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Rehabilitation of the Pelvis and Pelvic Floor

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Urogenital Pain

Abstract

Chronic pelvic pain (CPP) is a vast and complex condition with many potential etiologies. The urogenital, gynecological, musculoskeletal, and gastroenterologic systems are most commonly involved. Timely evaluation, diagnosis, and treatment are important to prevent frustration for both the provider and patient. Physical modalities, medications, psychotherapy, and alternative medicine can be used to treat both specific causes of CPP or to alleviate general symptoms. Commonly used interventional treatments include superior and inferior hypogastric plexus blocks as well as the ganglion impar block. Often, multidisciplinary treatment plans yield superior results.

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References

  1. Green IC, Cohen SL, Finkenzeller D, et al. Interventional therapies for controlling pelvic pain: what is the evidence? Curr Pain Headache Rep. 2010;14:22–32.

    Article  PubMed  Google Scholar 

  2. Mathis SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: prevalence health related quality of life, and economic correlates. Obstet Gynecol. 1996;87(3):321–7.

    Article  Google Scholar 

  3. Garry R. Diagnosis of endometriosis and pelvic pain. Fertil Steril. 2006;86:1307–9.

    Article  PubMed  Google Scholar 

  4. Reiter RC, Gambone JC. Demographic and historic variables in women with idiopathic chronic pelvic pain. Obstet Gynecol. 1990;75:428–32.

    CAS  PubMed  Google Scholar 

  5. Berger MY. Chronic abdominal pain in children. BMJ. 2007;334:997–1002.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Stein SL. Chronic pelvic pain. Gastroenterol Clin N Am. 2013;42:785–800.

    Article  Google Scholar 

  7. International Pelvic Pain Society – Pelvic pain assessment form. http://www.pelvicpain.org/docs/resources/forms/History-and-Physical-Form-English.aspx.

  8. Dwarkasing RS, Schouten WR, Geeraedts TE, et al. Chronic anal and perianal pain resolved with MRI. AJR Am J Roentgenol. 2012;200(5):1034–41.

    Article  Google Scholar 

  9. Zondervan KT, Yudkin PL, Vessey MP, et al. Chronic pelvic pain in the community: symptoms, investigations, and diagnoses. Am J Obstet Gynecol. 2001;164:1149.

    Article  Google Scholar 

  10. Rao SS, Paulson J, Mata M, et al. Clinical trial: effects of botulinum toxin on levator ani syndrome – a double-blind, placebo controlled study. Aliment Pharmacol Ther. 2009;29:985–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Mazza L, Formento E, Fonda G. Anorectal and perineal pain: new pathophysiological hypothesis. Tech Coloproctol. 2004;8:77–83.

    Article  CAS  PubMed  Google Scholar 

  12. Shin JH, Howard FM. Management of chronic pelvic pain. Curr Pain Headache Rep. 2011;15:377–85.

    Article  PubMed  Google Scholar 

  13. Hogston P. Irritable bowel syndrome as a cause of chronic pain in women attending a gynaecology clinic. Br Med J. 1987;294(6577):934–5.

    Article  CAS  Google Scholar 

  14. Clemons JL, Arya LA, Myers DL. Diagnosing interstitial cystitis in women with chronic pelvic pain. Obstet Gynecol. 2002;100:337–41.

    PubMed  Google Scholar 

  15. Farquhar C. Endometriosis. Endometriosis Br Med J. 2007;334:249–53.

    Article  Google Scholar 

  16. Patijn J, Janssen M, Hayek S, et al. Coccygodynia. Pain Pract. 2010;10(6):554–9.

    Article  PubMed  Google Scholar 

  17. Janicki TI. Chronic pelvic pain as a form of complex regional pain syndrome. Clin Obstet Gynecol. 2003;46(4):797–803.

    Article  PubMed  Google Scholar 

  18. Potts JM. Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. 2005;6(4):313–7.

    Google Scholar 

  19. Howard FM, Perry CP, Carter JE, et al. Pelvic pain diagnosis and management. Philadelphia: Lippincott Williams & Wilkins; 2000. ISBN 0-7817-1724-8.

    Google Scholar 

  20. Newman DK. Pelvic floor muscle rehabilitation using biofeedback. Urol Nurs. 2014;34(4):193–202.

    PubMed  Google Scholar 

  21. Poterucha TJ, Murphy SL, Rho RH, et al. Topical amitriptyline-ketamine for treatment of rectal, genital, and perineal pain and discomfort. Pain Physician. 2012;15(6):485–8.

    PubMed  Google Scholar 

  22. Kroenke K, Krebs EE, Bair MJ. Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. Gen Hosp Pyschiatry. 2009;31:206–19.

    Article  Google Scholar 

  23. Van Ophoven A, Hertle L. Long-term results of amitriptyline treatment of interstitial cystitis. J Urol. 2005;174:1837–40.

    Article  PubMed  Google Scholar 

  24. Dawson TE, Jamison J. Intravesical treatments for painful bladder syndrome/interstitial cystitis. Cochrane Database Syst Rev. 2007;4:CD006113.

