Abdominal wall trigger points can cause pelvic pain and may be identified by an abdominal examination of the lateral borders of the rectus muscle. If trigger points are not directly injected, the injection may be less effective but still lessens tenderness, relaxes the muscle spasm, and lessens pain when the rectus muscle is palpated. Laboratory studies are needed to rule out organic causes of pain. Emotional problems may manifest as physical complaints. Often the patient has multiple complaints for which no organic cause can be identified.
Psychiatric consultation is recommended.
Victims of physical or sexual abuse in childhood or in adulthood may present with chronic pelvic pain. These patients are at high risk of other psychologic or psychiatric disorders. Inquiries must be compassionate, but the patient must be asked if she has ever been touched by anyone against her will as a child or as an adult. Referral for counseling and to a support group may help. All rights reserved.