Perineal Pain or Perineum Pain: Causes, Symptoms, Treatment, Recovery, Diagnosis, Pathophysiology
Perineal pain is known as perineum pain. In men, the area between the testicles and the anus is called perineum. In women, the area between the vagina and the anus is called perineum. Perineal pain or perineum pain is also known as groin pain, lower abdominal pain or genital pain.
Both men and women equally get affected by the symptoms of perineal pain or perineum pain.
In chronic conditions, the persistence of perineal pain or perineum pain will be for over a period of three or more months. If the duration is lesser than this, then it is called acute perineal pain or acute perineum pain.
Most of the times, it is very confusing to determine the exact area of pain in the abdominal area. It is very important to differentiate the exact type of pain whether it is acute or chronic pain in order to better understand pain syndromes related to pelvic area. The most common pain is acute pelvic pain which the patient usually experience after surgery or soft tissue traumas. The patient will experience immediate, severe pain which will be often shortlived. In chronic conditions of perineal pain or perineum pain, the pain persists for more than a normal recovery period and will last longer, more than three to six 6 months time.
Women experience perineal pain or perineum pain at some point of time in their lives. The moment girls enter menarche/puberty, pain related to abdomen and pelvis will become a common complaint. Different common conditions can cause abdominal pain, which include: uterine, bladder or bowel pain.
Causes of Perineal Pain or Perineum Pain
Common Causes of Perineal Pain or Perineum Pain: Some of the most common possible medical causes of perineal pain or perineum pain include abscess, prostatis, entrapment of pudendal nerve, postpartum, ischiorectal abscess, perineural cyst, ejactulary duct obstruction, benign prostatic hypertrophy, and prostatitis.
Some of the other less common causes of perineal pain or perineum pain may be due to trauma, femoral hernia, psychogenic causes, renal calculi, obstructed hernia, prostate cancer, and urinary tract infection.
Gynecologic Causes of Perineal Pain or Perineum Pain
- Ovarian Cysts - The ovaries produce a large cyst, which may be painful and rupture.
- Endometriosis - Pain that is caused by tissues that are outside uterus.
- Ectopic Pregnancy - It is a pregnancy that is implanted outside uterus and causes perineal pain or perineum pain.
- Pelvic inflammatory disease - Pain that is caused by damage likely from infections.
- Ovarian torsion - Twisting of ovary in such a way that it interferes blood flow can cause perineal pain or perineum pain.
- Dysmenorrhea - Abdominal pain during menses.
Abdominal Causes of Perineal Pain or Perineum Pain
- Colitis - Inflammation or infection of colon can cause perineal pain or perineum pain.
- Proctitis - Inflammation or infection of rectum or anus.
- Appendicitis - Inflammation or infection of appendix/bowel can cause severe pain in perineal region.
Signs and Symptoms of Perineal Pain or Perineum Pain
Some of the Common Symptoms of Pain in Perineal or Perineum Region Are:
- Urinary Tract Infection: Frequent urination, purulent urethral discharge, urgency, sensation of burning during urination, and urinary dribbling. Edema of the bladder can also cause difficulty voiding, urinary disruption or mutation. In some cases, urinary retention is severe.
- Systemic Signs and Symptoms of Perineal Pain or Perineum Pain: Prostration, chills, fever, anorexia, fatigue, nausea, weakness, or vomiting. Sudden onset of symptoms would not show up the actual cause of pain. Clinical evaluation is very important in such cases.
- Rectal Indications: Pain will be severe, fullness of rectum, painful defecation.
- Local Signs and Symptoms of Perineal Pain or Perineum Pain: Increased frequency or sedentary bowel movement, feeling of increase in weight of suprapubic or perineal area, lower abdomen, waist, thighs, back, etc.
Some Common Confusing Factors Associated With Perineal Pain or Perineum Pain Include
Tearing of Perineum: Laceration of complete perineum or 3rd degree laceration which may include anal sphincter laceration, perineal laceration or vaginal laceration. In some severe cases, extension of rupture can be seen to rectal wall leading to gas or fecal incontinence.
Some patients with pain in the perineal area says that they usually do not feel pain but have some variation of squeezing, aching, discomfort, burning, tightness, fullness, or sensation sharp/dull. Often, perineal pain or perineum pain is exacerbated with prolonged sitting and is associated with some other symptoms. Symptoms typically include the following:
- Depression, helplessness, and anxiety with regard to the symptoms of perineal pain or perineum pain.
- Pain after bowel movement, discomfort during sitting usually has feeling like golf ball.
- Suprapubic pain, anorectal pain, genital pain, pain in tail bone, lower back pain, bladder pain are some of the other symptoms of perineal pain or perineum pain.
- Urgency, hesitancy in urination, urinary frequency, frequent urination during nighttime, and burning.
Treatment of Perineal Pain or Perineum Pain
- Common Treatment for Perineal Pain or Perineum Pain: Three to four days of bed rest, adequate intake of water, less consumption of alcohol and avoid eating spicy food is usually recommended to treat perineal pain or perineum pain. Use hot water for bathing, and use of perineal heater.
- Antibiotic Treatment for Perineal Pain or Perineum Pain: Acting on perineal pain or perineum pain on time and early visit to doctor will avoid chronic perineal conditions.
- Antibiotic treatment will be started when patient's temperature is high, or if the patient has higher blood leukocytes.
- In case of high temperature, symptomatic treatment for perineal pain or perineum pain will be useful. Usually patient will be started on antipyretics.
Pathophysiology of Perineal Pain or Perineum Pain
Chronic perineal pain or perineum pain is the perineal and anorectal pain without evidence of underlying endopelvic, organic disease or anorectal, which has been excluded through careful radiological, endoscopic investigations and physical examination. A wide range of neuromuscular abnormalities of the pelvis floor lead to the different pathological disorders such as urinary incontinence, constipation of obstructed defecation, anorectal incontinence, sexual dysfunction and different pain syndromes. The most commonly seen functional disorders of the pelvic muscles that are accompanied by pelvic pain are proctalgia fugax, levator ani syndrome, coccygodynia and myofascial syndrome. In diagnosis of such syndromes, which contributes to a thorough history, special investigations, physical examination and exclusion of organic disease is carried out. Accuracy in diagnosis of these syndromes help in selecting an appropriate treatment modality and to avoid ineffective and unnecessary surgical procedures, which are often performed in an attempt to help alleviate the patient's pain symptoms.
Risk Factors of Perineal Pain or Perineum Pain
Sometimes it is difficult to analyze or identify internal hernias in women, and wrong or misdiagnosis with regard to chronic idiopathic pelvic pain or endometriosis is often done. Sometimes common misdiagnosis is seen when the woman lies flat on exam table, all medical indications hernia will disappear. When symptoms persist, typically the hernia can be found or detected, and diagnosis is done by positioning the patient's body in such a way that symptoms are provoked.
Investigations to Diagnose Perineal Pain or Perineum Pain
- Diagnostic workup to identify the cause of perineal pain or perineum pain starts with careful history and physical examination, which is done after pregnancy test. In some cases, additional imaging studies are taken or bloodwork will be drawn. In some cases, surgical evaluation will be helpful.
- Blood tests to diagnose perineal pain or perineum pain would include blood differential or CBC.
- Radiological evaluation or ultrasound.
Recovery Period of Perineal Pain or Perineum Pain
Recovery period of healing time for chronic perineal pain or chronic perineum pain will be for over a period of three or more months.
Recovery period of healing time for acute perineal pain or acute perineum pain will be less than 3 months.
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