We specialize in the treatment of chronic pelvic pain. A noticeable improvement is usually possible within 2-4 weeks of treatment. Treatment is carried out by a neurologist-immunologist or rheumatologist. If necessary, we will involve a urologist or gynecologist in treatment.
The average duration of treatment is 3 months (you take the medications yourself).
- Causes and symptoms of chronic pelvic pain
- Diagnose and treat chronic pelvic pain syndrome
Condition Characteristics
The pathology is characterized by nonspecific pain radiating to the lumbar region, perineum, vagina, rectum or external genitalia. Chronic pelvic pain syndrome usually has a vague onset. This diagnosis is indicated if pain has been present for more than six months. An important feature of the condition is the absence of pathologies in tissues and organs that can cause discomfort.
The disease is unpleasant because it significantly reduces the quality of life, and therefore requires qualified and adequate help.
How do you find out the cause of pain? Diagnostics
A diagnostic search for the causes of pelvic pain is impossible without a thorough analysis of the woman’s complaints and medical history . Everything is important here: the nature (pulling, cutting, pressing, etc.) and localization of pain (in the middle, right, left, in the sacrum, rectum, bladder), its duration, in case of unstable pain - the frequency of its occurrence, connection with provoking factors (movement, body position, diet, urination, sexual contact).
the menstrual cycle (during menstruation, after, between menstruation, before it) and data on previous pregnancies or concomitant infertility is extremely important . Clarification of this connection often provides the key to understanding the causes of the disease. In addition, the doctor must know everything about the characteristics of the menstrual cycle and sex life of a woman, as well as about any sexually transmitted diseases and vaginal discharge.
Since pain is often associated with other organs, the doctor should ask in detail about the function of the intestines and urinary organs, concomitant diseases of the musculoskeletal system, and previous operations.
A general and gynecological examination is required . Already at this stage, it is possible to exclude the possibility of a major pelvic pathology (tumor), as well as establish the localization of painful sensations.
Based on the survey and examination, the doctor will be able to identify some types of pain syndromes, which significantly narrows and facilitates the further search for the cause. These syndromes include:
- Dyspareunia - painful sexual intercourse
- (Algo)dysmenorrhea - painful menstruation
- Ovulatory pain is cyclical pain in the middle of the menstrual cycle associated with ovulation.
- Pain in the vagina, external genitalia, and perineum (may be associated with infection, tumor, neuropathy, vulvodynia)
- Painful bladder (causes: infectious process, interstitial cystitis, bladder stones and tumors, consequences of previous surgeries)
- Pain associated with filling and bowel movement
- Neuropathies of the sciatic and pudendal nerves
Additional research.
The doctor takes vaginal and cervical discharge for analysis to rule out the possibility of an infectious disease. It is recommended to conduct a cytological examination of a scraping from the cervix. An ultrasound examination of the pelvic organs is always performed In some cases (suspicion of endometriosis of the recto-vaginal septum, retroperitoneal tumors, suspicion of pathology of the pelvic lymph nodes), magnetic resonance imaging .
Most patients with pelvic pain require diagnostic laparoscopy. Laparoscopy is the most useful minimally invasive examination method, allowing direct examination of the pelvic organs and the entire abdominal cavity. Laparoscopy is the only reliable method for identifying foci of endometriosis in the peritoneum, as well as adhesions. If during a laparoscopic examination formations of the appendages, foci of endometriosis, and adhesions are detected, then during the same intervention they are surgically treated. That is why laparoscopy is an indispensable research method and the first (and sometimes sufficient) method of treating identified diseases.
If corresponding diseases of related organs are suspected, examination and treatment is carried out by a urologist, gastroenterologist, proctologist, neurologist, or psychotherapist. Accordingly, depending on the expected diagnosis, the doctor will prescribe an additional examination.
