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

Uterine artery embolization is a new method of treating uterine leiomyomata, first carried out in France in the early 90s. The procedures involve placing a small catheter into an artery in the groin and directing it to the blood supply of the fibroid. Little plugs of polyvinyl alcohol are injected through the catheter to block these arteries. This cause the fibroid to shrink. Indications for uterine fibroid embolization include menorrhagia, pelvic pain or pressure, other "bulk" syndrome (low-back pain, urinary frequency and constipation. The fluoroscopic-guided procedure is performed under local anesthesia. Most patients are discharged within 72 hours. Post-embolization syndrome including severe pain is managed with morphine via patient-controlled pump. Paper reviews long term outcomes. Uterine artery embolization has several advantages: high efficacy, less invasiveness, ability to treat multifocal changes, uterine preservation, shorter hospitalisation and recovery (low cost) and disadvantages: postembolic syndrome (pain and fever), unknown relations to pregnancy and lack of long term results.
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PMID:[Uterine arteries embolization as a treatment of uterine leiomyoma]. 1271 43

Sixteen women requesting surgical treatment of menorrhagia were recruited for a study on microwave endometrial ablation. The mean age at treatment was 41.4 years and all patients had completed their family and were pre-menopausal. Average treatment time was 2 minutes 6 seconds. All patients reported a reduction in their menstrual loss and 87.5% were satisfied with their treatment after 1 year follow-up. One patient required overnight admission for analgesia while 15 patients were treated on a day case basis using light general anaesthesia. Sixty-seven per cent of patients reported a reduction in dysmenorrhoea scores at 1 year, two patients reported no change in symptoms and one patient reported a modest increase. One patient had a hysterectomy 10 months after treatment despite being amenorrhoeic. The indication for hysterectomy was pelvic pain (which was present before endometrial ablation). There were few minor complications but no uterine perforation or emergency hysterectomies.
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PMID:Microwave endometrial ablation for menorrhagia. 1551 73

Laparoscopy under local anaesthesia (LULA) is a safe, feasible and well-tolerated procedure. LULA has been successfully used for such outpatient gynaecological procedures as diagnosis of chronic pelvic pain and sterilisation. Single studies have indicated that LULA can be performed for diagnosis of possible intra-abdominal catastrophe in ICU patients, appendectomy and preperitoneal inguinal hernia repair. LULA in abdominal surgery for diagnosis of conditions presenting with acute lower abdominal pain is being introduced at our institution. This paper describes the possible applications of LULA in current practice as well as the technical aspects of the procedure.
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PMID:[Diagnostic laparoscopy under local anaesthesia]. 1628 20

Low back and pelvic pain (LBPP) is prevalent during pregnancy and also post-partum. The aetiology is poorly understood. The aim of this study was to investigate possible associations between epidural or spinal anaesthesia and caesarean section (CS) with persistent LBPP half a year after pregnancy. In a previous questionnaire study (n=891) altogether 639 (72%) women had reported LBPP during pregnancy. We sent these respondents a second questionnaire at approximately 6 months post-delivery. The response rate was 72.6% (n=464). The respondents were divided into three groups reporting 'no pain', 'recurrent pain' and 'continuous pain' in relation to LBPP 6 months after delivery. Pearson's chi-square test was used to test the difference between groups and logistic regression analysis was performed. Forty percent of the respondents had received epidural anaesthesia (EDA) or spinal anaesthesia during delivery and 18.5% of women had been delivered by CS. Epidural or spinal anaesthesia was not associated with persistent LBPP. There was no significant difference in CS rates between different sub-groups. The risk of persistent LBPP was increased three- to fourfold in women delivered by elective CS compared with women delivered by emergency CS. Epidural or spinal anaesthesia was not associated with risk of persistent LBPP. Elective CS was associated with an increased risk of persistent LBPP. However, the results must be interpreted with caution because of a relatively small study sample.
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PMID:Does caesarean section negatively influence the post-partum prognosis of low back pain and pelvic pain during pregnancy? 1667 52

