Chronic Female Pelvic Pain—Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region

Abstract

Chronic pelvic pain is defined as the presence of pain in the pelvic girdle region for over a 6-month period and can arise from the gynecologic, urologic, gastrointestinal, and musculoskeletal systems. As 15% of women experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective evaluation and management strategies of this condition are necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain conditions, including a careful history-taking and clinical examination. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central sensitization of the nervous system associated with the chronicity of the symptoms, as well as the potential influence of the affective and biopsychosocial factors on symptom development as persistence. Once the musculoskeletal origin of the symptoms is identified, a clinical examination schema that is based on the location of primary onset of symptoms (lumbosacral, coccygeal, sacroiliac, pelvic floor, groin or abdominal region) can be followed to establish a basis for managing the specific pain generator(s) and manage tissue dysfunction.

Impact of Kinesio Taping application on pregnant women suffering from pregnancy-related pelvic girdle pain — preliminary study

“…In addition, the pelvic pain is associated with instability of the lumbosacral complex what is connected with altered laxity and stiffness forces and leads to increased joints translations [2]. Asymmetrical immobilization in the sacroiliac joints is associated with asymmetric muscular tension [3,4]. Pregnancy-related pelvic girdle pain (PPGP) appears at the end of the 1st trimester and usually lasts until the end of the first month after child delivery.…”

“…The severity of PPGP fluctuates according to a study within the range of 50-60 mm VAS scale (Visual Analogue Scale) [6]. Posture during the occurrence of PPGP is characterized by excessive snap with increased antetorsion of the pelvis while seated or the patients has a "swayback" posture type [3,7]. We can observe the deterioration of coordination (increased rotational amplitudes of pelvis, lumbar segment and thorax), slower gait, followed by increased rotation of the pelvis relative to the chest [8].…”

Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review

“… PF, pelvic floor; LA, levator ani; OI, obturator internus; TP, transverse perineal muscles; ATFP, arcus tendineus fascia pelvis; USL, uterosacral ligament. * Abdominal wall includes rectus abdominis. ** Other sites examined include the adnexa 28,47,52 , bladder and urethra 27,35,43,51,52,55,58,62 anorectal raphae 35 , anus/rectum 36,44,50,53,55,59,60 , pelvis 39 , buttock 39 , sacroiliac joint 39,55 , Iliopsoas 39 , hamstring 39 , hip flexor 39 , and coccyx 44,50,59,60 , sphincter urethra and compressor urethra 3,46 , cervix 47,52,53 , adductor muscles 49 , clitoris 50 , pubovaginalis 50,54 , uterus 51 , sacrococcygeus ligaments 53,59,60 , urogenital triangle 53 , quadratus lumborum 54,61 , gluteal muscles 49,54,59,61 , pubic symphysis 55,59,60 , anterior superior iliac spines 55 , iliopsoas 61 , anal sphincter 60,61,62 . …”

The Pelvis and Beyond

“…1,2 CPP is characterized as persistent pain in the pelvic region perceived to arise from the gynecologic, urologic, gastrointestinal, and/or musculoskeletal systems. Common and frequently coexisting CPP conditions include myofascial pelvic pain (MPP) and bladder pain syndrome (BPS).…”