be answered from the doctor and the patient. A personal and family history taking and a detailed clinical examination of the systems that they are probably involved in Chronic Pelvic Pain Syndrome is of paramount importance. The diagnostic tests are individualised in every case and depend from the gender and the particular symptoms of each patient. These include simple or specialised microbiological and radiological examinations, and specialised diagnostic or therapeutic interventions(please see the Center's Equipment column). The range of therapeutic possibilities is broad, but their effectiveness depends from the level of collaboration between the doctor and the patient. Below we list the main categories of therapeutic possibilities in Chronic Pelvic Pain Syndrome: A. Pharmaceutical treatment Analgesics Simple painkillers like aspirin and paracetamol, and more evolved drugs as non steroid anti-inflammatory (Voltaren, etc), antiepileptics, and drugs for neuropathic pain can be used in the Chronic Pelvic Pain Syndrome as monotherapy or in combination. Hormone-therapy This treatment is addressed in women that present with a periodical form of Chronic Pelvic Pain Syndrome. Contraceptive pills use is an example of hormone-therapy. Antibiotics With main representative the Chronic Prostatitis in men, and genital infections in women, the correct use of antibiotics can bring the suitable results. Antidepressant In some cases the correct use of antidepressants or tranquilizers, always under the monitoring of doctor, can help. The issuing of these medicines for the Chronic Pelvic Pain does not mean that the patient necessarily suffers from depression other psychiatric illness, but is granted for their palliative and analgesic effects. C. Physiotherapy Application of hot or cold energy in the painful areas, relaxation exercises, and the use of techniques like Electrostimulation of pelvic floor muscles, Biofeedback, and the Transdermal Electrical Nerve Stimulation (TENS), are some of the methods for the treatment of Chronic Pelvic Pain used in our centre. These techniques and methods are applied by the physiotherapist under the supervision of urologist (Dr. Kalyvas). D. Surgical treatment The surgical interventions for the treatment of Chronic Pelvic Pain are separated into two categories: Minor interventions The infiltration of painful muscular points with long acting local anaesthetics (Trigger point injections) is usually the first type of minimally invasive treatment that we use in order to alleviate the pain in the Chronic Pelvic Pain Syndrome. It is high effectiveness, is enough is followed the suitable process. Major interventions If the above mentioned treatments do not bring the expected results then a number of surgical interventions can be used:
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