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CASE REPORTSCase No. 5PPOD symptoms: pelvic pain; coccygeal pain; rectal pain; urinary frequency, urgency, sluggishness, difficulty emptying bladder and incontinence; chronic diarrhea; mucous discharge; recurring periods of constipation; pelvic pain with intercourse; inability to achieve orgasm; vaginal spotting. A 48 year old woman was seen for the complaints of low back and bilateral lower extremity pain of many years duration. She stated that back pain had had its onset at 12 years of age as a result of a fall on her buttocks while ice skating. Although her back pain diminished in its intensity, it had never completely resolved. Over time, bilateral inguinal (anterior pelvic), coccygeal (tail bone) and proctalgia (rectal pain) had developed. These pains would be distinctly aggravated during periods of increasing low back pain. Since its onset at age 12, menstruation had been painful, heavy and irregular; ranging in duration from about four days to two weeks, and occurring every three to six months. From its onset, coitus (intercourse) had been intensely painful, with pain being located primarily in the inguinal (anterior pelvis over ovary) and suprapubic (above pubic bone) regions. Because of diminished genital sensitivity, orgasm had never been possible. She became pregnant three times, and delivered three normal children. At 25 years of age, due to worsening menstrual dysfunction, a right oophorectomy (ovary removal) was performed. Despite having undergone this operation however, pelvic pain and menstrual dysfunction continued unchanged. Gradually, over time, bilateral lower extremity pain, numbness and tingling had developed. In addition, bladder dysfunction, consisting of urinary frequency, urgency, sluggishness, difficulty and stress incontinence had their onset. About this same period of time, chronic diarrhea and mucorrhea (mucus discharge) with intermittent periods of constipation had begun to occur. She had given up many foods which were found to further aggravate bowel function. As her condition worsened, she noticed a gradual loss of all sexual desire. About one year prior to being seen by the author, she entered her climacteric. Menstruation ceased to occur and she developed persistent vaginal spotting due to what was diagnosed as atrophic vaginitis. Although she had undergone numerous prior evaluations for the various disturbances that had developed, no specific abnormalities could be identified. Clinical examination by the author however, revealed the characteristic features of a Type II mechanically induced PPOD Syndrome with secondary bladder, bowel, gynecologic and sexual dysfunction as described above. Treatment following the Type II mechanically induced PPOD protocol resulted in gradual but progressive improvement of all of her complaints. After two weeks of care, low back, lower extremity and pelvic pain had diminished, and bladder and bowel function were improved. Genital sensitivity was increasing, and dyspareunia had diminished. Approximately five weeks into treatment, she experienced her first orgasm. Vaginal spotting disappeared, and she was aware of improved coital (sexual) lubrication, the deficiency of which had not been apparent to her before. Gradually her condition stabilized and she was able to be discharged from care 2 1/2 months after initiating treatment with no residual bladder, bowel, gynecologic or sexual dysfunction. |
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