Chronic Pelvic Pain

 

Refer to General Gynae Clinic with pelvic USS attached

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.

Information to include when referring

• Describe symptoms and effect on QOL, duration, relation to cycle
• Concerns
• Irritable Bowel Syndrome (IBS) considered and treated
• Interstitial cystitis considered and treated
• Psychological / social factors - consider a pain diary for 2-3 months
• Relevant past medical / surgical history
  • PID
  • Abdominal surgery

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 – Arrange a Ca125

In women, especially if >50 years, with persistent / frequent (more than 12 times per month) of

• Persistent abdominal distension (bloating)
• Feeling full (early satiety) +/- loss of appetite
• Pelvic or abdominal pain
• Increased urinary urgency+/- frequency
• Unexplained weight loss or fatigue or changes in bowel habit

If Ca125 raised arrange an urgent pelvic USS and refer 2ww if suspicious of ovarian cancer

Reference:

RCOG Greentop Guideline No 41 May 2012 ‘The initial management of chronic pelvic pain’

Author:                       Dr S Burns GP

Contributors:                        Lisa Verity Consultant Gynaecologist RCHT.

Date reviewed             December 2020

Review date                December 2021

Version 1.2