Diagnosis of Chronic Pelvic Pain
Examination and imaging methods are used for the correct diagnosis in people who apply with pain complaints.
Gynecological/Pelvic Examination
The gynecological/pelvic examination performed with the patient's history helps to detect areas of infection, abnormal growth of the pelvic floor muscles, tension, or sensitivity.
Laboratory Tests
Blood tests, culture tests, urine tests, and different laboratory tests may be requested for symptoms. For example, vaginal culture tests may be required to screen for infections such as chlamydia or gonorrhea in the gynecological examination or urinalysis may be required to determine urinary tract infection.
Ultrasound
Ultrasound is performed to evaluate the ovaries, uterus, and tubes structurally.
Other Imaging Tests
If any abnormality is detected during gynecological examination and ultrasound evaluation, advanced examination, and imaging methods such as computed tomography (CT) or magnetic resonance imaging (MRI) can be used.
Chronic Pelvic Pain Treatment
The purpose of chronic pelvic pain treatment is to reduce symptoms and improve quality of life. Although a personalized treatment approach is adopted, the optimal approach to pain usually includes a combination of treatments. In this direction, the treatments listed below are planned and applied individually or together according to the needs of the patient.
Painkillers
Analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs are generally well tolerated, but studies have concluded that nonsteroidal anti-inflammatory drugs are not effective in treating chronic pelvic pain associated with endometriosis.
Hormonal Treatment
Oral contraceptives are effective in treating dysmenorrhea associated with endometriosis, although there is only limited evidence that they are beneficial for non-menstrual pelvic pain. The intrauterine system (Mirena) releasing levonorgestrel has been shown to reduce the recurrence of dysmenorrhea if placed after laparoscopic treatment of endometriosis.
Antidepressants
Oral contraceptives are effective in treating dysmenorrhea associated with endometriosis, although there is only limited evidence that they are beneficial for non-menstrual pelvic pain. The intrauterine system (Mirena) releasing levonorgestrel has been shown to reduce the recurrence of dysmenorrhea if placed after laparoscopic treatment of endometriosis.
Surgical Treatments
Physical Treatment (Stretching Exercises, Massage, and Relaxation Techniques)
Diet and Nutrition Treatment
Neuromodulation
Neuromodulation devices stimulate the nerves with electrical signals or other forms of energy. For selected patients, through a multidisciplinary assessment, in addition to other care, or when symptoms do not adequately respond to more conservative measures, e.g., when existing drugs are ineffective or become problematic for long-term use), tolerance, dependence, adverse side effects or development of toxicity) neuromodulation treatment may be considered.
Trigger Point Injections
It aims to reduce the tension of the connective tissue and restore the mobility of the muscle fascia. Patients who were treated for at least one month had a 25% or greater improvement.
Psychotherapy
Acupuncture
Patients who cannot benefit from other treatments, especially medication, for chronic pelvic pain are trying alternative methods to solve their problems. Acupuncture is also one of these methods. Acupuncture, which has been used in the treatment of many diseases in the far east for thousands of years and the west for the last 60 years, is also used in the treatment of chronic pelvic pain.
Cognitive Behavior Therapy
Regardless of the underlying cause, it is a critical component of care for women with chronic pelvic pain. One promising treatment modality is a mixture of cognitive psychotherapy and physiotherapy, called somatocognitive therapy. Its purpose is to promote awareness of one's own body, develop coping strategies, and release muscle pain manually.
