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DIAGNOSIS:
 POPSS syndrome can be strongly suspected on clinical examination usually within 40-50 minutes. Lab tests, x-rays, and endoscopies are used primarily to rule out other serious conditions and are used sparingly.
It is important to rule out other commonly seen conditions which cause groin, lower abdominal, and pelvic pain. Primary care physicians, gynecologists, and general surgeons, are aware of these conditions, and they will be able to diagnose them. After unsuccessful treatments of these conditions, if the pain persists, it is time to consider POPSS syndrome.
A detailed history with emphasis on some of the following points is helpful:
a. Pain increases with physical activity.
b. Previous history of lower abdominal surgeries, especially multiple surgeries.
c. History of infections in pelvic organs, e.g., cystitis, prostatitis, pelvic inflammatory disease.
d. History of tendonitis in other parts of the body, e.g., tennis elbow, plantar fascititis, etc.
e. Previous diagnosis of fibromyalgia.
f. Very few gastro-intestinal symptoms.
On physical exam, in addition to detailed examination of the abdomen, including pelvic and rectal exams, we describe seven signs that lead to a strong possibility of POPSS syndrome.
Confirmation of POPSS syndrome is made by giving a series of strategically placed steroid injections.
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