This chapter summarises the evidence of the benefits and harm of surgical therapies for benign gynaecological disease. We have limited the discussion in this chapter to three gynaecological conditions - menorrhagia, endometriosis and benign ovarian tumours - with a further section on the different surgical approaches for performing a hysterectomy for menorrhagia due to dysfunctional uterine bleeding and pelvic masses such as fibroids and benign adnexal masses. The currently available evidence suggests that there is little to choose between the four first-generation endometrial destruction techniques - laser ablation, transcervical resection of endometrium, vaporisation ablation and rollerball ablation - in terms of clinical efficacy and patient satisfaction. There is a paucity of evidence with regards to the comparison of the different second-generation endometrial-destruction techniques but current evidence suggests that bipolar radiofrequency ablation is more effective than thermal balloon ablation for treating menorrhagia. Overall, the second-generation techniques are at least as effective as first-generation methods but are easier to perform and can be done under local rather than general anaesthesia in some circumstances. Hysteroscopic endometrial ablation is an alternative to hysterectomy and should be offered to women with menorrhagia because of its high satisfaction rates, shorter operation time, shorter hospital stay, earlier recovery and reduced postoperative complications; hysterectomy remains the surgical option of choice for women with intractable menorrhagia despite repeated endometrial ablations and for those who do not wish under any circumstances to continue to have menstrual bleeding. The combined use of laparoscopic laser ablation, adhesiolysis and uterine nerve ablation has been shown to have a beneficial effect on pelvic pain associated with mild to moderate endometriosis. Current evidence also supports the use of laparoscopic treatment of minimal and mild endometriosis to improve the on-going pregnancy and live birth rate in infertile patients. The current available evidence suggests that the laparoscopic approach is superior to laparotomy for the surgical management of benign ovarian cysts. It results in less postoperative pain and a shorter postoperative hospital stay; it also costs less. With regards to the surgical approach for performing a hysterectomy for menorrhagia and benign pelvic masses, vaginal hysterectomy should be performed over laparoscopic and abdominal hysterectomy when possible. Where it is not possible to perform the hysterectomy vaginally, then laparoscopic hysterectomy can be employed instead of abdominal hysterectomy to avoid a laparotomy scar. There appears to be no significant advantage in performing a subtotal hysterectomy instead of the total removal of the uterine corpus and cervix.
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PMID:Health technology assessment of surgical therapies for benign gynaecological disease. 1714 85

Limbic associated pelvic pain is a proposed pathophysiology designed to explain features commonly encountered in patients with chronic pelvic pain, including the presence of multiple pain diagnoses, the frequency of previous abuse, the minimal or discordant pathologic changes of the involved organs, the paradoxical effectiveness of many treatments, and the recurrent nature of the condition. These conditions include endometriosis, interstitial cystitis, irritable bowel syndrome, levator ani syndrome, pelvic floor tension myalgia, vulvar vestibulitis, and vulvodynia. The hypothesis is based on recent improvements in the understanding of pain processing pathways in the central nervous system, and in particular the role of limbic structures, especially the anterior cingulate cortex, hippocampus and amygdala, in chronic and affective pain perception. Limbic associated pelvic pain is hypothesized to occur in patients with chronic pelvic pain out of proportion to any demonstrable pathology (hyperalgesia), and with more than one demonstrable pain generator (allodynia), and who are susceptible to development of the syndrome. This most likely occurs as a result of childhood sexual abuse but may include other painful pelvic events or stressors, which lead to limbic dysfunction. This limbic dysfunction is manifest both as an increased sensitivity to pain afferents from pelvic organs, and as an abnormal efferent innervation of pelvic musculature, both visceral and somatic. The pelvic musculature undergoes tonic contraction as a result of limbic efferent stimulation, which produces the minimal changes found on pathological examination, and generates a further sensation of pain. The pain afferents from these pelvic organs then follow the medial pain pathway back to the sensitized, hypervigilant limbic system. Chronic stimulation of the limbic system by pelvic pain afferents again produces an efferent contraction of the pelvic muscles, thus perpetuating the cycle. This cycle is susceptible to disruption through blocking afferent signals from pelvic organs, either through anesthesia or muscle manipulation. Disruption of limbic perception with psychiatric medication similarly produces relief. Without a full disruption of both the central hypervigilance and pelvic organ dysfunction, pain recurs. To prevent recurrence, clinicians will need to include some form of therapy, either medical or cognitive, targeted at the underlying limbic hypervigilance. Further research into novel, limbic targeted therapies can hopefully be stimulated by explicitly stating the role of the limbic system in chronic pain. This hypothesis provides a framework for clinicians to rationally approach some of the most challenging patients in medicine, and can potentially improve outcomes by including management of limbic dysfunction in their treatment.
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PMID:Limbic associated pelvic pain: a hypothesis to explain the diagnostic relationships and features of patients with chronic pelvic pain. 1729 60