Pathogenesis
Experts agree that treatment of chronic pelvic pain must be carried out with a focus on the possible causes of its occurrence. As a rule, this is a whole complex of factors that affect a woman’s condition. Ineffective treatment of the underlying disease significantly increases the risk of CPPS. Since all organs in the pelvis are interconnected, the pathological process can cause unpredictable disorders.
There are several dozen causes of pain.
- Gynecological.
endometriosis;
- inflammatory processes of organs in the pelvis;
- sexually transmitted infections;
- adhesions;
- ovulatory and menstrual pain;
- endometrial polyps;
- tumor growths in the genital organs;
- traumatic injuries.
- chronic urinary tract infection;
- chronic colitis;
- dysfunction of the pelvic floor muscles;
Also, chronic pain can be psychogenic in nature: the result of depression, stress disorders, post-traumatic conditions, and schizophrenia.
Chronic pelvic pain in women
Pelvic pain (pain in the lower abdomen, sometimes in the sacrum, rectum, vagina) can be of a different nature.
First of all, pain can be acute or chronic. The causes of these two types of pain are significantly different, which means that the treatment is also different. Acute pain is a sudden onset of severe pain that lasts several hours or days. Acute pain may be accompanied by fever, nausea, vomiting, intestinal problems, severe weakness and malaise. In cases of acute pain, especially in combination with the complaints described above, it is necessary to urgently consult a doctor - this is how acute surgical diseases often manifest themselves (for example, appendicitis, cholecystitis, intestinal obstruction and others). Acute pain manifests itself in almost any inflammatory disease of the uterus and appendages, ectopic pregnancy, torsion or rupture of an ovarian cyst, cystitis and pyelonephritis (inflammation of the bladder and/or kidneys), enteritis and colitis (inflammation of the intestines), as well as a number of other conditions requiring immediate help .
Symptoms
First of all, treatment of chronic pelvic pain syndrome in women is aimed at improving quality of life and reducing symptoms. That is why the doctor carefully collects anamnesis to find out the reason that worries the patient.
Most often, women complain of the following symptoms:
- nagging pain in the lower abdomen;
- lower back pain;
- painful syndrome during menstruation;
- dyspareunia (pain during sexual intercourse, before or after sexual intercourse);
- vulvodynia (stabbing pain in the vestibule of the vagina or perineum).
The syndrome can manifest itself constantly or be cyclical. With a long course of the disease, the psycho-emotional state changes: CPPS provokes irritability, insomnia, reduces activity, is one of the factors of depressive and hypochondriacal moods, and leads to social maladjustment.
general information
In 1822, the disease was described for the first time as anterior crural neuritis. Inflammation of the femoral nerve has been studied for almost 200 years, but remains poorly understood. Among mononeurotic pathologies, femoral neuritis is more common than others. The lack of complete information on this type of neurological disorders leads to the fact that the disease cannot be differentiated from radicular syndrome or myelopathy. Difficulties arise due to the variability of clinical symptoms from sensory distortions to movement disorders, depending on etiological factors.
Establishing diagnosis
Treatment for chronic pelvic pain in Moscow is offered by the Dr.AkNer clinic. You can undergo comprehensive diagnostics to determine the causes of the pathology and develop effective treatment.
The list of examinations for CPPS includes the following measures:
- gynecological examination;
- rectal examination;
- tests for sexually transmitted diseases;
- local ultrasound;
- assessment of blood flow in the area of discomfort;
- x-ray of the sacral and lumbar spine;
- histological studies;
- diagnostic laparoscopy.
Diagnostics
For an accurate diagnosis, it is important to determine the cause of neuropathy. The conclusion is made by a neurologist after carefully collecting anamnesis and studying the results of instrumental research methods. X-ray of the spinal column is not a reliable diagnostic method, since identified spinal defects do not exclude the manifestation of neuropathy. EMG allows you to resolve controversial issues in making a diagnosis.
