Güncel Proktoloji: Anorektal Hastalıklar ve Modern Yaklaşımlar

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KRONİK PELVİK AĞRI YÖNETİMİ

Doç. Dr. Abdullah YILDIZ

SBÜ Ümraniye EAH, Genel Cerrahi Kliniği, İstanbul, Türkiye

ÖZET

Kronik Pelvik Ağrı (KPA), sıklıkla alt üriner sistem, jinekolojik disfonksiyon, duygusal ve cinsel sorunlarla birlikte olan; ancak menstrüel siklusla ilişkisi bulunmayan, pelvik bölge yapılarından kaynaklanan, altı aydan uzun süren kronik ve persistan bir ağrı olarak tanımlanmaktadır. KPA, insanların yaklaşık %20’sini etkileyerek bireylerin yaşam kalitesini ciddi şekilde bozmaktadır. Genellikle üreme çağındaki kadınların %25’ini, yaşam boyuda kadınların %15’ini ve erkeklerin %10’unu etkilemektedir. Heterojen etiyolojisi nedeniyle tanı ve tedavisi bazen zor olabilmektedir. KPA’nın etiyolojisi, pelvik bölge içindeki veya pelvisi çevreleyen anatomik yapıların bozukluklarının yanı sıra; kronik proktalji, levator spazmı, pelvik gerginlik miyaljisi, piriformis sendromu ve puborektalis sendromu gibi fonksiyonel rahatsızlıkları da içermektedir. Kronik ağrının çok yönlü etkileri, kaygı, hareket kabiliyetinde azalma, iştahsızlık, sosyal izolasyon, depresyon, uyku bozuklukları ve iş hayatında sınırlamalar gibi birçok fiziksel ve psikolojik soruna neden olmakta, dolayısıyla bireyin yaşam kalitesini düşürmektedir. Ağrının doğru bir şekilde değerlendirilebilmesi için iyi bir pelvik anatomi ve fizyopatoloji bilgisine sahip olunması gerekmektedir. Ayrıca, tanı ve tedavi sürecininde iyi yönetilmesi önemlidir. Standart tanı prosedürleri, ayrıntılı bir anamnez, fizik muayene ve hedefe yönelik tanısal araştırmaları kapsamalıdır. Abdominopelvik muayene, laboratuvar testleri ve ileri görüntüleme yöntemleri (Abdomen ve Endoanal Ultrasonografi (EAU), Bilgisayarlı Tomografi (BT), Manyetik Rezonans (MR), MR defekografi, üst ve alt gastrointesinal endoskopik incelemeler, konvansiyonel defekografi, kolon transit zamanı, anal manometri) kullanarak ayırıcı tanıya ulaşılmalıdır. Gerekli durumlarda ilgili branşlardan konsültasyonlar istenmelidir. Ayırıcı tanıda jinekolojik, gastroenterolojik, ürolojik ve muskuloskeletal (miyofasiyal ağrı, koksigodini, pelvik taban spazmı) ve nörovasküler hastalıklar değerlendirilmelidir. Bazı vakalarda tanısal laparoskopi gerekebilir. Ağrının kaynağı belirlendikten sonra, etiyolojik nedenlere yönelik mültidisipliner bir tedavi planı oluşturulmalı ve hastanın yönetimi bu çerçevede yürütülmelidir.

Anahtar Kelimeler: Kronik ağrı; Ağrı yönetimi; Kas-iskelet ağrısı

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