Management of Pelvic Pain in Older Women

Abstract

Chronic pelvic pain (CPP) is defined as intermittent or constant pain in the lower abdomen, pelvis, anterior abdominal wall, lower back, or buttocks that has a duration of at least 6 months and is associated with limitations on the ability to attend to daily living activities. Females who suffer from CPP may have several etiologies for their pain; hence, the evaluation should identify specific peripheral causes of pain and differentiate them from centralized pain syndromes, given that the treatments can differ substantially. 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 (Whitaker et al., PloS One 11:e0151950, 2016). The socioeconomic CPP cost is considerable, with an estimated direct healthcare cost of $880 million per year in the United States, besides $2 billion direct and indirect costs annually (Ahangari, Pain Physician 17:E141–7, 2014). Of these women, 15% report missing work, and 45% note experiencing reduced productivity. This chapter provides a comprehensive summary of chronic pelvic pain management in older women for the generalist and facilitates appropriate investigation and management.