Neuropathy corresponds to the slow passage of impulses along the femoral nerve column, a decrease in the amplitude of the M-response, symptoms of impaired innervation in the corresponding muscles, as well as the muscles of the L2-L4 segments. Using ultrasound diagnostics, the integrity of the femoral nerve is traced, pathological neoplasms, swelling, adhesive-scar changes and degenerative phenomena are determined. The level of nerve mobility in the adductor canal is confirmed by ultrasound with dynamic tests.
Differential diagnosis is aimed at excluding radiculopathies of the lumbar vertebrae of vertebrogenic origin, lumbosacral plexopathy caused by diabetes mellitus, injuries and gonarthrosis of the knee joint. To differentiate diseases of the abdominal cavity, ultrasound, MRI or CT are performed.
Therapy
Treatment of chronic pelvic pain in women involves a multi-vector approach. When pathologies are identified, complex therapy is prescribed, antibiotics or antiviral drugs are prescribed, and inflammatory foci are stopped.
The main direction in the treatment of CPPS is the use of symptomatic therapy: patients are prescribed non-narcotic analgesics, as well as non-steroidal anti-inflammatory drugs to improve the quality of life.
Physiotherapeutic methods of influence have proven themselves well. Taking into account the situation, the patient may be advised to visit a psychotherapist, rehabilitation specialist, or neurologist.
At the Dr.AkNer clinic you can count on a sensitive attitude and a comprehensive, highly professional approach to your problem. Our specialists will make every effort to make you forget about the painful illness and enjoy life again.
Treatment of pelvic neuralgia
Treatment of pelvic neuralgia in women and men should begin by eliminating the potential cause of the development of this disease. For example, if damage to the nerve fiber is observed at the level of the roots during the development of degenerative dystrophic disease of the intervertebral discs, then several manual traction procedures are first recommended. This allows you to eliminate compression from the root nerves and relieve the patient from pain. Then a course of treatment is developed aimed at restoring the structure of damaged cartilage tissue. This is often enough to completely restore all pelvic nerves.
If the disease is caused by biochemical changes and metabolic disorders, including a total deficiency of microelements and vitamins, then it is necessary to work with this cause. The doctor will develop a complete diet for the patient and give recommendations on the selection of vitamin and mineral complexes. In parallel, an individual course of treatment will be carried out aimed at restoring the trophism of the nerve fiber that has undergone degeneration.
A course of treatment is developed in a similar way for other types of lesions. In particular, treatment of pelvic neuralgia caused by inflammatory processes in the pelvic cavity begins with relief of the underlying disease. This may require consultation with a gynecologist or urologist. Once the inflammatory swelling is eliminated, a chiropractor or neurologist will be able to develop an effective course for restoring innervation. This helps prevent future problems with innervation and blood supply.
If you need safe and effective treatment for pelvic neuralgia, we invite you to a free appointment with a neurologist at our manual therapy clinic. You can sign up right now. To do this, fill out the doctor appointment form located further on the page. Our administrator will contact you and agree on a convenient time for the visit.
Pathophysiology
Pathological conditions associated with pudendal nerve damage
The exact mechanism of nerve dysfunction and damage depends on the etiology. The damage may be one or two sided.
Causes of PN can include compression, stretching, direct nerve injury, and radiation. Pudendal neuralgia is a functional pinching in which pain occurs during compression or stretching of the nerve. Symptoms worsen over time due to repeated microtrauma, ultimately leading to persistent pain and dysfunctional complaints. The pudendal nerve becomes pinched during prolonged sitting or cycling.
Pudendal neuropathy can be caused by stretching of the nerve due to straining during labor or constipation. Other etiological factors include fitness classes, working out in the gym, weighted squats, leg presses, karate, kickboxing and roller skating. Sports popular among young people are considered a risk factor, which may be associated with bone remodeling of the ischial spine. Vibration injuries can occur from driving on rough roads and agricultural fields. Pudendal neuralgia can also be caused by falling on the buttocks.
