PPOD Case Report 3

PPOD Syndrome Diagnoses: bilateral inguinodynia (chronic inguinal pelvic pain), coccygodynia (coccyx pain), vulvodynia (genital pain), urinary frequency, urinary urgency, chronic constipation, dysmenorrhea (painful and irregular menstruation), amenorrhea (absence of menstruation).

A 15-year-old female presented with chronic pelvic pain of approximately one year duration. She stated that her pain was located in the inguinal regions on both sides of the pelvis. Approximately 6 months prior to being seen, she additionally developed persistent constipation which fluctuated in its severity. Menstruation, which had been regular and non-painful since its onset at age 11, suddenly became painful and irregular. Approximately 4 months before being seen, her menstruation abruptly stopped altogether. During this same period of time she experienced intermittent episodes of back and leg pain which had spontaneously developed for no apparent reason. Her condition progressively worsened and she began to experience symptoms of urinary frequency and urgency, as well as, coccygeal (tailbone) pain, and pain and numbness in the genital (labia and clitoris) region. Although she had been evaluated by her family physician and a gynecologist, no abnormalities could be found. She was brought for evaluation by her mother, who herself had previously undergone treatment for PPOD syndrome related complaints. Examination revealed the presence of the mechanically induced pelvic pain and organic dysfunction syndrome. Treatment resulted in a progressive resolution of all of her complaints. After one week of treatment, bowel function had significantly improved. After two weeks of care, bowel function was approaching normal and she experienced the return of her normally pain free menstruation. By the end of her third week of care, her bladder dysfunction had resolved, and after four weeks of care her pelvic pain, genital pain and numbness and coccygeal pain had all disappeared.

Comment: Like Case 1, this individual had been diagnosed before her condition had progressed to where invasive procedures were considered. Had it not been for her mother’s awareness that these problems may have been caused by an underlying spinal disorder, this may not have been the case. Of interest however is to note how at such a young age and over such a relatively short time the condition, after having begun with pelvic pain, had quickly progressed to effect urologic, enterologic and gynecologic function as well.