Management of pelvic pain in older women

Abstract

Chronic pelvic pain (CPP) is defined as intermittent or constant pain in the lower abdomen or pelvis for at least 6 months in duration, with subsequent impact on the ability to attend to daily living activities. Gynecologists have traditionally focused on the organ-specific approach or viscera to explain or identify the pain source. It is important to recognize that as many as 55% of women presenting with CPP will have no well-defined etiology following completion of all investigations. CPP is fairly common, with an estimated prevalence of 3.8% in the adult female population. It is the impetus for 10% of gynecologic referrals, 12% of hysterectomies, and 40% of laparoscopic procedures. The socioeconomic CPP cost is considerable, with estimated direct health care cost of $880 million per year in the United States, besides $2 billion dollars direct and indirect costs annually. Of these women, 15% report missing work, and 45% note experiencing reduced productivity. This chapter will provide a comprehensive summary of chronic pelvic pain management in older women for the generalist and to facilitate appropriate investigation and management.