Case of the Month #38: Chronic pelvic pain by Dr Kerry Bosworth

Mr D expressed frustration during his pain clinic appointment. He felt that he wasn't able to enjoy life because of his health problems and that no one seemed able to help him.

He described last feeling well during a holiday four years ago with his wife and teenage son. Unfortunately the family had all had food poisoning at the end of the holiday. His wife and son recovered quickly but he found himself very tired for months afterwards and had to take time off from his job as a shop manager.

He has continued to have intermittent stabbing pains in his abdomen and sometimes suffers with constipation. His GP told him he has irritable bowel syndrome.

His urinary symptoms developed gradually. His first symptom was frequency, followed by dysuria which became increasingly severe. Antibiotics were prescribed but had no benefit. He developed a constant aching pain that feels as though it is deep inside his pelvis. His sexual dysfunction symptoms developed later and had a significant impact on his relationship with his wife. 

In total he has had eight courses of antibiotics. He has never had a positive urine culture. 

He has no other significant medical history and takes no medications. He has put on a significant amount of weight over the past four years and now has a BMI of 38. He admits to having a poor diet of junk food and drinking to excess. This has worsened over the past year after he separated from his wife and his son moved away to start university. 

His work have been supportive and allowed him to reduce his hours. He thinks this has been helpful but has led to some financial struggles.

He denied any history of sexual abuse or trauma.

He was tearful during the consultation and confessed that he had increasingly been finding life pointless.

Before continuing, consider how you would manage this patient.