1/10. A systematic history for the patient with chronic pelvic pain.Chronic pelvic pain is a source of frustration to both the physician and the patient. physicians have been ill equipped by their training to confront the multifaceted nature of the complaints of patients with chronic pelvic pain. patients have experienced a repetitive dismissal of their complaints by physicians too busy in their practices to address their problems comprehensively. The approach to the patient with chronic pelvic pain must take into account six major sources of the origin of this pain: 1) gynecological, 2) psychological, 3) myofascial, 4) musculoskeletal, 5) urological, and 6) gastrointestinal. Only by addressing and evaluating each of these components by a very careful history and physical examination and by approaching the patient in a comprehensive manner can the source of the pain be determined and appropriate therapy be administered. This article was developed to provide the clinician with a set of tools and a methodology by which the patient with this complaint can be approached.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/10. Clinical utility of pelvic pain mapping.STUDY OBJECTIVE: To survey physicians' opinions concerning the impact of pelvic pain mapping on clinical management and surgical decisions. DESIGN: Opinions of physicians based on clinical experience (Canadian Task Force classification III). SETTING: Evening meetings appended to two national meetings. MEASUREMENTS AND MAIN RESULTS: After viewing videotaped interviews, physical examinations, standard laparoscopy, and pelvic pain mapping at laparoscopy in two patients, practicing gynecologists completed questionnaires recording their opinions about the utility of pelvic pain mapping. A second group of gynecologists viewed only one tape. The first group considered pain mapping to be moderately or extremely useful (patient 1, 57.9%; patient 2, 73.7%). Mapping data either made surgeons change the surgical procedure they would have chosen or further clarified the diagnosis (patient 1, 68.4%; patient 2, 84.2%). Of the second group of 67 surgeons, 73% thought that mapping results would have made them change their surgical approach. CONCLUSION: In appropriate cases, pelvic pain mapping during microlaparoscopy under conscious sedation can provide information that may influence surgical decisions as well as general clinical management.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/10. Chronic perineal pain and lower urinary tract dysfunction--a clinical feature of the "gulf war syndrome"?A Persian gulf war veteran presented to the University Neuro-urology service for management of severe chronic perineal pain. The overall physical and neurological exam was unremarkable. However, the rectal exam and the urodynamic study revealed a severe pelvic floor dysfunction. A neuro-behavioral approach is recommended and discussed.- - - - - - - - - - ranking = 0.23834713211257keywords = physical (Clic here for more details about this article) |
4/10. Adhesions caused by umbilical piercing.A 31-year-old woman experienced chronic pelvic pain, unresponsive to medical therapy. history, physical examination, and laboratory analyses were noncontributory except for multiple body piercings. Diagnostic laparoscopy revealed an umbilical adhesion from the small bowel to the anterior abdominal wall. The patient removed the umbilical piercing but declined surgery for adhesiolysis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/10. pelvic floor physical therapy in urogynecologic disorders.physical therapists are uniquely qualified to treat pelvic floor dysfunction with conservative management techniques. Techniques associated with incontinence and support functions of the pelvic floor include bladder training and pelvic floor rehabilitation: pelvic floor exercises, biofeedback therapy, and pelvic floor electrical stimulation. Pain associated with mechanical pelvic floor dysfunction can be treated by physical therapists utilizing various manual techniques and modalities. research documents that conservative management is effective in treating many conditions associated with pelvic floor dysfunction. research should be conducted to determine if addressing diastasis recti and contracture of the pelvic floor musculature should be a component of the standard physical therapy protocol.- - - - - - - - - - ranking = 1.4300827926754keywords = physical (Clic here for more details about this article) |
