Pelvic Pain and Associated Syndromes

Irritable Bowel Syndrome:
A complex sensory and neurologic disorder of the bowel resulting in alterations of bowel habits. Its cause is unknown but it often occurs with overlapping disorders such as allergies, pelvic floor dysfunction, interstitial cystitis, vulvodynia, and prostadynia.

Symptoms:

  • Alternating diarrhea and constipation
  • Abdominal pain, bloating, gas, distention and cramping
  • Highly variable symptoms between individuals

Causes:
Bowel motility is affected with the bowel muscles often related to distention or stretching, hormones and stress.  Alterations in the sensation of the nerves in the gut or the brain dysregulation  of these nerves appear to be a factor.

Treatment:

  • Avoidance of constipation
  • Stool softener, fiber supplement and/or Miramax daily
  • Probiotic supplement daily
  • Antispasmodics i.e. Lesinex, Lomotil, or Bentyl, Librax
  • Avoid dietary irritants – caffeine, spices, acid foods, carbonated  drinks
  • Accupuncture

Vulvodynia
Vulvodynia is a pain involving the vulvar and perineal area in a female.  The etiology is unknown and most often occurs between 15 and 25 years of age.

Pain is described as burning, stinging, raw, irritative or stabbing can vary from mild to debilitating.
Generally, the  condition is divided into two categories:

  • General  Vulvodynia – the pain is in the perineal area radiates to the buttocks or thigh.  It remains fairly constant but may be intermittent.  Prolonged sitting aggrevates vulvar pain or fecal straining.
  • Vulvar Vestibulitis –  Primarily the discomfort is felt when the vulvar skin is touched by Qtip evaluation during gynecologic exam, tampon insertion vaginal penetration during intercourse.

Treatments:

  • Discontinuation  of Irritants
  • Oral Pain- Blocking Medicines
  • Tricyclic Antidepressants
  • Seratonin-Norepinephrine Reuptake Inhibitors
  • Anticonvulsants
  • Narcotics
  • Topical Medicines
  • Hormonal creams ( testosterone, estrogen etc)
  • Anesthetic gels or creams ( Lidocaine, marcaine etc)
  • Pelvic Floor Muscle Therapy
  • Nerve Blocks
  • Neurostimulation
  • Surgery to remove skin with glans (for  women with Vulvar Vestibulitis)
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