Gastroenterological Causes of Pelvic Pain

Summary Chronic abdominal pain accounts for 10% of gynecological consultations and over 30% of diagnostic laparoscopies. There are numerous causes of chronic pelvic pain, and it is important to consider non-gynecologic causes such as gastroenterological, urological, and neurological causes. The most common gastroenterological cause of chronic abdominal and pelvic pain is irritable bowel syndrome (IBS), but other gastrointestinal conditions such as diverticular disease of the colon, inflammatory bowel disease, endometriosis, colorectal cancer, hernias, proctalgia fugax, levator ani syndrome, and chronic appendicitis must be considered in the differential diagnosis. When evaluating a patient with IBS and chronic pelvic pain, it is extremely important to establish a relation of trust and respect with the patient, to include a social history, explore the possibility of emotional, physical, or sexual abuse because these are factors that are often ignored by health care providers and have a significant impact in the disease process, symptoms, and clinical outcome. The gastrointestinal system performs complex functions that require the proper function of the intrinsic nervous system (enteric nervous system), central nervous system, neuroendocrine and immune systems. The neuroendocrine system plays an important role in the regulation of intestinal motility, secretions, and visceral sensation. Between 90 and 95% of the serotonin in the human body is found within the gastrointestinal system, particularly within the epithelial layer. There are numerous abnormalities that have been described in IBS including abnormal enterochromaffin cell numbers, serotonin content, tryptophan hydroxylase levels, 5-hydroxyindoleacedic acid levels, serum serotonin levels, and expression of the serotonin-selective reuptake transporter. Therefore, serotonin agonists and antagonist alter sensory input and have a significant effect in gut function including secretion and motility (1,2). The concept of “visceral hyperalgesia” was proposed by Ritchie in 1973 (3), this concept has helped us better understand the pathophysiology and symptoms of IBS, and conceptually, it serves as the basis for some pharmacological treatments; however, this knowledge has not translated into better diagnostic modalities. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Preview Unable to display preview. Download preview PDF. Similar content being viewed by others References Gershon MD. 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A randomised controlled trial assessing the efficacy and safety of repeated tegaserod therapy in women with irritable bowel syndrome with constipation. Gut 2005;54:1707–1713. Editor information Editors and Affiliations Rights and permissions Copyright information © 2008 Humana Press About this chapter Cite this chapter Brzezinski, A. (2008). Gastroenterological Causes of Pelvic Pain. In: Potts, J.M. (eds) Genitourinary Pain And Inflammation. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-60327-126-4_8 Download citation DOI: https://doi.org/10.1007/978-1-60327-126-4_8 Publisher Name: Humana Press Print ISBN: 978-1-58829-816-4 Online ISBN: 978-1-60327-126-4 eBook Packages: MedicineMedicine (R0)