    Google Scholar 

  25. Cervigni M, Natale F, Natasa L, et al. A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis. Int Urogynecol J. 2008;19:943–7.

    Article  CAS  Google Scholar 

  26. Toft BR, Nordling J. Recent developments of intravesical therapy of painful bladder syndrome/interstitial cystitis: a review. Curr Opin Urol. 2006;16:268–72.

    Article  PubMed  Google Scholar 

  27. American Urological Association Guideline. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. 2014. https://www.auanet.org/education/guidelines/ic-bladder-pain-syndrome.cfm.

  28. Plancarte R, Amescua C, Patt RB, et al. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 1990;73:236–9.

    Article  CAS  PubMed  Google Scholar 

  29. de Leon-Casasola OA, Kent E, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain. 1993;54(2):145–51.

    Article  PubMed  Google Scholar 

  30. Ghoneim AA, Mansour SM. Comparative study between computed tomography guided superior hypogastric plexus block and the classic posterior approach: a prospective randomized study. Saudi J Anaesth. 2014;8(3):378–83.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mishra S, Bhatnagar S, Rana SP, et al. Efficacy of the anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients. Pain Med. 2013;14(6):837–42.

    Article  PubMed  Google Scholar 

  32. Plancarte R, de Leon-Casacola OA, El-Helaly M, et al. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 1997;22:562–8.

    CAS  PubMed  Google Scholar 

  33. Schutz DM. Inferior hypogastric plexus blockade: a transsacral approach. Pain Physician. 2007;10(6):757–63.

    Google Scholar 

  34. Foye P, Buttaci C, Stitik T. Successful injection for coccyx pain. Am J Phys Med Rehabil. 2006;85(9):783–4.

    Article  PubMed  Google Scholar 

  35. Johnston PJ, Michalek P. Blockade of the ganglion impar (walther), using ultrasound and a loss of resistance technique. Prague Med Rep. 2012;113(1):53–7.

    Article  CAS  PubMed  Google Scholar 

  36. Wemm Jr K, Saberski L. Modified approach to block the ganglion impar (ganglion of Walther). Reg Anesth. 1995;20(6):544–5.

    PubMed  Google Scholar 

  37. Ahmed DG, Mohamad MF, Mohamad SA. Superior hypogastric plexus combined with ganglion impar neurolytic blocks for pelvic and/or perineal cancer pain relief. Pain Physician. 2015;18:E49–56.

    PubMed  Google Scholar 

  38. Whitemore KE, Payne CK, Diokno AC, et al. Sacral neuromodulation in patient with interstitial cystitis: a multicenter clinical trial. Int Urogynecol J. 2003;14:305–9.

    Article  Google Scholar 

  39. Seigel S, Paszkiewicz E, Kirkpatrick C, et al. Sacral nerve stimulation in patient with chronic intractable pelvic pain. J Urol. 2001;166:1742–5.

    Article  Google Scholar 

  40. Everaert K, Devulder J, De Muynk M, et al. The pain cycle: implications for the diagnosis and treatment of pelvic pain syndromes. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:9–14.

    Article  CAS  PubMed  Google Scholar 

  41. Peters KM, Killineger KA, Boguslawski BM, et al. Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms. Neurourol Urodyn. 2010;29(7):1267–71.

    Article  PubMed  Google Scholar 

  42. Bolash R, Vrooman B. Chapter sympathetic blocks for chronic abdominal pain. In: Kapural L, editor. Chronic abdominal pain: an evidence based, comprehensive guide to clinical management. New York: Springer; 2015. p. 143–52.

    Google Scholar 

  43. Scott-Warren JT, Hill V, Rajasekaran A. Ganglion impar blockade: a review. Curr Pain Headache Rep. 2013;17:306.

    Article  PubMed  Google Scholar 

  44. Reissing ED, Brown C, Lord MJ, et al. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. J Psychosom Obstet Gynecol. 2005;26(2):107–13.

    Article  CAS  Google Scholar 

  45. Carrico DJ, Peters KM. Vaginal diazepam use with urogenital pain/pelvic floor dysfunction. Urol Nurs. 2011;31(5):279–84.

    PubMed  Google Scholar 

  46. Crisp CC, Vacarro CM, Estanol MV, et al. Intra-vaginal diazepam for high-tone pelvic floor dysfunction: a randomized placebo-controlled trial. Int Urogynecol J. 2013;24(11):1915–23.

    Article  PubMed  Google Scholar 

  47. Rogalski MJ, Kellog-Spadt S, Hoffman AR, et al. Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction. Int Urogynecol J. 2010;21(7):895–9.

    Article  PubMed  Google Scholar 

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Correspondence to Ryan R. Ramsook MD .

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Ramsook, R.R., Nampiaparampil, D.E., Mogilevksy, M. (2017). Rehabilitation of the Pelvis and Pelvic Floor. In: Sabia, M., Sehdev, J., Bentley, W. (eds) Urogenital Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-45794-9_9

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  • DOI: https://doi.org/10.1007/978-3-319-45794-9_9

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