Chronic pelvic pain(long-term lower abdominal - groin-waist pain) in women is an important problem that is frequently encountered and reduces the patient's quality of life. It is a strong>healthproblem. The economic burden of chronic pelvic pain (CPA) on the healthcare system is also quite high. Chronic pelvic pain also negatively affects work productivity in working women. For this reason, significant work lossesoccur in patients. Chronic pelvic pain restricts patients' activities and causes problems in their sexual lives. The causes of chronic pelvicpain are very complex. Pain can arise from many organs in the pelvic region. Chronic pelvic pain may originate from the genital organs, urinary organs, pelvic floor muscle structure, gastrointestinal organs in this region, or may arise from other factors such as the neuropsychiatric system. It may also originate from systems. Only less than half of the patients with chronic pelvic pain consult a physician. Patients who apply to health services and are diagnosed with chronic pelvic pain are adequately evaluated. It has been reported in studies that appropriate correctguidance was not given. For correct diagnosis, the severity of the pain, its spread, the reasons that increase and decrease the pain, the relationship between pain and sexual intercourse and menstruation, Findings that include detailed questions such as possible pregnancy status, previous surgeries, menstrual cycle, depression symptoms. > Evaluation and a good examination are very important. So, it is necessary to spare time for the patient. Treatment options for the disease include a wide range of options, from simple drug treatment to surgical treatment. Versatile in the treatment of this disease approachis very important.
In this review, the definition of long-term lower abdominal - groin-lower pain aka chronic pelvic pain in women It is aimed to provide up-to-date information on the evaluation, evaluation and treatment.
In women, long-term lower abdominal - groin- Low back painis a very common clinical problem. KPA is defined by the American College of Obstetricians and Gynecologists (ACOG):
- Lasting for 6 months or more,
- spreading to the groin and/or lower-front abdominal wall and/or waist and/or hips
- creating functional and/or sexual limitations
- defined as pain severe enough to require medical treatment.
Long-term lower abdominal, groin and waist pain in women negatively affects people's mental health, physical activity and quality of life. . It also negatively affects the work efficiency of working women. In a study conducted on 5,325 American women, 16% of the patients reported CPA and 11% reported that their home activities were restricted due to CPA, 12% restricted their sexual life, 16% took various medications, and 4% reported that they were at least monthly due to CPA. It was determined that he did not go to work one day.
In womenlong-term lower abdominal - groin-waist pain patients are caused by the confusion of the lower abdominal nerves and the close proximity of the lower abdominal organs (bladder-uterus-intestine). They can apply to various clinics and seek treatment. With these complaints, patients apply to gynecology, algology, gastroenterology, urology, physical therapy and psychiatry clinics.
COMMONITY OF long-term lower abdominal - groin-lower back pain in women
p>Although it is difficult to determine the frequency of CPA due to variations in its definition, considering patients aged 15-73 who apply to primary health care in England, 38 out of every 1000 applications are women. It occurs due to long-term lower abdominal, groin and waist pain. This frequency is equal to or even higher than the frequency of patients applying to primary healthcare services due to asthma. As age increases, the frequency of applying to health institutions with long-term lower abdominal - groin-waist pain in women increases. In many field studies, women have long-term lower abdominal - groin-waist pain Its frequency varies by country and varies between 2.1% and 25.4%. In a study conducted in New Zealand, the female population between the ages of 18-50 was scanned and the frequency of long-term lower abdominal - groin - waist pain in women was reported as 25.4%. In a study from the USA examining a similar age range, the frequency was reported as 14%. It is the cause of 12% of uterine surgeries and 40% of diagnostic laparoscopies in women. These figures reveal that long-term lower abdominal, groin and waist pain is a common and important problem in women in society.
In women The causes of long-term lower abdominal - groin - waist pain are complex and have not been fully elucidated. Many organs are located side by side in this region and the pain may originate from the reproductive organs, excretory organs, lower abdominal floor muscle structure, intestines or nervous system.
In womenlong-term pain may arise. Diseases that may cause lower abdominal - groin-waist pain are given in detail below.
