what are the causes for deep pelvic pain in women?suggest clinical and laboratory investigations and treatment
suggest step-by – step approach for diagnosis and treatment of deep pelvic pain in women
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Any patient presenting with pelvic pain should be considered initially for a diagnosis of Endometriosis.
Upon presentation of pelvic pain, patient should be prescribed a course of NSAIDs or oral contaceptives. If successful, maintain drug therapy. If not;
Rule out obvious pelvic pathology through Doppler. If evidence of other pathology is found, treat accordingly. If no pathology is found or if Endometriosis continues to be suspected, proceed to operative intervention.
Removal of all disease from pelvis and surrounding abdominal cavity through meticulous exicison offers best success for long term relief and improved fertililty. Where operator is limited in excision skills and/or excision is otherwise impossible, extensive vaporization and restoral of normal pelvic anatomy is recommended. If successful, watchful waiting for symptom recurrence may be adopted. If failure;
Course of Aromatase Inhibitors, Danazol, GnRH agonist or other suppressive medication may be warranted for a course of 6 months. If successful, watchful waiting may be adopted. If failure;
Patient should be referred to tertiary treatment center specializing in excision of Endometriosis and/or RE for IVF protocols if pregnancy is desired.
There are lab tests which can diagnose Endometriosis; likewise, diagnostic intervention such as MRI etc. are not definitive. Surgical diagnosis is required. CA125 elevations are not accurate, as the levels are elevated in women with Endo who do not have malignancy.
Suggest following protocols offered at specialty centers such as Redwine, Albee, et.al. – http://www.endometriosistreatment.org, http://www.centerfornendo.com for – best patient success.
December 13th, 2009 at 11:57 pmpelvic inflammatory disease
December 13th, 2009 at 11:57 pmthere are a lot of things that can go wrong with the female reproductive organs. Polly Cistic Overian Syndom can cause a huge amount of problems and that’s just one problem.
December 13th, 2009 at 11:57 pmIn case of female the most common cause is Pelvic Inflammatory Disease(PID). Superficial palpation, Deep palpation of the lower abdomen. Temperature should be noted. To exclude Appendicitis Rebound tenderness is an important clue.
Laboratory test: TC, DC, USG of uterus and adnexa.
Treatment depending on the cause, from Conservative treatment to surgical intervention.
December 13th, 2009 at 11:57 pmPhysical exam including a pelvic exam.
Lab tests: CBC, HCG qual – quant if pos.
Additional Lab tests: Routine UA & Urine Culture depending on UA results, Vag culture: including gram stain, wet mount, and test for trichimonas
Xray tests -If HCG negative: Ultrasound
There are soo many things that could cause pelvic pain – so these tests would narrow it down. Possiblilities include pregnancy, ectopic pregnancy, ovarian cysts, vag. infection, fibroid tumors, bladder infection, gastroenteritis, appendicitis, hernia, or even cancer.
December 13th, 2009 at 11:57 pm