6/10. Laparoscopic appendectomy in a female patient with situs inversus: case report and literature review.BACKGROUND: situs inversus is an uncommon condition caused by a single autosomal recessive gene of incomplete penetration. A potential diagnostic dilemma can occur in the young female patient with a history of situs inversus who presents with pelvic pain. methods: A 32-year-old multiparous patient with a known history of situs inversus presented with complaints of pelvic pain. A medical history and full physical examination were indicative of possible endometriosis. RESULTS: The patient underwent an operative laparoscopy, which revealed stage II pelvic endometriosis based on the American Fertility Society Revised classification for endometriosis (R-AFS), with appendicular and periappendicular adhesions involving the cecum. Ablation of endometriosis and an appendectomy were performed. CONCLUSION: The authors believe the laparoscopic approach to an appendectomy is ideal in a patient with situs inversus and should be performed at the time of laparoscopy performed for another reason.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/10. endometriosis presenting as a urethral diverticulum: a case report.BACKGROUND: pelvic pain is a common complaint among women of childbearing age. It has an extensive differential diagnosis that at times can make it difficult to determine its etiology. One must therefore rely on the characteristics of the physical examination, symptoms and imaging studies. However, in doing so, one should keep in mind that many diseases mimic one another. physicians must be careful not to fall into the trap of simply assigning a specific disease to a given group of symptoms. CASE: A 35-year-old woman, gravida 2, para 0020, presented to a clinic complaining of left lower abdominal pain. She had a history of dyspareunia, dysmenorrhea, urinary frequency and numerous urinary tract infections. Previous laparoscopies had been negative for endometriosis. Physical examination demonstrated a 1.5-cm mass left of the midurethra. No pus was expressed through the urethra with cyst massage. Imaging showed a 1.1 x 1.1-cm lesion in the left posterolateral aspect of the urethra consistent with a urethral diverticulum. Uterine adenomyosis was also noted. Although clinical symptoms, physical examination and imaging suggested a urethral diverticulum, a vaginal endometriotic cyst was encountered at surgery. Pathologic evaluation of the surgically excised lesion revealed endometriosis, revealed endometriosis. CONCLUSION: In this case, clinical findings, location and imaging characteristics of a periurethral endometriotic lesion suggested a urethral diverticulum. endometriosis should be considered in patients with a history of pelvic pain who present with urinary frequency and a periurethral lesion.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
8/10. Musculoskeletal origins of chronic pelvic pain. diagnosis and treatment.Musculoskeletal dysfunctions often contribute to the signs and symptoms of chronic pelvic pain and in many cases may be the primary cause. The traditional team approach to chronic pelvic pain has not, however, routinely included a practitioner skilled in musculoskeletal examination and treatment. Characteristics of musculoskeletal pain are reviewed as are specific dysfunctions commonly found to produce lower abdominal and pelvic floor pain. A screening examination is presented to assist the gynecologic physician in identifying patients who may benefit from physical therapy.- - - - - - - - - - ranking = 0.23834713211257keywords = physical (Clic here for more details about this article) |
9/10. Duplicate cervix and vagina associated with infertility, endometriosis, and chronic pelvic pain.BACKGROUND: Mullerian anomalies are associated with several gynecologic complications including endometriosis, infertility, and pelvic pain. CASE: A woman with duplicate cervix and a non-communicating longitudinal vaginal septum, but no other uterine anomalies, presented with pelvic pain, secondary infertility, and a long history of endometriosis. She was treated with operative laparoscopy and excision of the vaginal septum. CONCLUSION: A thorough evaluation, including history, physical examination, and appropriate imaging techniques (hysterosalpingography and magnetic resonance imaging) facilitates accurate diagnosis of anatomical defects and any associated disease in cases of unusual mullerian anomalies. An accurate preoperative diagnosis allows a planned, efficient surgical approach.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/10. Partial detachment of round ligament found at laparoscopy for chronic pelvic pain in a female adolescent.A 13-year-old female adolescent presented with pelvic pain localized in the right lower abdominal quadrant with diffusion to the groin and internal thigh and worsened by marked leg abduction. No symptoms were detected on physical or sonography examination. The patient reported pain for a further 4 months with no moderation. A laparoscopy was performed, which showed normal adnexa and pelvic hollow. No adhesions were found. The uterus was normal in size and appearance, but the right round ligament presented with a partial detachment at cornual insertion. An inflammation was present. The decision was made to perform no surgical repair with the belief that pain would worsen. The pain gradually lessened, and in 1998 she remains pain free.- - - - - - - - - - ranking = 0.23834713211257keywords = physical (Clic here for more details about this article) |
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