Chronic pelvic pain in women - gastroenterological, gynaecological or psychological?

Michael A. Kamm
In: International Journal of Colorectal Disease · 1997 · vol. 12(2) , pp. 57–62 · doi:10.1007/s003840050081 · PMID:9189771 · W2083097097
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⚙ AI-generated summary by claude@2026-07+body, 2026-07-09 ⓘ

This review discusses the diagnostic challenges and patient/physician helplessness surrounding chronic pelvic pain in women, particularly when gastrointestinal symptoms suggest intestinal involvement and visceral hypersensitivity is identified.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This paper discusses how women with chronic pelvic pain are evaluated by gynecologists, gastroenterologists, and surgeons, each using different diagnostic approaches, yet in many cases the pain source remains obscure due to lack of abnormal findings or persistent symptoms despite treating identified pathology. It highlights a downstream limitation of prolonged and often ineffective workups and treatments, including surgery, which can compound physical and social disability through diagnostic confusion and foster helplessness in both patients and physicians. The author specifically notes that when low abdominal pain is accompanied by bowel habit changes, an intestinal contribution is reasonable, with evidence including pain provocation during endoscopy (e.g., air insufflation or balloon distension), and reviews a shift from colonic motility-pressure studies toward altered thresholds of visceral sensitivity in conditions such as irritable bowel syndrome. Relevance to endometriosis: endometriosis is not explicitly discussed in the provided text, so this paper was included via a keyword match related to chronic pelvic pain in endo/adeno research.

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Abstract

Women with chronic pelvic pain form a substantial part of the workload of gynaecologists, gastroenterologists and surgeons. Each investigates with their own diagnostic bias but the source of pain often remains obscure, with a lack of abnormal findings or failure of symptom resolution despite treatment of identified pathology. The patient's physical and social disability may become compounded by diagnostic confusion, and by prolonged and ineffective treatments including surgery. The end result is often a sense of helplessness in both the patient and the physician.
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Abstract. Women with chronic pelvic pain form a substantial part of the workload of gynaecologists, gastroenterologists and surgeons. Each investigates with their own diagnostic bias but the source of pain often remains obscure, with a lack of abnormal findings or failure of symptom resolution despite treatment of identified pathology. The patient's physical and social disability may become compounded by diagnostic confusion, and by prolonged and ineffective treatments including surgery. The end result is often a sense of helplessness in both the patient and the physician. Résumé. Des femmes porteuses de douleurs pelviennes chroniques constituent une part importante de l'activité des gynécologues, gastroentérologues et chirurgiens. Chacun de ces spécialistes investigue ses cas avec ses propres biais diagnostiques alors même que la cause des douleurs demeure le plus souvent obscure en raison d'une absence de mise en évidence d'anomalies ou de la non guérison des symptômes malgré un traitement d'une pathologie identifiée. L'atteinte physique et sociale des patients peut être aggravée par la confusion diagnostique et peut être prolongée en raison des traitements ineffectifs et de la chirurgie. Le résultat final est souvent un sentiment d'impuissance à la fois patient et du médecin. Lorsque la douleur abdominale basse est accompagnée d'un changement des habitudes d'exonération, il est raisonnable de penser que l'intestin est impliqué dans la genèse de ces symptômes. Certaines manoeuvres comme la reproduction de la douleur par l'insufflation d'air ou la distension d'un ballon au cours d'une endoscopie rendent plus vraisemblable cette relation. Chez les patients porteurs de troubles fonctionnels de l'intestin, les études de pression de la fonction motrice du côlon ont perdu de leur importance en partie parce que la corrélation des symptômes est mauvaise. Une importance croissante semble revenir à la baisse des seuils de sensibilité viscérale mais non somatique. Des études de la motilité de l'intestin grêle ont démontré que des patients porteurs d'un syndrome de l'intestin irritable perçoivent davantage que des sujets ne présentant aucune douleur des évènements physiologiques survenant de manière normale et/ou qu'ils présentent des seuils plus bas de perception pour des stimuli anormaux. Similar content being viewed by others Author information Authors and Affiliations Additional information Accepted: 17 December 1996 Rights and permissions About this article Cite this article Kamm, M. Chronic pelvic pain in women – gastroenterological, gynaecological or psychological?. Int J Colorect Dis 12, 57–62 (1997). https://doi.org/10.1007/s003840050081 Issue date: DOI: https://doi.org/10.1007/s003840050081

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