"Pain is part of this life
whether we like it or not
lucky people have less of it,
others a lot"
(Arjomandi 2011)
Sanjeeta's story
Current history
Sanjeeta is a 28 year old woman who has been referred to a physiotherapist by a Midwife because she was suffering from severe pregnancy related lumbo pelvic pain/ symphysis pubis dysfunction. Sanjeeta was diagnosed with Joint Hypermobility syndrome by a physiotherapist several years ago and has had back pain on and off for as long as she can remember. She works for a marketing company and in the last six weeks has found her symptoms are severely interfering with her ability to engage with work, drive a car and do the shopping. She lives with her partner who is supportive, but he travels a lot with his job is not always at home.
Her main concern is the effect the pain will have on her unborn child. She also reports that until she met her current midwife her symptoms were dismissed and she was told she would need to put up with the pain until after delivery. She has had more time off work than at any time before in her working career and she is concerned that she might lose her job.
Ann was surprised that health professionals did not appear to know or understand the pain she was experiencing, she had not been given a diagnosis and the professionals she met did not offer any suggestions on how this could be treated.
She suffers from sharp pain that radiates from her pelvis down her leg and/or towards her pubis symphysis when she tries to walk up stairs, getting in and out of a car and turning over in bed.
Read the following paper and consider the following questions (Create link)
file:///C:/Users/Carol/Downloads/Pregnancy%20related%20lumbopelvic%20pain%20Clark%20et%20al%202013.pdf
- What is pregnancy related lumbo pelvic pain?
- What other names have been used to describe this type of pain in pregnancy?
- What could be causing the pain reported by Sanjeeta?
- What advice would you give Sanjeeta or any health professionals involved in meeting Sanjeeta during:-
- a) pregnancy?
- b) delivery?
- c) post partum?
- What are the risk factors for Pregnancy related pain continuing after delivery?
Causes of Chronic Pelvic Pain
Look at the following and expand your knowledge about aspects which may contribute to chronic pelvic pain. Bearing in mind that their maybe a multitude of factors that influence pain perception. For example some pain originates as a result of disturbances within the nervous system. These may occur peripherally in a nerve supplying the pelvic area, or centrally at the spinal level or within the sensory cortices of the brain.
Extrauterine and Intrauterine causes
Urologic disorders
Musculoskeletal disorders
Gastrointestinal disorders
Neurologic disorders
Psychological and other disorders
Look at the following and expand your knowledge about aspects which may contribute to chronic pelvic pain. Bearing in mind that their maybe a multitude of factors that influence pain perception. For example some pain originates as a result of disturbances within the nervous system. These may occur peripherally in a nerve supplying the pelvic area, or centrally at the spinal level or within the sensory cortices of the brain.
Extrauterine and Intrauterine causes
- Endometriosis
- Adhesions
- Chlamydial endometriosis
- Ovarian Cysts
- Pelvic Congestion syndrome
- Pelvic Inflammatory disease
- Endometrial or cervical polyps
- Prolapse
- Intrauterine contraceptive device
Urologic disorders
- Chronic urinary tract infection
- Recurrent cystitis
Musculoskeletal disorders
- Faulty or poor posture
- Fibromyalgia
- Mechanical low back pain
- Chronic coccygeal pain
- Muscular strains and sprains
- Hernias
Gastrointestinal disorders
- Diverticular disease
- Inflammatory bowel disease
- Irritable bowel syndrome
Neurologic disorders
- Shingles
- Neuralgia (surgical scar in the lower part of the abdomen)
- Disk Herniation
- Spondylosis
Psychological and other disorders
- Depression
- Sleep disorders
- Sexual and/or physical abuse
- Personality disorder
(NHS Choices 2014a, Singh 2012)
Please go to the games and quizzes part of the website and fill in the definitions for the above conditions to expand your knowledge about causes of chronic pelvic pain.
Lola's story Living with chronic pelvic pain
Pelvic pain may be perceived by both men and women, it can be described as shooting, burning, stabbing or cramping pain. It may be severe, impact on the ability to sit for long periods of time and also impact on the ability to sleep. This can lead to feelings of despair and depression, low esteeem, difficulty maintaining employment and suffers may even stop being socially interactive. Many sufferers of chronic pain feel their stories are not believed as test results are negative. Chronic pelvic pain can be detrimental to a pain sufferer physically, socially and psychologically and is best managed by a multidisciplinary team for this reason (Cambitzi 2011).
Listen to Lola's story and answer the following:-
What does pelvic floor pain make Lola feel?
What did the Doctor offer Lola other than medication?
Did the doctor advocate that she was the only professional who could treat Lola?
Listen to Lola's story and answer the following:-
What does pelvic floor pain make Lola feel?
What did the Doctor offer Lola other than medication?
Did the doctor advocate that she was the only professional who could treat Lola?
The International Pelvic Pain Society's assessment form used to assist clinicians to assess a patient they suspect of having chronic pelvic pain.