Analysis of diagnostic and treatment measures for chronic pelvic pain in women in routine clinical practice

Abstract

Chronic pelvic pain (CPP) for a long time remains one of the important medical and social problems due to the variability of clinical manifestations, negative impact on reproductive health and quality of patient’s life. Epidemiological studies indicate that CPP occurs in 15-20% of women of reproductive age. According to many authors, diagnosis and treatment of CPP is not an easy task due to unclear diagnostic criteria, variety of symptoms, insufficient diagnostic tools, etc.The objective: to analyze the diagnostic and therapeutic measures of women with pelvic pain syndrome in routine clinical practice.Materials and methods. A retrospective study of the medical patient’s cards of 557 women of reproductive age (19–49 years old) who were consulted by a gynecologist for CPP was conducted.Results. A significant prevalence of pelvic pain syndrome in patients under 30 years of age (51.2%) was revealed. In 290 women with complaints only for CPP, in 15.9% of cases, in the absence of gynecological pathology, were diagnosed the following pathologies: interstitial cystitis (19.6%), diverticulitis and dolichosigma (17.4%), irritable bowel syndrome (23.9%), myofascial pain (15.2%), pathology of the lumbosacral spine (10.9%). In the same group of women the following gynecological pathologies were found: malformations of the genitourinary system (3.3%), anomalies of the development of the uterus (9.3%), endometriosis (24.2%), adenomyosis (8.8%), leiomyoma of the uterus (8.4%), combined proliferative benign diseases of the genitals (14.9%), pelvic inflammatory diseases (7.9%), pelvic adhesive process (9.8%), pelvic floor dysfunction (13.5%). The diagnosis of CPP was established in 10.0% of women in the absence of gynecological and non-gynecological pathology.Conclusions. Identifying the CPP reasons in women is a difficult diagnostic process, as it can be caused by the presence of endometriosis, combined proliferative benign diseases of the genital organs, anomalies of genitourinary system, adenomyosis, pelvic inflammatory diseases, pelvic adhesions, pelvic floor dysfunction, venocongestion. CPP in women is often a result of non-gynecological pathology or a combination of such with gynecological diseases, which determines the need for an interdisciplinary approach to both diagnosis and treatment of such patients. In routine clinical practice, not enough attention is paid to determine the intensity and characteristics of the pain syndrome, which is often combined with late referral of patients for examination. In more than half of the analyzed cases (51.5%), the reason for women’s referral for examination is not pelvic pain syndrome as such, but a pathology that could be related to or a consequence of diseases causing CPP (abnormal uterine bleeding, infertility, etc.).