Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the womb grows outside the uterus. While surgery and hormonal treatments can help many women, pelvic pain may persist even when scans show no visible disease. At Pain Spa, we focus on understanding the full spectrum of pain mechanisms involved in endometriosis, including nerve involvement, pelvic floor dysfunction, and central sensitisation.
A hypertonic pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax. Many people with a tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency and pelvic pain. A hypertonic pelvic floor may also be accompanied by tension in surrounding hip and pelvic muscles such as the piriformis, obturator internus, coccygeus and hamstrings.
Ilioinguinal neuralgia is one of the most common causes of lower abdominal and pelvic pain encountered in clinical practice. Ilioinguinal neuralgia is caused by compression of the ilioinguinal nerve as it passes through the transverse abdominis muscle at the level of the anterior superior iliac spine. The most common causes of compression of the ilioinguinal nerve at this anatomic location involve injury to the nerve induced by trauma, including direct blunt trauma to the nerve, as well as damage during inguinal herniorrhaphy and pelvic surgery. Rarely, ilioinguinal neuralgia can occur spontaneously.
Chronic pelvic pain can be defined as intermittent or constant pain in the lower abdomen or pelvis of at least 6 months in duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy. It is a symptom not a diagnosis. Chronic pelvic pain presents in primary care as frequently as migraine or low-back pain and may significantly impact on a woman’s ability to function.
Approximately 96% of all groin hernias are inguinal hernias, with the remaining 4% being femoral. Hernias are bilateral in 20% of cases. The most common abdominal wall hernia is an inguinal hernia with a male to female preponderance of 9 to 1. Femoral hernias are more common in women.
Chronic abdominal wall pain occurs in about 10–30% of patients presenting with chronic abdominal pain. Entrapment of abdominal cutaneous nerves at the lateral border of the rectus abdominis muscle has been attributed as a cause of abdominal pain. Chronic abdominal wall pain is frequently misdiagnosed asarising from a visceral source, often resulting in inappropriate diagnostic testing and unsatisfactory treatment.
Abdominal cutaneous nerve entrapment syndrome (ACNES) is not an uncommon condition. When a patient is seen for abdominal pain without other clinically significant symptoms, ACNES should be high on the list of likely diagnoses.
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