What is Pelvic Pain?
Pelvic pain is a common complaint in both men and women, affecting 12% of the population, and can be due to many different organ systems. This pain can be intermittent, constant, or related to certain events. Pelvic pain that is present for more than six months is classified as chronic.
In order to diagnose a pelvic pain syndrome, reproductive, urologic, and gastrointestinal sources of the pain must be ruled out. A careful history and physical must be performed to diagnose each of these syndromes.
What is Coccygodynia?
Coccygodynia or coccydynia (tailbone pain) is identified by pain with pressure or movement of the tailbone (coccyx). This may be due to a fracture or bruising of the tailbone, disc disease within the spine, or thinning of the bone itself. X-rays may help to evaluate fractured or weakened bone.
How is Coccygodynia Treated?
Injection of anesthetics or anti-inflammatory medications may provide pain relief. Manipulation of the tailbone in the office or under anesthesia may improve the symptoms in certain patients. Cases that do not respond to non-operative management may require removal of the tailbone. The exact causes of levator syndrome are not known, but it is largely attributed to spasm or inflammation in the muscles of the pelvic floor (levators).
What is Levator Syndrome?
Levator syndrome is episodic pain in the rectum, sacrum, or coccyx, also associated with aching pressure in the buttocks and thighs. The exact causes of levator syndrome are not known, but it is largely attributed to spasm or inflammation in the muscles of the pelvic floor (levators). The pain may be vague or localize to the rectum, anus, rear of the pelvis, or tailbone. This is intermittent, but may last for days in certain cases. Digital rectal examination by a practitioner may reproduce this pain.
What is Proctalgia Fugax?
A variant of levator syndrome is known as proctalgia fugax (fleeting rectal pain). This is characterized by brief, intense pain in the rectum that lasts for just seconds to minutes. The spasms often wake patients from sleep, but may happen during the day as well. Proctalgia fugax is difficult to evaluate due to its brief episodes, but often may be diagnosed on history alone. It is felt to be due to cramping of the pelvic floor muscles.
How is Levator Syndrome Treated?
Physical therapy, including massage of the pelvic floor muscles, is extremely effective at treating the symptoms. Biofeedback therapy relieves the pain by modifying the pelvic activity. Muscle relaxants provide excellent relief, though with the side effect of drowsiness. Local anesthesia or steroid injections have been performed, but are less consistent than therapy or muscle relaxants.
What is Pudendal Neuralgia?
Pudendal neuralgia is pain in the areas supplied by the sensory nerves of the pelvis. It typically affects the reproductive organs, rectum, or prostate gland. It may be worsened by bowel movements or by certain positions. It is caused by muscle entrapment or repetitive injury to the nerves of sensation. It is diagnosed by reproduction of the pain when the pudendal nerve is pushed through the rectal wall.
How is Pudendal Neuralgia Treated?
Anti-inflammatory agents, either steroidal or NSAIDS, are the mainstay of treatment, as are muscle relaxants. Routine injection nerve block may be used for patients who do not improve with an oral regimen. Surgery is reserved for severe cases where conservative management fails.