| Abstract | Kronična bol u zdjelici (CPP - chronic pelvic pain) stanje je koje zahvaća 10% svih žena reproduktivne dobi. To je kompleksno bolno stanje čija je etiologija raznovrsna, a može biti posljedica različitih patoloških kroničnih stanja koja se najčešće povezuju s reproduktivnim sustavom žene, ali mogu biti i posljedica patologija vezanih uz gastrointestinalni, mokraćni i neurološki sustav. Recentna istraživanja pokazuju da mogu biti prouzročena i negativnim psihološko-emocionalnim stanjem žene, koje znatno utječe na proces kronifikacije boli. Kronična zdjelična bol kao dijagnoza predstavlja zajednički nazivnik različitih patoloških stanja koja zahvaćaju područje male zdjelice, a rezultiraju bolju koja traje više od šest mjeseci i dovodi do trajnoga funkcionalnog oštećenja. Endometrioza se često spominje kao sinonim za kroničnu zdjeličnu bol u žena. Unatoč tome 60 – 80% pacijentica kojima je učinjena eksplorativna laparoskopija ne pokazuje nikakvu intraperitonealnu patologiju. Rekurentni cistouretritis, intersticijski cistitis, sindrom iritabilnog kolona, miofascijalni sindrom abdominalnoga zida i zdjeličnoga dna te neuropatije živaca zdjeličnoga dna, česti su neginekološki uzroci, premda su često zanemareni u odnosu na ginekološke uzroke kronične zdjelične boli. Mnoge pacijentice pokazuju sklonost razvijanju anksioznosti i depresije te, iako nije u potpunosti razjašnjena uloga tih psihološko-emocionalni elementa u patofiziologiji kronične zdjelične boli, takve pacijentice imaju lošije rezultate kad se primjenjuju tradicionalni terapijski modaliteti. Također, s obzirom na patofiziološke mehanizme neuromodulacije, poput mehanizama periferne i centralne senzibilizacije, danas se razvijaju koncepti poput sindroma kronične zdjelične boli (CPPS - chronic pelvic pain syndrome), koji je zaseban entitet u odnosu na pojam kronične zdjelične boli i predstavlja konkretnu dijagnozu regionalnoga bolnog sindroma. Usmjereno liječenje primarne bolesti često ne rezultira rezolucijom simptoma boli, stoga liječenje kronične zdjelične boli zahtijeva holistički pristup koji uključuje fizikalnu, bihevioralnu, psihološku i seksulanu komponentu. |
| Abstract (english) | Chronic pelvic pain (CPP) is a condition that affects 10% of all women of reproductive age. It is a complex pelvialgia that has many possible etiologies, and can be a result of various chronic pathologies that are most commonly associated with the reproductive system as well as gastrointestinal, genitourinal or neurological system, or as it has been proven by the latest research, negative psycho-emotional state of the woman that can play an important role in the chronification of the pain. Chronic pelvic pain as a diagnosis presents as a common denominator of all different conditions that affect the area of the pelvis and result in pain that lasts for a period of at least six months or more and causes functional disability. Endometriosis is often considered a synonym for chronic pelvic pain in women. Despite that 60% to 80% of patients undergoing diagnostic laparoscopy for CPP show no intraperitoneal pathology associated with possible gynecological causes of pain. Recurrent cystourethritis, intersitial cysitis, irritable bowel syndrome, abdominal wall or pelvic floor myofascial syndrome, and pelvic neuropathy are common non-gynecological causes of chronic pelvic pain, though they tend to be overlooked in favor of endometriosis. Many patients show tendencies towards anxiety and depression, although the pathophysiological role of those psycho-emotional elements stays unclear in the process of developing chronic pelvic pain. These patients show poor treatment outcomes from traditionally effective gynecologic and medical therapy. Furthermore, considering pathophysiological mechanisms of neuromodulation, such as peripheral and central sensitisation, concepts like chronic pelvic pain syndrome (CPPS) have been developed that appear as a separate entity to the term of chronic pelvic pain, and represent a concrete diagnosis of regional pain syndrome. Lastly, targeted treatment of primary pathology often doesn’t result in the resolution of pain, therefore treatment of chronic pelvic pain requires a holistic approach that includes physical, behavioral, psychological, as well as, sexual components. |