Non-Cancerous Causes of Chronic Pelvic Pain
A. Gynecological – related to gynecological diseases
1. Endometriosis (chocolate cyst)
2. Adhesions (adhesions)
3. Pelvic Congestion Syndrome (blood accumulation in the lower abdominal area)
4. Ovarian remnant syndrome (remaining ovarian waste after surgery)
5. Ovarian Retention Syndrome (ovarian compression after surgery)
6. Pelvic Inflammatory Disease (inflammation of the uterus and ovaries)
7. Myomas
8. Adenomyosis (uterine muscle disease)
9. Adnexal Cysts (ovarian cysts)
1 O. Intrauterine UterineVehicle (spiral)
11. Symptomatic pelvic desensus (uterine prolapse)
12. Cervical Stenosis (narrowing of the cervix)
13. Cervical or Endometrial Polyp (stalked tissue pieces of the uterus and cervix)
-B. Gastroenterological (gastrointestinal system)
1. IrrtableGlass Syndrome
2. InflammatoryIntestinal Syndrome
3. Celiac
4. Constipation
5. Diverticula
C. Urological
1. InterstitialCystitis (inflammation of the bladder muscle)
2. Chronic kidney system infections
3. Urolithiasis (renal excretory stones)
4. Urethral Syndrome (urinary excretory tube disease)
5. Detrusitor Dyssynergia (bladder muscle disease)
D. Musculoskeletal system
1. Degenerative Disc Disease (deteriorated vertebrae)
2. Fibromyalgia (connective tissue inflammation)
3. Myofascial pain (pain caused by muscle - joint - beam)
4. Levator Ani Syndrome
5. Hearing disorder
6. Priformis Muscle Syndrome
7. Hernias
8. Osteitis pubis(inflammation of the pelvis)
E. Neurological-Psychiatric
1. Depression
2. Abdominal Migraine
3. Abdominal Epilepsy
4. Somatization
5. Iliohypogastricand/or Ilioinguinaland/orGenitofemoral Neuralgia
6. Pudendal Neuralgia
F. Others
1. Familial Mediterranean Fever
2. Porphyria
Evaluation of long-term lower abdominal, groin-waist pain in women:
These patients cannot find permanent solutions to their problems because they are not adequately evaluated and guided by the clinics and physicians they frequently consult.
Moreover, only 1/3 of the patients consult a physician. Long-term lower abdomen - groin-waist a� in women 60% of patients are not sent to tertiary healthcare institutions. Taking a good history (severity of pain, its spread, reasons that increase and decrease pain, relationship of pain with sexual life and menstruation, possible pregnancy status, previous operations, menstrual pattern, vacuum birth, superficial or deep sexual life pain, discharge, sexually transmitted infections History of diseases, pain during urination, urinary frequency, frequent urination at night, constipation and diarrhea attacks, sexual abuse, history of domestic violence, depression symptoms, etc. should be questioned) and a good examination in women (long-term lower abdomen - groin-waist) It is important for the diagnosis of pain.
Complete blood count, urine analysis, urine culture and sedimentation determination, smear taking and smears to detect gonorrhea and chlamydia are appropriate in the first stage. Patients who are first evaluated should be given a pain diary and the nature of the pain should be carefully questioned for 2-3 menstrual periods. Although pain is generally classified as mild, moderate and severe, the use of a pain scale in which the patient expresses his pain between 0 and 10 (for example, visual analog pain scale -YAS- or verbal pain scale -VAS-) gives better results in understanding the severity of pain. These scales are also important for evaluating the change of pain over the day or over time. Giving patients a body pain map to mark the places where they feel the pain and marking the location of the pain and its spread areas on this map will make the physician's job much easier. Transvaginal ultrasound or abdominal ultrasound examination is useful in this group of patients. Although magnetic resonance examination and computed tomography examination are not used routinely, they can assist in diagnosis. Hysteroscopy can play an important role in the diagnosis of CPA causes that may have gynecological origins and is an important part of the treatment of these causes. Laparoscopy is a method used successfully for the diagnosis and treatment of causes of CPA, such as endometriosis and adhesions that cannot be diagnosed by ultrasound, in patients where the cause is not found. But one point that should not be forgotten here is that adhesions do not always cause CPA.
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