Chronic Pelvic Pain
Definition:
Intermittent or constant pain in the lower abdomen or pelvis of at least 6 months’ duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy.
Refer to General Gynae Clinic
Information to include when referring
- Indication of parity
- Describe symptoms and effect on QOL, duration, relation to cycle
- Her concerns
-
Irritable Bowel Syndrome (IBS) considered and treated
- Doesn’t have pain on defecation / change in stool
- ‘trial of dietary modification / antispasmodic unhelpful’
- Any significant abnormal smears
-
Relevent past medical / surgical history
- PID
- Previous abdominal surgery
- Current regular medication
Investigations prior to referral
- Swabs (Chlamydia / HVS)
- Pelvic USS
Desirable Information
- Smear history (including last smear & result) the patient will still be seen without this but if you can retrieve it automatically it speeds up the appointment
-
Treatment so far
- Eg COCP / Mirena
- Expectations of referral
Red Flag Symptoms
If >50 years with persistent / frequent (>12 times per month) symptoms of abdominal distension / bloating, feeling full and/or loss of appetite, pelvic or abdominal pain, increased urinary urgency and / or frequency consider serum Ca125. If >35 IU/L arrange urgent pelvic USS and refer urgently if suggestive of ovarian cancer
Reference:
RCOG Greentop Guideline No 41 April 2005 ‘The initial management of chronic pelvic pain’
NICE Guideline April 2011 Ovarian Cancer The recognition and initial management of ovarian cancer