Intestinal endometriosis accounts for 8-12% of all endometriosis and rectal involvement is most often encountered in the context of deep pelvic infiltration. Intestinal symptoms, often nonspecific, are most typically seen as painful defecation or constipation worsening in the premenstrual period associated with pelvic pain, dysmenorrheal, dyspareunia, and infertility. Physical examination should include a pelvic exam under anesthesia. Endorectal ultrasound best evaluates rectal muscle invasion, while pelvic MRI and CT will evaluate the full extent of pelvic involvement and other GI sites of implantation. Only radical extirpative surgery of all intestinal, urologic, deep pelvic, and adnexal sites of endometriosis will permit relief of pain, prevent recurrence, and hopefully preserve fertility. In view of the frequency of extra-intestinal sites of involvement and technical difficulties augmented by previous surgical interventions, open laparotomy remains the preferred approach. A laparascopic approach would be reserved only for well-selected patients presenting with isolated colorectal involvement.
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PMID:[Surgical treatment of rectal endometriosis]. 1736 54

Pregnancy taxes the musculoskeletal system. The enlarging gravid uterus alters the maternal body's center of gravity, mechanically stressing the axial and pelvic systems, and compounds the stresses that hormone level fluctuations and fluid retention exert. While the pregnant woman is prone to many musculoskeletal injuries, most can be controlled conservatively, but some require emergent surgical intervention. This article describes pregnancy-related orthopedic problems and related conditions, and discusses their pathogenesis, signs, symptoms, physical examination findings, diagnostic work-up, and interventions. Topics specifically covered include the following: pregnancy-related posterior pelvic pain (PRPPP), lumbar disc herniation with cauda equine syndrome, low back pain, kyphoscoliosis and scoliosis issues for anesthesia during pregnancy and delivery, pubic symphysis rupture, transient osteoporosis versus osteonecrosis, management of pregnancy after hip replacement surgery, and carpal tunnel syndrome. Specific musculoskeletal systems discussed in this article include the spine, pelvis, hip joint, and wrist.
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PMID:Orthopedic issues in pregnancy. 1819 83

The purpose of this study was to compare the clinical efficacy of ultrasound (US) therapy and laser therapy in patients with symptomatic benign ectopy of the uterine cervix. Patients with symptomatic benign ectopy of the cervix (n = 200) were enrolled in this study. Abundant leukorrhea, contact bleeding, recurrent cervicitis and pelvic pain were also evaluated. Patients were allocated alternately to the US and laser groups. In the laser group, Nd: YAG laser was used for tissue vaporization destruction. In the US group, the therapeutic US device Seapostar (Chongqing Haifu [HIFU] Technology, Co. Ltd., Chongqing, China) was applied. Neither anesthesia nor analgesia was used. Results showed that patients in both groups tolerated the procedure well and had excellent treatment outcomes. A symptomatic cure rate of 97.33% was obtained in the US group, and 98.81% was obtained in the laser group (p > 0.05). Ectopy areas were managed with a success rate of 95.95% in the US group, and 96.43% in the laser group (p > 0.05). The rate of side effects (including vaginal reactive discharge and colporrhagia) was found to be lower in the US group than that in the laser group. Mild-to-moderate bleeding occurred in US group (8.42%) and laser group (45.56%). The bleeding rate in the US group is significantly lower than that in the laser group (p < 0.01). We conclude that focused US can treat symptomatic ectopy of the cervix successfully, with excellent clinical results and minimal risk. Focused US therapy appears to be a promising new treatment method for symptomatic ectopy of the uterine cervix.
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PMID:A comparison between ultrasound therapy and laser therapy for symptomatic cervical ectopy. 1847 53

Pelvic pain as the presenting symptom of demyelinating disease is rare. We report on a 49-year-old female patient that initially had symptoms of pain and anesthesia in the perineum. Symptoms later evolved to include both lower and upper extremity weakness and were associated with enhancing spinal cord lesions on MRI. Recognizing that the patient's disease was localized only to the spinal cord led to an eventual serological diagnosis of neuromyelitis optica (Devic's disease), a demyelinating syndrome that is now considered distinct from multiple sclerosis and that primarily affects the spinal cord and optic nerves. Pelvic pain is an unusual first presentation of this illness. Additionally, this case illustrates the challenges of establishing a diagnosis of neuromyelitis optica. Recognizing the distinct clinical features of this rare illness, referring specifically from a spinal cord or ophthalmological etiology, is essential for its rapid diagnosis, and hence for initiation of appropriate therapy.
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PMID:Pelvic pain as an unusual first presentation of a demyelinating disease. 1876 78


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