Abdominal Wall Pain in Women With Chronic Pelvic Pain

Review of Bladder Pain and Referred T12–L2 Input as One Etiology for Interstitial Cystitis

“…In more recent work, elimination of vagus afferents was shown not to affect the afferent impulses to the thoracolumbar outflow track in mice, and the stretch receptors were demonstrated, by immunohistological staining of (calcitonin gene-related peptide) receptor, to be located in the detrusor muscle. [25][26][27] We may conclude from this that sensory input from the bladder reaches the thoracolumbar dorsal root entry zone, where spinal reflexes result, and then that input is routed up the brainstem to the conscious level for cortical interpretation. In the present hypothesis, we conclude that the somatic input to this thoracolumbar spine from the II, IH (and possibly from the GF) nerves evokes that same spinal response and cortical interpretation.…”

“…Inclusion of the GF (L1-L2) nerve in this hypothesis seems warranted because patients with IC/BPS report pain in the "genitals," 23 patients with IC/BPS have segmental hyperalgesia in the T11 dermatome (T12-L2 were not tested), 24 and the high percentage of women with "abdominal wall pain" associated with pelvic pain. 25 To determine whether this inclusion is warranted, patients whose main complaint is testicular or mons pubis/labial pain would need to be queried on whether they also have symptoms consistent with IC/BPS and then have appropriate level spinal nerve blocks to determine their outcome on the IC/BPS symptoms.…”

Clinical analysis of high-intensity focussed ultrasound ablation for abdominal wall endometriosis: a 4-year experience at a specialty gynecological institution

“…Ultrasound [14,15,[17][18][19][20][21] plays a vital role in verifying the presence of lesions, regardless of how small they are; moreover, ultrasound can be used to determine the location, size, texture, margins and number of AWE lesions and even differentiate cystic from solid neoplasms. The typical ultrasound features of an AWE lesion is a solid, hypoechoic and vascularized mass with irregular borders invading the surrounding tissue (fascia, muscle and fat).…”

“…AWE is a rare disease that usually has a unique characteristic of a periodically painful mass associated with the menstrual cycle; due to the increasing trend in cesarean section as one of the most common causes of extra-pelvic endometriosis in recent years [9][10][11][12][13][14]. When this ectopic endometrial tissue arises, periodic bleeding and fibrosis occur in combination with changes in menstrual cycle hormones, which ultimately lead to the formation of a painful mass [12,13,15]. However, due to the high rates (0-29%) of relapse and defects in the abdominal wall [9,10,16], a safer non-invasive approach, such as HIFU, is necessary for the clinical setting.…”

Electromyographic characterisation of abdominal wall trigger points developed after caesarean section and response to local anaesthesia: an observational study

“…1,2 A well-documented longterm complication of CS is chronic pain, which may occur in approximately 1-18% of patients. 3,4 The majority of abdominal or pelvic chronic pain is described as a disease of the intraabdominal or intrapelvic viscera; however, data in the literature suggest that persistent pain may originate from the abdominal wall, usually secondary to inguinal neuralgia, 5 myofascial trigger points, 6 or even the development of adhesions, 7,8 especially when related to raised scars. 6 Clinically, the Carnett's sign helps physicians to identify a painful condition originating from the abdominal wall.…”