PPOD Case Report 6

PPOD Syndrome Diagnoses: bilateral inguinodynia (chronic inguinal pelvic pain), dyspareunia (pelvic pain with intercourse), vulvodynia (genital pain and paresthesias), urinary frequency, urinary urgency, urinary dribbling, urinary incontinence (loss of bladder control), enuresis (wetting the bed), dysmenorrhea (painful and irregular menstruation), leukorrhea (persistent vaginal discharge), recurrent spontaneous miscarriage (loss of pregnancy).

A 40-year-old woman was seen for complaints related to a lifting injury that had occurred one week earlier. While attempting to move a heavy object she experienced pain on both sides of the front of the pelvis that seemed to radiate to the low back. She described this pain as feeling like intense muscle cramping occurring deep in her pelvis and noted that it was made distinctly worse by bending forward. In reviewing her history, it became apparent that she had suffered from a multitude of chronic urologic, gynecologic and sexual complaints for over 20 years. She stated that from the outset, menstruation, at age 15, had been accompanied by low back and intense pelvic pain which radiated bilaterally across the front of the pelvis. During her early menstrual years, persistent vaginal discharge had also developed. She had been pregnant five times and each pregnancy had been accompanied by intense back pain. Following her first pregnancy, which ended in the delivery of a normal healthy girl, vaginal discharge became more severe. Her next three pregnancies had terminated in spontaneous miscarriages at various stages of gestation, with no gynecological cause being identified. Three years prior to her last pregnancy she experienced the onset of increasingly painful back pain which was accompanied by left sided inguinal pain. At this time menstruation became more painful and was preceded by 2-3 days of severe sharp pelvic pain forcing her to stay off of her feet and remain in bed. During this time intercourse had become severely painful and resulted in sharp pain in the inguinal and suprapubic regions which would additionally frequent radiate to the outer genital region. She stated that the labia and clitoris had become extremely sensitive and painful to even light touch. In addition, recurring bladder infections also began to occur. Gynecologic examination at that time resulted in an exploratory laparoscopy and the removal of cysts on each ovary. Following this operation however, her pelvic pain remained unchanged and as a result she was re-hospitalized two additional times for further testing. Being unable to identify any type of abnormality she was discharged with no improvement in her pelvic pain and no known cause for its presence. Several months later, low back and left sided leg pain began to occur. She underwent spinal manipulation for these complaints and experienced improvement in her back and leg pain, however, there was no change in any of her pelvic symptoms (pelvic pain, painful and irregular menstruation and persistent vaginal discharge). During her last pregnancy, urinary disturbances consisting of frequency, urgency dribbling and incontinence had their onset. She stated that she was unable to raise her voice without losing complete bladder control. After the delivery of a normal healthy boy her urinary symptoms, vaginal discharge and painful menstruation continued to persist. In addition, nocturnal enuresis (wetting the bed) had begun to occur 3-4 times per week. These symptoms all remained unchanged for five years, at which time she was seen by the author. A PPOD syndrome examination revealed the presence of the mechanically induced pelvic pain and organic dysfunction syndrome. Treatment yielded surprisingly quick improvement. After one week of care her pelvic pain had greatly diminished and she was aware of improved bladder control so that coughing and sneezing did not result in incontinence or dribbling. During the course of treatment she experienced the onset of menstruation completely unaware of its arrival due to the absence of the severe pelvic pain that would typically precede and accompany her menstruation. Her additional urological disturbances (frequency and urgency) had resolved and she was no longer wetting the bed. At the conclusion of her treatment, ten weeks after initiating care, she reported that her persistent vaginal discharge had also completely disappeared.

Comment: Of interest in this case is her response to chiropractic treatment performed at an earlier time. After having suffered from significant pelvic organic dysfunction for a number of years, and having subsequently developed back and leg pain, she underwent conventional spinal manipulation for her back and leg pain complaints. Although the procedures were effective at resolving her back and leg symptoms, they had no effect at improving any of her accompanying pelvic organic dysfunction, which had been rather significant at the time. This type (or lack) of response of PPOD related complaints to prior spinal manipulation of a conventional nature has been frequently observed.