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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prostatitis is the most frequently diagnosed illness in men under 50, accounting for about 8% of all consultations with urologists. Estimates based on published studies suggest that the incidence of prostatitis in the population is somewhere between 4% and 11%. In 1995 the National Institutes of Health (NIH) classified prostatitis into 4 main categories: 1) acute bacterial; 2) chronic bacterial; 3) pelvic pain syndrome; 4) asymptomatic inflammatory. The aetiological agent most often involved is bacterial, particularly the category of Gram (-) bacteria, followed by Gram (+), chlamydiae and mycoplasmas; however many cases of prostatitis are caused by bacteria which are difficult to isolate or by aetiopathogenic mechanisms which are immunological, neurological, psychosomatic or anatomical in nature. An observational study was recently done on the Italian territory in order to estimate the incidence and risk factors of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The disease incidence estimation was 13.8%. Cigarette smoking, high caloric diet with low consumption of fruit and vegetables, constipation, meteorism, slow digestion, sexual relationship with more than one partner and coitus interruptus were more likely in CP/CPPS patients than in controls (p < 0.001). CP/CPPS had a negative influence on sexual desire, erectile dysfunction and premature ejaculation (p < 0.001). The Meares Stamey test was positive in 13.3% of patients and 2.9% of controls.
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PMID:Introduction to chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS). 1769 9

We describe the case of a young woman with anterior sacral meningocele (ASM), initially identified during a routine ultrasound examination and subsequently diagnosed using magnetic resonance imaging (MRI). ASM is a rare disorder characterized by uni- or multilocular extensions of the meninges from the sacral spinal canal to the retroperitoneal presacral space. Common symptoms include lower back and pelvic pain, constipation, difficulties in defecation, dysmenorrhea and dyspareunia, and urinary incontinence, retention or urgency. Perineal and lower-extremity paresthesias may present when nerve roots are affected. Despite its more posterior location, ASM can mimic an ovarian cyst or other adnexal cystic mass, and in the obstetric patient can present a mechanical obstacle to delivery with a risk of rupture and infection during labor and delivery. Although it is a rare condition, we feel that awareness of the etiology, presentation and imaging characteristics of ASM is of importance and have therefore carried out a review of the literature, taking into account case findings and the obstetric and gynecological management of this disorder.
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PMID:Anterior sacral meningocele: management in gynecological practice. 1778 29

Sacral nerve modulation (SNM) is an effective way to treat non-neurogenic dysfunctions of pelvic organs. For over 20 years, this technique has been used for the treatment of overactive bladder, urinary retention, pelvic pain and even more recently, fecal incontinence and constipation. The objective of the study is to improve the fixation of the temporary testing electrode (TTE) in order to obtain more reliable results in the testing phase which should lead to have a comparable success rate as the two-stage implant for a chronic implant. Twenty-eight patients (ratio of sex women:men = 3:1; with overactive bladder, urinary retention, pelvic pain syndrome and fecal incontinence) were evaluated by the modified temporary test electrode (TTE) placement. With the subcutaneous tunneling technique (mean time of evaluation 8.3 days), it is possible to perform percutaneous nerve evaluation (PNE) more effectively with an objective, reliable and less expensive outcome prior to the implantation of the implantable sacral nerve stimulator in almost 80% of the evaluated patients. Because the costs of therapy are not covered by health insurance in all countries, there is a need for an effective and inexpensive way to test and select patients appropriately. The tunneled TTE maintains its place for consistent amplitude during the entire test duration. The modification of placing the TTE produces repayable results. This technique can be performed on an outpatient basis to evaluate sacral nerve modulation as an early treatment option for non-dysfunctions of pelvic organs before they are forwarded to a specialized center for a chronic SNM implantation.
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PMID:Subcutaneous tunneling of the temporary testing electrode significantly improves the success rate of subchronic sacral nerve modulation (SNM). 1791 30

Pelvic floor abnormalities often impact significantly the quality of life and result in a variety of symptoms, including chronic pelvic pain, fecal incontinence, and obstructed constipation. Fluoroscopic defecography and MR defecography enable identification of rectocele, rectal prolapse, enterocele, sigmoidocele with high prevalence in female patients with obstructed constipation, fecal incontinence, and chronic pelvic pain. In this manuscript, we describe the techniques and indications of the two techniques of defecography. We discuss the abnormalities of the posterior pelvic floor compartment at the origin of constipation, incontinence, chronic pelvic pain. Finally we compare the data obtained by clinical examination and defecography, remembering that 50% of enterocele and 100% of sigmoidocele are missed at clinical examination.
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PMID:[Role of defecography in female posterior pelvic floor abnormalities]. 1803 77

Interstitial cystitis (IC)/painful bladder syndrome (PBS) is a painful debilitating chronic visceral pain disorder of unknown etiology that affects an estimated 1 million people in the United States alone. It is characterized by inflammation of the bladder that results in chronic pelvic pain associated with bladder symptoms of urinary frequency and urgency. Regardless of the etiology, IC/PBS involves either increased and/or abnormal activity in afferent nociceptive sensory neurons. Pain-related symptoms in patients with IC/PBS are often very difficult to treat. Both medical and surgical therapies have had limited clinical utility in this debilitating disease and numerous drug treatments, such as heparin, dimethylsulfoxide and amitriptyline, have proven to be palliative at best, and in some IC/PBS patients provide no relief whatsoever. Although opiate narcotics have been employed to help alleviate IC/PBS pain, this strategy is fraught with problems as systemic narcotic administration causes multiple unwanted side effects including mental status change and constipation. Moreover, chronic systemic narcotic use leads to dependency and need for dose escalation due to tolerance; therefore, new therapies are desperately needed to treat refractory IC/PBS. This has led our group to develop a gene therapy strategy that could potentially alleviate chronic pelvic pain using the herpes simplex virus-directed delivery of analgesic proteins to the bladder.
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PMID:Herpes simplex virus vector-mediated gene delivery for the treatment of lower urinary tract pain. 1924 23

