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CASE REPORTSCase No. 1PPOD symptoms: pelvic pain; coccygeal pain; genital pain, numbness and tingling; urinary frequency and urgency; chronic constipation; painful and irregular menstruation followed by absence of menstruation. A 15 year old female presented with bilateral inguinal (anterior pelvic) pain of approximately one year duration. Approximately six months prior to being seen, she developed persistent constipation which would fluctuate in its severity. Menstruation, which had been regular since its onset at age 11, became painful and irregular. Approximately 4 months prior to being seen, menstruation abruptly stopped altogether. During this same period of time she experienced intermittent periods of back and the leg pain that had developed unrelated to any mechanical stress or injury. Her condition worsened and she developed urinary frequency and urgency in the absence of difficulty or pain. In addition, coccygeal (tailbone) pain and genital pain and paresthesias (numbness and tingling) developed. Although she had been evaluated by her family physician as well as a gynecologist, no abnormalities could be found. She was brought to the author by her mother, who herself had previously undergone treatment for complaints related to the mechanically induced PPOD Syndrome. Clinical examination revealed the characteristic features of a Type I mechanically induced PPOD Syndrome with secondary bilateral inguinodynia (anterior pelvic pain); vulvodynia (genital pain); urinary frequency and urgency; constipation and amenorrhea (absence of menstruation). Treatment, following the Type I mechanically induced PPOD protocol resulted in a progressive resolution of her complaints. After one week of care, bowel function improved so that evacuation was occurring once every one to two days, without the need to forceably strain. After two weeks of treatment, bowel function was approaching normal and menstruation had returned. After four weeks of care, all lower extremity, pelvic and genital pain had resolved, and her urological function had normalized. Gradually her overall condition stabilized, and she was discharged from care fully improved with no residual pelvic pain or pelvic organic dysfunction. |
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