Pelvic Pain

What is pelvic pain?

• With abdominal pain is meant pain in the lower abdomen or the sex organs in women ( drawing of the abdomen )
• Pelvic pain may originate from the genital tract, but can also come from the urinary bladder, the ureter or the intestinal system
• Chronic pelvic pain is often caused by muscle tension in the abdomen, in particular voltage (myalgia) of ileopsoasmusklen, which is also called the tenderloin. The tenderloin is a muscle that goes from the back and inside of the pelvis and adheres to the inside of the femoral neck. These muscles get hip to flex and the back to sway and constantly adjusting the position, both when walking, sitting or standing

Occurrence

• Abdominal pain is very frequent and constitutes 1-2% of all queries to the doctor. It is estimated that 300,000 South African women annually seek medical advice because of pain in the abdomen. Many are being treated for suspected pelvic inflammatory disease, but only at every 4th, there are clear signs of infection
• The pain may be acute or chronic, or they may vary in step with menstruation (cyclic pain)
• For chronic pelvic pain, the pain can sit on one side of the abdomen or on both sides. Pain in the lower back groin or may radiate into the legs, either continuously or as pain. The leg may feel limp and heavy. The pain can worsen when you’ve been sitting in the same position or after you have gone a little. For some, the pain can be triggered deep inside the vagina during intercourse and can last for several hours after intercourse. There may also be muscle tension in the stomach muscles, and some women have bloated stomach or tendency to constipation

What can be the reason?

Common causes of acute pain

• Urinary tract infection
  • Frequent, scanty urination
  • Often typical symptoms such as a burning sensation during urination, discomfort of the urinary bladder, optionally, there may be blood in the urine
• Spontaneous abortion
  • Usually 6-12 weeks of pregnancy
  • Starts like as strong menstrual pain (threatened abortion), gradually increases the bleeding often with lumps (ongoing abortion)
• Ruptured ovarian cyst (ovarian cyst)
  • Small cysts on the ovaries can jump by itself during physical activity or intercourse
  • It can cause acute, but often moderate pain downwards in the stomach. In most cases, the pain goes by itself in a few hours
• appendicitis
  • The condition often develops over at least a day, the pain moves like from the middle of the upper part of the stomach around the navel to the lower right abdomen
  • There comes a fever, you feel sick and there may be nausea and vomiting
• Pelvic inflammatory disease (salpingitis / PID)
  • Most frequently occurs among sexually active young women
  • May be due to infection by example. chlamydia, and may occur after, for example. warehousing of spiral, curettage, abortion and birth
  • Often insidious onset, nagging pain or tenderness at the bottom of the stomach, increased vaginal discharge, bleeding disorders, fever
• Inflammation of the pouches in the colon (diverticulitis)
  • Occur mainly in older women
  • The symptoms may resemble appendicitis, but the pain is on the left side of the stomach
• Pregnancy outside the uterus (ectopic pregnancy)
  • The fertilized egg is outside the uterus, often in the fallopian tube
  • Typically, there is pain, failed to appear irregular menstruation or small bleedings. Pregnancy typically lasted 6-8 weeks, when the condition is found
  • The risk is highest in women who previously had surgery on fallopian tubes, previous ectopic pregnancy, pelvic inflammatory disease, appendicitis or has been pregnant in the treatment of infertility
  • The pain can range from sudden severe pain downwards in the stomach for an easy nagging soreness.
• Complication of fibroids (myoma)
  • Women often know they have fibroids in the uterus
  • Some fibroids can have a thin stem which can be rotated around so that the blood supply to muscle node ceases and is triggered pain
• Kidney stone
  • Provides acute and very severe pain in the flank, which comes in shooting
  • The sick can not stay still and moving restlessly around

