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CASE REPORTSCase No. 3PPOD symptoms: pelvic pain; genital pain; urinary frequency, urgency, dribbling and incontinence; wetting the bed; painful menstruation; pelvic pain with intercourse; persistent vaginal discharge; recurrent miscarriage. A 42 year old woman was seen for back and left leg pain that had its onset one week earlier while attempting to lift and move an object. During this time she continued to work, and experienced increasingly painful back and leg pain, with the subsequent development of "muscle cramps" located in the inguinal regions which would become especially painful while bending forward. Since menarche (the onset of menstruation), at age 15, menstruation had been accompanied by low back and intense pelvic pain which would radiate bilaterally across the inguinal regions (front of pelvis). During her early menstrual years, persistent vaginal discharge had also developed. She had been pregnant six 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 discharged had become more severe. Her next four pregnancies had terminated in spontaneous miscarriage at varying 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 a left sided inguinal pain. At this time, menstruation became more painful, and was preceded by 2-3 days of severe sharp inguinal pain forcing her to stay in bed, and would reliably serve as a reminder that menstruation was about to begin. During this time, intercourse had become painful, and resulted in sharp pelvic (inguinal and suprapubic) pain and pain radiating to the genital region. She stated that the genital region had become exquisitely sensitive and painful to touch. In addition, recurrent bladder infections also had their onset. Gynecologic examination at that time, resulted in an exploratory laparoscopy with the removal of ovarian cysts bilaterally. Following this operation however, her pelvic pain had remained unchanged and as a result, she was rehospitalized two additional times for further testing. Unable to identify any abnormalities, she was discharged with no improvement in her pelvic pain and no known cause for its presence. Several months later, left leg pain had its onset. She underwent spinal manipulation, and experienced improvement in her back and leg pain, however, there was no change in her pelvic pain, dysmenorrhea (painful and irregular menstruation) or leukorrhea (vaginal discharge). A few months prior to her last pregnancy, low back and left leg pain returned. During this pregnancy, urinary disturbances consisting of frequency, urgency, dribbling, and incontinence had their onset. She stated that "just talking loud" would cause her to completely empty her bladder. After the delivery of a normal healthy boy, her urinary symptoms, vaginal discharge and painful menstruation persisted. In addition, nocturnal enuresis (wetting the bed) had begun to occur three-four times per week. These symptoms all remained unchanged for five years, at which time she presented to the author. Clinical examination however, reveal the presence of a Type I mechanically induced PPOD Syndrome. Treatment following the Type I PPOD protocol yielded surprisingly quick improvement. Following one week of care, 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 her menses, totally unaware of its arrival due to a lack of the usual severe pelvic pain that would preceded and accompany her menstruation. Urinary frequency and urgency had resolved and she was no longer enuretic. By dismissal from care, she reported that her persistent vaginal discharge had completely resolved. |
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