Diagnosis and Treatment of Chronic Pelvis Pain in Women Suffering from Dysuria

Aim. To establish the nature of psychovegetative and hemodynamic reactions, to assess clinical symptoms of pelvic floor dysfunction, to optimize diagnostic search and to determine the tactics of managing patients with pelvic pain syndrome and dysuria.

Design. A prospective study.

Materials and methods. The study involved 244 women of reproductive age with complaints of pain in the pelvic area and dysuria with a disease duration of more than 6 months, including 141 patients with chronic pelvic pain (CPP) and dysuria, 103 — only with dysuria. The control group consisted of 35 conditionally healthy women. The patients underwent laboratory and bacteriological diagnostics, pelvic sonography, urethrocystoscopy. To objectify the pain intensity, a digital rating scale, the DN4 neuropathic pain questionnaire were used, and to assess dysuria, — urination diaries, and the International Prostate Symptom Score (IPSS) questionnaire were used.

Results. Women with CPP and dysuria had longer and more frequent exacerbations of the disease, the presence of symptoms during remission, and the absence of a clear connection with provoking factors (p < 0.001). In addition to pain and dysuria, patients complained mainly of rapid fatigue, sleep disturbances, and irritability. During treatment, special attention was paid to the correction of pelvic floor muscle syndromes, hemodynamic disorders, autonomic nervous system functioning, and psychoemotional state. Complex therapy was used with an emphasis on pelvic muscle relaxation methods. Positive dynamics were noted in 87.2% of women with CPP and dysuria and in 90.3% with dysuria only. The patients had a decrease in the number of urinations and imperative urges, episodes of urgent incontinence. The severity of urination disorders according to the IPSS scale decreased in patients with pelvic pain and dysuria and amounted to 6.5 ± 2.1 and 8.8 ± 2.7 points, in patients with dysuria only — 4.9 ± 1.3 and 5.9 ± 1.6 points (p < 0.001), which corresponded to mild and moderate disorders.

Conclusion. An integrated approach to the diagnosis and therapy of this category of patients allows to optimize treatment and achieve greater effectiveness, and also helps to improve the quality of life of women.

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