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Chronic Pelvic Pain
What is Chronic Pelvic Pain?
Chronic Pelvic Pain (CPP) is generally defined as pain in the pelvic areat that is persistent for three to six months or longer, is severe enough to cause functional disability or require treatment, and it unrelated to pregnancy.
What Causes of Chronic Pelvic Pain?
1. Endometriosis: is a condition where a woman has endometrial tissue outside the uterus. This by far the most common cause of CPP. Women will often associated symptoms of nausea, urinary frequency, and/or loose stools during their periods. They may have dysparunea (painful sex on deep penetration), dyschezia (deep pelvic pain with bowel movements), mid-cycle spotting (pink spotting with ovulation) and/or post-coital spotting (spotting after intercourse). The research is somewhat variable, but Napro surgeons will find endometriosis about 80% of the time in women who experience CPP. To learn more about NaPro surgery click here.
2. Intra-abdominal Adhesions: the term "adhesions" refers to scar-like formation within in the pelvic or abdominal cavity, which forms when the body perceives something foreign or infectious is present and /or after an injury is perceived. Adhesions have been reported to develop following more than 90 % of abdominopelvic surgeries. Adhesions can attach to the organs and/or pelvic side walls and completely distort the anatomy. My Intro to NaProlecture will briefly discuss both endometriosis and adhesions.
3. Adenomyosis: is a condition in which endometrial tissue is found within the smooth muscle layer of the uterus. The ectopic implants can induce abnormal changes in the myometrium, and cause abnormal uterine bleeding and dysmenorrhea (painful periods). Women who have adenomyosis often also have endometriosis.
4. Pelvic Inflammatory Disease (PID): results from an acute, subacute, or chronic infection in the genital track that ascended through the vagina, into the upper reproductive organs. PID can involve uterus, fallopian tubes, and/or the ovaries. The CPP associated with PID is believed to be caused by a prior infection that perhaps went untreated for a period of time. About as 30 % of women with PID will develop CPP.
5. Pelvic Congestion Syndrome (PCS): is a vascular disorder where the veins of the pelvic region become engorged due to improper drainage of blood out of the region. PVC often presents very similarly to endometriosis with some or all of the following symptoms: dysparunea, dyschezia, urinary frequency, nocturia, or chronic pelvic pressure, and/or lower leg swelling, that is worse after standing for a while. PVC is more common in women who have had multiple pregnancies.
6. Uterine Fibroids: area benign growths in the muscle layer of the uterus that can cause abnormal uterine bleeding, dysmenorrhea (painful periods), "bulk" symptoms, such as urinary frequency, leakage of urine with cough or sneeze, and nocturia (having to urinate in the middle of the night). Fibroids can also cause pelvic pressure. In the study linked to the button below, chronic pelvic pain was reported to be nearly 15 % in women with fibroid as compared to only 3% of women without fibroids.
BLEEDING KEY: How do I Measure Period Flow on my CrMS Chart?
I will be asking you to tell me very specifically how much you are bleeding. An example of a "detailed flow" is: M, M, H, L, L, VL/B
TAMPON or PADS:
- Very Heavy (VH): changing a full pad/tampon every 1-2 hours
- Heavy (H): changing a full pad/tampon every 3-4 hours
- Moderate (M): changing a full pad/tampon every 5-7 hours
- Light (L): changing a full pad/tampon every 8-12 hours
- Very Light (VL): changing pad/tampon less than every 12 hours
MENSTRUAL CUP MEASUREMENTS
- Very Heavy (VH): 60 cc in a 24 hours
- Heavy (H): 40 cc in 24 hours
- Moderate (M): 20 cc in 24 hours
- Light (L): 10 cc in 24 hours
- Very Light (VL): 5 cc in 24 hours
**The Diva Cup comes in 20, 30 and 32 ml cups 32 being the largest but other cups may vary. 1 ml = roughly 1 cc
Other important information about your flow:
- Tail End Brown Bleeding (TEBB): brown bleeding at tail end of period.
- Premenstrual bleeding: pink spotting or brown spotting at the prior to a full period starting.
- Intermenstrual bleeding: bleeding between periods.
Pelvic Congestion Syndrome (PCS)- Medical Professional Lecture
Rick Kennedy, PA-C, MHS, is a clinical provider and CEO for the Center for Vascular Medicine in Greenbelt, MD. During this lecture Rick will discuss the common causes of pelvic pain with a focus on those of a vascular origin. Rick will review diagnosis, imaging, treatment options and health maintenance for Pelvic Congestion Syndrome.
