Bowel

Pelvic Pain of Gastrointestinal Origin

The ability to tell pelvic pain due to gastrointestinal disease apart from other sources of chronic pelvic pain is a challenging and complex problem for surgeons, gynecologists, gastroenterologists and general practitioners. Understanding the differences between the sources of pain has important implications for the approach to diagnosis and treatment as well as the prognosis for the patient.

The history and physical exam are essential and should include screening for symptoms such as any link with diet, (ie irritable bowel syndrome- see below,) change in bowel habits, bleeding or pain on bowel movement. The nature of the pain including the location, quality, length of time, frequency, areas the pain spreads to and triggering or relieving factors should be noted. The physical exam may indicate findings that suggest a gastrointestinal cause for pelvic pain. 

Cramping, intermittent pain that suggests bowel obstruction should be evaluated immediately.  

The appropriate use of diagnostic tests will assess most gastrointestinal causes of chronic pelvic pain. Appropriate consultation between gynaecologist, colorectal surgeon, gastroenterologist and members of the pain management team will often lead to effective treatment of the disorder.  

References

Rapkin AJ, Mayer EA Gastroenterologic causes of chronic pelvic pain. Obstet Gynecol Clin North 1993