Are you suffering from Undiagnosed Groin, Abdominal, and Pelvic (UGAP) pain? Stop! Don’t be silent, sufferers.
Be proactive, learn more about this condition and prevent yourself from being shuffled from one physician to another. Also, prevent having unnecessary expensive diagnostic studies. More importantly, prevent being subjected to unnecessary endoscopies, laparoscopies, and unnecessary surgeries.
The volume of these patients, including the economic impact, is staggering. It is estimated that millions of patients are reported as having chronic groin, abdominal and pelvic pain in the USA. The annual medical cost of diagnosis and treatment is almost 1.2 billion dollars. Nearly 15 million women have chronic pelvic pain (CPP), and in this subset, 46% have dyspareunia. It is estimated that 50% (tens of millions) of all adult males suffer from chronic groin and pelvic pain due to a type of prostatitis which is not due to infection.
Interstitial cystitis affects half to one million people, causing CPP. Sportsman’s hernia affects 0.5% to 6.2% of all professional athletes. Also, nearly 30% (225,000) of patients suffer from groin pain following groin hernia repair.
This condition mimics several lower abdominal, groin, and pelvic conditions like appendicitis, colon diverticulitis, diseases of the ovaries and tubes, etc.
Why patients stay silent
Many of these unfortunate patients do not seek treatment for this disabling condition. There are several reasons for this, including apathy, ignorance, and stigma, especially in patients with painful intercourse. A rather common situation is patients who have vaginal or deep pelvic pain causing painful intercourse and pain when using tampons. There is a stigma about this condition and patients rarely complain, even to their gynecologist.
Chronic pain causes emotional problems, sleep disturbances, and even depression; productivity and self-esteem are affected. Patients and physicians are equally frustrated because the diagnosis is elusive.
Help is available
This diagnosis can be suspected in most patients with a detailed history and a thorough physical exam, including rectal exam and pelvic exam. Using the signs described by me can pinpoint the exact diagnosis. On the rectus flexion sign and adductor resistance sign the patient experiences pain on flexion of the muscle. In the vaginal hook sign, paraprostatic sign and spermatic cord traction sign the patient experiences pain over the inflamed pubic bone. Confirmation is made with strategically placed steroid injections.
Treatment is multidisciplinary, involving pain management, mainly with steroid injections and occasional use of NSAIDs. We use emotional treatment and anti-anxiety/anti-depressants in most of our chronic patients. Specialized pelvic physical therapy is used in almost all patients to prevent flare-ups.