PPOD Case Report 1

PPOD Syndrome Diagnoses: metrodynia (deep suprapubic/uterine pain), menometrorrhagia (irregular menstruation), nocturia (having to get up at night to empty the bladder).

A 36-year-old woman was seen for the complaint of pelvic pain. She reported that her pain began approximately three months earlier, its onset having been unrelated to any specific event. The pain was located deep within the pelvis immediately above the pubic region and at times would radiate upward toward her umbilicus.

She additionally noted that if she sat for long periods of time, or, on occasion during movement while changing positions, she would experience a distinct increase in the intensity of her pelvic pain. She stated that when she first became aware of this pain it had a familiar cramping quality and felt as though it was emanating from her uterus and, as a result, she thought it was most likely the result of her impending menstruation.

However, as her menses did not appear as anticipated, and, as over the next week her pelvic pain began to progressively intensify she consulted her gynecologist and underwent a series of tests. A complete gynecologic examination, transvaginal ultrasound and abdominal CT scan were all negative for any type of abnormality that could account for her condition. As a result, in the absence of any specific problem to dictate a specific course of treatment she was given a prescription for medication to ease her pain and advised to return if her condition should change. Of note in her history however, was the fact that she did additionally experience irregular menstruation and, for as long as she could remember, consistently had to get up 1 time every night to go to the bathroom to empty her bladder.

However, she had never considered these issues to be abnormal, problematic or indicative of an underlying problem. In fact, until just recently, despite the irregularity, she had never experienced any significant menstrual or uterine related pain. Interestingly, as is not uncommonly the case in the mechanically induced pelvic pain and organic dysfunction syndrome patient, she had no history of accompanying back pain. Having learned of the author’s expertise in this area, she presented for evaluation of her pelvic pain. Although by comparison hers is a mild case, on examination, she did exhibit clear and absolute evidence of the mechanically induced pelvic pain and organic dysfunction syndrome. Following her first few treatments, she noted a distinct increase in the intensity of her deep uterine pelvic pain, as well as the onset of low back pain. After two weeks of treatment her pelvic pain had completely resolved and her low back pain was diminished.

After four weeks of treatment, she became aware that she was no longer having to awaken from sleep to go to the bathroom at night, something that she had had to do for as long as she could remember. In addition, her low back pain was further diminished. After eight weeks of treatment, all of her complaints had completely resolved and she was able to resume normal activities without pain or difficulty.

Comment: One of the fortunate aspects in this case, was that of having had the opportunity to be involved early on during the syndromes development (as emphasized by a comparison to other more severe cases later), in order to be able to institute proper treatment before such time that the condition worsened to take on additional characteristics, mimicking other disorders, and potentially leading the patient down the path of unnecessary invasive diagnostic procedures and ineffective surgeries. Additionally, of note is the fact that her PPOD related complaints had developed in the absence of any accompanying back pain. It wasn’t until after initiating her treatment (a common effect of the “post-treatment flare”) that transient back pain had developed.