Cases You work in a women’s health clinic. Many come lower abdominal discomfort. with Chronic Pelvic Pain (CPP).
Questions for the case • Discuss and described the pathophysiology and symptomology/clinical manifestations.
• Give three examples with definition of Chronic Pelvic Pain (CPP) of:
I. Gynecologic origin with ICD 10 numbers.
II. Non-gynecologic origin with ICD 10 numbers.
• Discuss patient education.
• Develop the management plan (pharmacological and nonpharmacological).
Once you received your case number; answer the specific question on the table above. Then, continue to discuss the 3 topics listed below for your case:
1. An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included on health assessments to reach maximal health potential on individuals.
2. Name the different family developmental stages and give examples of each one.
3. Describe family structure and function and the relationship with health care.
Sample Answer
Chronic Pelvic Pain (CPP) in Women
Chronic Pelvic Pain (CPP) is non-cyclic pain lasting six months or longer, localized to the anatomic pelvis, anterior abdominal wall at or below the umbilicus, lower back, or buttocks, that is severe enough to cause functional disability or require medical intervention.
Pathophysiology and Symptomology
Pathophysiology
CPP is a complex syndrome, often resulting from a dynamic interplay of multiple organ systems and central nervous system (CNS) sensitization.
Peripheral Sensitization: Chronic inflammation, infection (e.g., endometriosis, Interstitial Cystitis, Pelvic Inflammatory Disease), or nerve irritation from gynecological or non-gynecological conditions leads to a reduced pain threshold in the pelvic region.
Central Sensitization: Persistent peripheral input causes changes in the spinal cord and brain. The CNS becomes hyper-responsive, leading to allodynia (pain from a non-painful stimulus) and hyperalgesia (increased pain response to a painful stimulus). This means the pain continues even if the initial cause has been partially treated.
Cross-Organ Sensitization: Due to the overlapping nerve supply in the pelvis (viscera, musculoskeletal structures), irritation in one organ (e.g., the bladder) can cause symptoms perceived in another (e.g., the bowel or uterus), leading to multi-system symptoms.
Musculoskeletal Component: Chronic pain often leads to involuntary splinting and spasm of the pelvic floor muscles, causing myalgia and myofascial pain, which further perpetuates the cycle.
Symptomology/Clinical Manifestations
CPP symptoms vary widely depending on the underlying cause but commonly include:
Pain Characteristics: Constant, intermittent, dull, aching, sharp, or pressure-like pain.
Dyspareunia: Pain during or after sexual intercourse.
Non-Menstrual Bleeding: Abnormal uterine bleeding.
Urinary Symptoms: Urinary frequency, urgency, or dysuria (painful urination) unrelated to infection (e.g., Interstitial Cystitis).
Gastrointestinal Symptoms: Bloating, constipation, or alternating diarrhea and constipation (e.g., Irritable Bowel Syndrome).