Diagnosis and treatment of pelvic pain

Abstract

Traditionally, treatment of pelvic pain is the responsibility of gynecologists and urologists, though even in the developed countries causes of chronic pelvic pain (CPP) are not always clear in most patients. A multidisciplinary approach is imperative for individual-based clarification of CPP pathogenesis and choosing the optimum treatment: pelvic organs are closely interrelated, having common afferent and efferent nerves, blood circulation, muscles and ligaments. Thus, problems in one organ often involve the adjacent organs in the pathogenetic process resulting in cross-sensitization of the peripheral and central nervous systems taking part in the regulation of the pelvic function and pelvic muscular-articular apparatus. Persistent groundless exaggeration of the role of infectious diseases in the pathogenesis of pelvic pain leads to failure of treatment and, consequently, chronic disease. Currently, a significant role in CPP is assigned to hip dysplasia and coxarthrosis, sacroiliac joint dysfunction with secondary myofascial pelvic syndrome and tunnel neuropathies of anterior abdominal wall and perineum. These diseases are largely under the responsibility of neurologists, orthopedists and rheumatologists rather than urologists, gynecologists and even proctologists.