In patients with functional bowel disorders not responding to maximal medical treatment, bowel lavage or biofeedback therapy, can nowadays be treated by sacral nerve neuromodulation (SNM). SNM therapy has evolved as a treatment for faecal incontinence and constipation. The exact working mechanism remains unknown. It is known that SNM therapy causes direct stimulation of the anal sphincter and causes changes in rectal sensation and several central nervous system areas. The advantage of SNM therapy is the ability to do a minimally invasive temporary screening phase to assess permanent stimulation outcome. Ideal candidates for SNM therapy are not known. Several studies have described positive and negative predictive factors, but the temporary screening remains the instrument of choice. Clinical results are good and as the technique is developing, fewer complications occur. New indications for SNM include constipation and anorectal or pelvic pain.
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PMID:Neuromodulation for functional bowel disorders. 1964 89

Local progression of prostate cancer occurs when the tumor grows beyond the prostatic capsule and invades adjacent structures such as the urinary bladder, rectum, pelvic side-wall and ureters. This is an important clinical event that can in itself cause significant morbidity, impaired quality of life and even mortality. Patients with this condition may experience urinary symptoms due to bladder outlet obstruction by the tumor mass, ureteral obstruction and renal failure, hematuria due to invasion of the tumor into the bladder, and pelvic pain, constipation or tenesmus, as a result of rectal involvement. In the absence of metastasis, some patients with Locally advanced prostate cancer (LAPC) may survive for Longer than 5 years. Therefore, effective and durable palliation is necessary to reduce morbidity and maintain patient quality of life. ALthough the majority of the patients with LAPC cannot be cured by any currently available modality, effective palliation is an independent clinical endpoint. This article presents the LAPC syndrome and treatment options.
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PMID:[Palliative surgery for locally advanced prostate cancer]. 1989 58

Sacral nerve stimulation (SNS) is an effective treatment for bladder and bowel dysfunction, and also has a role in the treatment of chronic pelvic pain. We report two cases of intractable pain associated with cauda equina syndrome (CES) that were treated successfully by SNS. The first patient suffered from intractable pelvic pain with urinary incontinence and fecal incontinence after surgery for a herniated lumbar disc. The second patient underwent surgery for treatment of a burst fracture and developed intractable pelvic area pain, right leg pain, excessive urinary frequency, urinary incontinence, voiding difficulty and constipation one year after surgery. A SNS trial was performed on both patients. Both patients' pain was significantly improved and urinary symptoms were much relieved. Neuromodulation of the sacral nerves is an effective treatment for idiopathic urinary frequency, urgency, and urge incontinence. Sacral neuromodulation has also been used to control various forms of pelvic pain. Although the mechanism of action of neuromodulation remains unexplained, numerous clinical success reports suggest that it is a therapy with efficacy and durability. From the results of our research, we believe that SNS can be a safe and effective option for the treatment of intractable pelvic pain with incomplete CES.
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PMID:Sacral nerve stimulation for treatment of intractable pain associated with cauda equina syndrome. 2061 98

At least one in four women will develop one or more fibroids during their lifetime. They occur most commonly in women aged 30-50 and are three times more common in women of Afro-Caribbean descent than in Caucasian women. Risk factors for fibroids include: age, nulliparity, race, family history and obesity. In two-thirds of cases there are no symptoms. If the tumours are small and not causing symptoms, they do not require treatment However, if they enlarge, they can cause abnormal bleeding, pressure on the bladderand/or bowel and the patient may have difficulty getting pregnant. Fibroids are often discovered as an incidental finding on ultrasound but may also present in the following ways: abnormal uterine bleeding and menorrhagia; infertility; pelvic mass; increasing girth; pressure symptoms (urinary frequency and/or constipation); urinary retention; acute pelvic pain due to torsion of a pedunculated fibroid. During pregnancy, fibroids enlarge and may undergo red degeneration causing pain. Medication can only be used to improve symptoms and/or shrink the fibroids prior to surgery. Women with fibroids >3 cm in diameter causing significant symptoms, pain or pressure and wishing to retain their uterus may consider myomectomy. Hysterectomy is the standard treatment for women with symptomatic fibroids who have not improved with medical treatment. If the woman's family is complete and the fibroids are multiple, hysterectomy provides a permanent cure. Uterine artery embolisation is only recommended if surgery was planned for symptomatic fibroids and if the fibroids are <20 weeks in size. Referral is recommended in the following cases: submucous fibroid and abnormal bleeding; fibroids >3 cm in diameter uterus palpable abdominally or >12 cm in size on scan; persistent intermenstrual bleeding; age >45 where treatment has failed or been ineffective. Sarcomatous change within fibroids is rare and is normally associated with rapid growth. Such cases should be referred urgently.
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PMID:Management of fibroids should be tailored to the patient. 2151 May 5

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. Although the exact pathophysiology is unclear, endometriosis is a well-known cause of pelvic pain and infertility in reproductive-aged women. Endometriosis can have extrapelvic manifestations relevant for colorectal surgeons to appreciate, such as cyclic constipation, diarrhea, hematochezia, and dyschezia. The treatment of endometriosis involves a combination of medical and surgical interventions where close collaboration between the gynecologist and colorectal surgeon can help achieve prolonged periods of symptom remission.
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PMID:Endometriosis for the colorectal surgeon. 2162 24


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