The Potential of Cesarean Section as a Causative Factor of Chronic Pelvic Pain - Revista Brasileira de Ginecologia e Obstetrícia
Regarding abdominal wall pain, neuropathy and myofascial syndrome are some of the most important. The most common neuropathies affect the iliohypogastric, ilioinguinal, and genitofemoral nerves. They are caused by nerve section (with neuroma formation or poor adaptive neuroplasticity), inadvertent nerve ligation or fibrous scarring of the surrounding tissue with nerve entrapment. The myofascial syndrome has a more obscure pathophysiology and is attributed to tissue ischemia due to prolonged muscle contraction and consequent accumulation of inflammatory substances such as serotonin, histamine, and prostaglandin. These substances have the ability to induce muscle contraction, which would generate a vicious reverberation cycle, even after cessation of the triggering event. Due to the similarities between them and the lack of consensus in the differential diagnosis, we will treat it as a single condition in this editorial.
It is primarily characterized by the presence of trigger points (TP) in the abdominal wall, although this does not necessarily exclude a visceral origin for the persistent pain. Such TP are defined as small areas of intense hyperalgesia located in a region of skeletal muscle or fascia (rectus abdominis and external oblique muscles, most commonly) which, when compressed, cause the abovementioned pain (in the corresponding dermatome or in a distant one), with or without perceived contracture of the local muscles and/or autonomic changes in the underlying skin, such as piloerection or sweating. Although it is not part of the routine physical examination by the gynecologist/obstetrician, the TP can be easily identified by trained observers. Alterations in sensitivity (hypoesthesia, anesthesia, dysesthesia) on the skin adjacent to the TP is frequently observed.
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Regarding abdominal wall pain, neuropathy and myofascial syndrome are some of the most important. The most common neuropathies affect the iliohypogastric, ilioinguinal, and genitofemoral nerves. They are caused by nerve section (with neuroma formation or poor adaptive neuroplasticity), inadvertent nerve ligation or fibrous scarring of the surrounding tissue with nerve entrapment. The myofascial syndrome has a more obscure pathophysiology and is attributed to tissue ischemia due to prolonged muscle contraction and consequent accumulation of inflammatory substances such as serotonin, histamine, and prostaglandin. These substances have the ability to induce muscle contraction, which would generate a vicious reverberation cycle, even after cessation of the triggering event. Due to the similarities between them and the lack of consensus in the differential diagnosis, we will treat it as a single condition in this editorial.
It is primarily characterized by the presence of trigger points (TP) in the abdominal wall, although this does not necessarily exclude a visceral origin for the persistent pain. Such TP are defined as small areas of intense hyperalgesia located in a region of skeletal muscle or fascia (rectus abdominis and external oblique muscles, most commonly) which, when compressed, cause the abovementioned pain (in the corresponding dermatome or in a distant one), with or without perceived contracture of the local muscles and/or autonomic changes in the underlying skin, such as piloerection or sweating. Although it is not part of the routine physical examination by the gynecologist/obstetrician, the TP can be easily identified by trained observers. Alterations in sensitivity (hypoesthesia, anesthesia, dysesthesia) on the skin adjacent to the TP is frequently observed.
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