骨盆 疼痛

原因

Chronic pelvic pain has many possible causes and may involve different systems in the body, 包括泌尿系统, 生殖胃肠, 肌肉骨骼和神经系统. 症状可能因病因而异. When we explore all the potential sources and address the issues we uncover, many women find relief.

妇科原因

子宫内膜异位

子宫内膜异位 is a condition in which the lining of the uterus (endometrium) grows outside the uterus. The lining can attach to the ovaries, fallopian tubes, intestines or other structures in the pelvis. Adenomyosis occurs when tissue from the lining of the uterus grows in the muscle of the uterus.

子宫内膜异位 may cause pelvic pain, especially during menstruation. 荷尔蒙 月经周期 cause the endometriosis to bleed each month. This can be painful and result in the formation of pelvic adhesions, also known as scar tissue. Blood trapped in the ovary can build up into a cyst. 这叫做子宫内膜异位瘤.

盆腔粘连

Adhesions are bands of scar tissue that bind organs together. 它们是由以前的感染造成的, such as appendicitis or pelvic inflammatory disease, 通过骨盆或腹部手术, 或者子宫内膜异位症. 粘连很难诊断, but in some cases the uterus and ovaries feel bound together on pelvic examination. A definitive diagnosis of adhesions is usually made during surgical exploration, 经常通过腹腔镜检查.

Symptoms from adhesions include generalized pelvic discomfort or localized pain. Surgery to cut bands of scar tissue can relieve pain. 然而，有时粘连会重新形成.

外阴疼痛

外阴疼痛 is pain at the opening to the vagina or the surrounding lips (vulva). 原因尚不清楚. 人们认为神经, muscles and tissues in the area are inflamed, so treatment is focused on addressing these factors.

Women with this condition may find it painful to insert a tampon, have sexual intercourse or even wear tight pants. Symptoms include burning, stinging, stabbing, irritation and rawness. The pain may be constant or intermittent, localized or diffuse.

Non-Gynecologic原因

Non-gynecologic problems can also cause pelvic pain. 最常见的是:

肠易激综合症

肠易激综合症(IBS) can cause diarrhea, constipation, or a combination of both. Symptoms of bloating and discomfort may be relieved by a bowel movement. Stress and diet can aggravate the condition. The 妇科 provider may make a referral to a gastrointestinal specialist for diagnosis and treatment.

间质性膀胱炎

Interstitial cystitis (IC) is a painful bladder syndrome. 这和其他膀胱症状, such as the need to urinate frequently or urgently, 可能需要泌尿科十大赌博平台排行榜评估.

肌肉骨骼的原因

Musculoskeletal causes of pelvic pain are very common but are often overlooked. The muscles, joints and nerves in the pelvis can be injured just like any other part of your body. 例如, 组织可能被过度拉伸, torn or cut in childbirth or surgery; muscles can weaken or tighten from disuse and injury; and habitual postures and movements can slowly stretch or compress structures in the pelvis, 导致疼痛和功能障碍. The pelvic muscles, joints and nerves may be the sole cause of pain or just a piece of the problem.

Chronic pain can be created by spasms of the muscles that line the pelvis, 又称盆底肌. 肌肉的“吊索”, along with connective tissue called fascia, lift and support the pelvic organs including the bladder, 子宫和直肠. Spasms in these muscles — known as pelvic floor tension myalgia or levator ani syndrome — may cause pain locally. 肌肉紧绷, 被称为触发点, 也许摸起来很柔软, and they may refer pain to other areas of the pelvis, 腹部和下背部.

A thorough examination of the 腹部和骨盆 can uncover these sources of pain, which can be treated with physical therapy and biofeedback.

抑郁和焦虑

Many women with chronic pain suffer from anxiety, depression, or both, which worsens pain. Recurring or chronic pain can cause some women to feel depressed. 这些感觉是正常的. In other cases, pelvic pain can be a symptom of depression or anxiety. It's essential to address depression or anxiety with therapy and medications as needed.

诊断

The diagnosis of chronic pelvic pain requires a good patient history and physical exam. 按你的约定, please come prepared to discuss many aspects of your health, 包括你过去的病史, 痛苦的历史, 性史和精神健康.

The physical exam will thoroughly assess the many possible sources of pelvic pain discussed under "Symptoms," with particular attention to the musculoskeletal system including the back, 腹部和骨盆. A Q-tip test may be performed to test the nerves outside and near the vagina.

If needed, we may order other diagnostic tests such as blood work, urine tests, a pelvic 超声波 或laproscopy. You may be referred to a urogynecologist if you have bladder symptoms, or a gastroenterologist if you have gastrointestinal symptoms. If you have a musculoskeletal component to your chronic pelvic pain, we may refer you to a physical therapist for further evaluation and treatment.

治疗

Treatment for chronic pelvic pain is tailored to each patient, depending on the underlying causes of the pain. 一些治疗方案包括:

• Hormones for conditions such as endometriosis or heavy menstrual bleeding.
• 疼痛 medications such as narcotics, nonsteroidal anti-inflammatories or medicines for nerve pain.
• Surgery for some women with adhesions, adenomyosis or endometriosis.
• Physical therapy and biofeedback for women with myofascial (connective tissue) or muscle pain.
• Psychological therapy, medication, or both to help you cope with chronic pain. A therapist can offer support and tools to handle living with chronic pain, and can also help you and your partner cope with the relationship and sexual issues that can arise as a result of chronic pain.
• Mind/body techniques such as meditation, breathwork, guided imagery and yoga.
• Nutrition and supplements — for instance, a diet rich in fruits, vegetables and grains is important. Avoiding foods that can increase inflammation and increasing foods that decrease inflammation can be useful.
• Alternative healing systems such as traditional Chinese medicine, which have been found to help relieve pain. We can refer you to an appropriate provider.

Chronic pain is very difficult to deal with. It's important to set reasonable goals and develop a treatment plan that addresses your unique health needs. It's also important to attend to your emotional health, and to focus on what brings joy and meaning to your life.

物理治疗

Some studies show physical therapy helps 60 percent of women with chronic pelvic pain and levator ani syndrome. It helps to align bone or muscular imbalances, decrease abnormal muscle tension and soft tissue, and strengthen your core muscles to prevent further injury. A physical therapist can also help identify other factors that may contribute to your pain, 比如姿势不好, 定位与习惯.

访问期间, your physical therapist will conduct a thorough musculoskeletal examination, identifying sources of pain and dysfunction. 有时是脚的排列, 臀部, and back will affect the posture of the pelvis and perpetuate the pain cycle. A woman who has had chronic pelvic pain long-term may notice she has symptoms in other areas of her body. 病人 may notice changes in the muscles, skin and tissue of the pelvis, back and abdomen.

Your physical therapist will examine the muscles of the pelvic floor as well as the abdomen, 大腿和背部. The therapist will work with you to develop a treatment plan to address your specific issues and goals.

Physical therapy techniques for disorders of the joints and soft tissues of the pelvis may include education, 内外肌筋膜松解, 手动疗法, 治疗性运动, and treatments such as electrical stimulation or biofeedback. You may also use tools for self treatment at home, such as dilators and a product called Crystal Wand. A home program is also a vital component of physical therapy, maintaining and improving the musculoskeletal changes we make in the clinic.