Common causes of chronic pain

• Muscle tension in the abdomen
  • The most common cause of chronic pelvic pain is muscle tension
  • Are most common in women between 20 and 30 years
  • As mentioned above, the precipitating causes are many, and often occurs pain after a pelvic disease or because of the position errors in the back. One can think of muscle tension as a natural defense response, which attempts to protect themselves, but gradually becomes tensions a bad habit that must be broken. Myös in the abdomen means that you can get muscle tension in the neck or shoulder muscles. It hurts when the tense and sore muscles affected or used
  • Problems in relationships or other stress conditions can help to maintain pain, often quite unconsciously
  • The doctor can often trigger pain by pressing the tense aching muscles, but it’s not all doctors who think that the reason may be muscle tension. Women who are being treated for suspected pelvic several times a year, has rarely pelvic inflammatory disease, but much more frequent infiltrations in the abdomen
  • The pain to be treated by stretching, to be produced from a day when the pain is the worst. These exercises may trigger the first times, with pain, and there may be need for an analgesic (paracetamol / ibubrufen). The exercises are not sufficient, may be referred to a physiotherapist with special knowledge in this field
• Fibroids in the uterus (myoma)
  • Available in 30% of women over 30 years. The incidence increases with age
  • Does not normally cause symptoms and are discovered like random. The most common symptoms are heavy bleeding, irregular bleeding, difficulty in urination, defecation difficulties, but large fibroids can cause abdominal pressure
• Endometriosis
  • Endometriosis is a condition in which the mucous membrane is found inside the uterine cavity are also other places outside of the uterus or uterine wall
  • The condition is not uncommon in women 30-40 years of age
  • Painful menstruation is often the only symptom. Others have pain in the time between ovulation and menstruation. In this period, some women with endometriosis deep painful intercourse
• sexual abuse
  • Often lead to chronic pelvic pain, either due to physical injuries or psychological reactions
• spiral Use
  • Can sometimes be the cause of chronic or recurrent pain
• Prolonged untreated chlamydia infection

Rarer causes of chronic pain

• cancer
  • A common feature of all cancers is that they will bring with other genes such as weight loss, poor appetite, bleeding from the abdomen or rectum. Cell changes in the cervix does not pain
  • Cancer of the uterus (almost only after menopause)
  • Cancer of the cervix (be ruled by common gynecological examination)
  • ovarian cancer
  • colon cancer

What can you do yourself?

• You can not do anything even compared to the acute pain. Chronic pain can be prevented with good attitude and good posture and stretching exercises at the beginning myalgia

When should you seek medical advice?

• In case of severe or prolonged abdominal pain should seek medical

When the physician should be contacted immediately?

• If acute pain does not subside and if other concurrent symptoms require, for example. bleeding

What does the doctor do in pelvic pain cases?

Medical history

Questions the doctor may ask you:

• How long has the pain been present?
• In acute pain
  • How is the pain?
    • Describe the pain – where it sits? how strong is it? similar to menstrual pain?
    • Have you tours show pain? – and what aggravates them?
    • Rays pain out – down the leg, on the lower back?
  • When did you last menstrual period? Are you pregnant?
  • Do you have a fever?
  • Is there increased vaginal discharge?
  • Have you bleeding?
  • Have you urination genes? Pain during urination?
  • Have you been diagnosed with fibroids in the uterus?
• For chronic or recurring pain
  • How long has the pain lasted? Has there been a triggering cause?
  • Have pain connected with menstruation?
  • Have you failed anything in the abdomen?
  • Do you have pain during intercourse?

medical examination

• The doctor will evaluate your general condition and perform a gynecological examination

other studies

• Depends on the circumstances
• In acute genes it will be relevant to take pregnancy test, blood samples and measuring the temperature and if necessary. bacterial sample from the abdomen
• On admission made other tests and often made an ultrasound scan of the abdomen

Referral to a specialist or hospital

• In acute severe abdominal pain the patient will often hospitalized
• In chronic nuisance it may be appropriate to refer to a gynecologist, if necessary. rheumatologist