Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ Ovarian vein and pelvic varicositiesPelvic venous incompetence ++ 625.5 Pelvic congestion syndrome ++ G89.4 Chronic pain syndromeR10.2 Pelvic and perineal painN94.89 Other specified conditions associated with female genital organs and menstrual cycle ++ As of July 2013, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathologyAssociated or secondary musculoskeletal patterns include:Pattern 4C: Impaired muscle performance1Pattern 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction1 ++ 729.1 Myalgia and myositis, unspecified782.3 Edema +++ Description2 ++ Non-cyclical, poorly localized pelvic painPain worsened by sitting, standing, at the end of the day, during or after intercourseBlood pooling in the pelvic and ovarian veinsPain associated with varicose veins in the thigh, buttock regions, and vaginal area +++ Essentials of Diagnosis ++ Initially is a diagnosis of exclusionMultidisciplinary approach to rule out other end organ pathologyStandard workup includes abdominal and pelvic examination, Pap smear, routine blood work, cross sectional imaging +++ General Considerations ++ Chronic pain conditionOften misdiagnosedPT intervention is often appropriate for associated musculoskeletal impairmentsDiagnosis is a process of exclusion and often takes time, requiring intensive diagnostic testingUrogenital pain disorders frequently affect nearby body areas; especially back, pelvic, hip, and groin regions, and may be inappropriately referred to PTMay mimic other visceral pain conditions including colon cancer or tumor, irritable bowel, colitisMay mimic gynecologic problems in females: endometriosis, uterine fibroids, ectopic pregnancy +++ Demographics ++ Only in females, typically between ages of 20 to 452More prevalent in multiparous womenExact prevalence of pelvic congestion syndrome is unknown +++ Signs and Symptoms2 ++ Symptoms often worsened by prolonged sitting or standing, anxiety, bowel movements, physical activity, or sexual intercoursePain becomes progressively worse throughout the dayGeneralized lethargy, depressionAbdominal or pelvic tendernessVaginal dischargeDysmenorrheaSwollen vulvaLumbosacral neuropathyRectal discomfortUrinary frequencyMay have tenderness of the uterine cervix, ovaries, or uterusPain during sexual intercourseReport of vaginal, rectal, or lower abdominal pain.Symptoms are usually vague and poorly localized +++ Functional Implications ++ PainPainful urination, defecation, and sexual activityUrinary urgency and frequencyFatigue, lethargy +++ Possible Contributing Causes ++ Pregnancy and vaginal childbirth +++ Differential Diagnosis ++ Bowel pathologyCancerNeurologic pathologyMusculoskeletal pathology or impairmentGynecologic problems in femalesEndometriosisMensesEctopic pregnancyOvarian cystFibroidsMenopauseUterine prolapseFibromyalgiaUrologic pathologyPelvic inflammatory disease +++ Laboratory Tests ++ Blood testsPap smearUrine culture/urinalysisH&H for signs of bleeding, anemia, pathogens, immune status, ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPhysiotherapy 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPhysiotherapy Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options