Introduction

Fitz-Hugh-Curtis syndrome (FHCS), also known as perihepatitis, is the inflammation of the tissue surrounding the liver (liver capsule). FHCS develops as a complication of chronic (lasting 3 months or longer) pelvic inflammatory disease (PID), an infection affecting the female reproductive system.¹ Patients with FHCS often present with pain in the right side of the abdomen caused by inflammation. Other symptoms include fevers, chills, nausea, vomiting, vaginal discharge, painful sex, painful urination, cramping, and bleeding after sex. However, all of these symptoms are similar to other diseases, including cholecystitis and subphrenic abscesses, making the diagnostic process a process of elimination.

PID, which is the only cause of FHCS, affects sexually active women between the ages of 15 and 30, with 750,000 cases in the United States each year. However, only an estimated 4% of these women go on to develop FHCS, making it a rare complication. Due to the stigma surrounding diseases affecting or related to the female reproductive tract, there are often several psychosocial impacts to young women. This article aims to explore these psychosocial impacts and how they impact women, coping strategies, and how patients can receive support. 

Physical symptoms and their psychosocial implications

Chronic pain and discomfort

FCHS is symptomatically associated with chronic pain and discomfort, affecting the abdominal region. Living with this long lasting pain can often negatively impact a woman’s ability to complete daily tasks, due to even the slightest movement exacerbating the pain. As a result, the mental health of FCHS patients can take a significant toll, with patients experiencing increased anxiety, frustration, anger, depression, and shame.² All of these symptoms are completely normal, and are known as “secondary suffering” because they make the life of a FCHS patient more unpleasant.

Impact on physical health

Chronic pain can result in a patient becoming less physically active due to the increased pain. Additionally, fatigue can decrease physical activity in FCHS, as patients are too drained to engage in their usual habits and hobbies. Ultimately, this can lead to social withdrawal, negatively impacting mental health yet again. Furthermore, the pain associated with FCHS can cause disturbances to sleep, decreasing quality of life because patients will not be well rested enough to enjoy day-to-day activities.

Emotional and psychological impact

Chronic diseases, such as FCHS, cause patients to adjust their lifestyle, employment, and life goals around their condition; this often results in patients with chronic illness grieving what could have been, or what they wanted their life to look like. Additionally, the stress caused either directly or indirectly from the pain can negatively contribute towards distress, leading to the development of psychiatric disorders, such as depression and anxiety. To that extent, approximately 20 to 25 percent of patients with chronic illness experience mental health disorders.³ 

Social and interpersonal relationships

Patients experiencing FCHS can face difficulties maintaining relationships, with reduced desire, time, and energy to engage in social interactions;this directly contributes to reduced communication with friends, family and colleagues, which further correlates with a feeling of isolation. The more isolated a person feels, the more susceptible they are to developing depression and anxiety.⁴

Impact on work and economic stability

When experiencing chronic pain, as seen in FCHS, maintaining employment becomes more difficult because the pain reduces the ability to go into a workplace, work long hours, and maintain focus and productivity. On average, people with chronic illness work 3.5 hours less per week than an individual with no illness.⁵ As a result, the income and financial stability of patients with a chronic disease is reduced. Furthermore the benefit and income support entitlements in the UK do not substantially help to increase financial circumstances. Additionally, chronic illness can be very financially demanding due to illness-related costs, such as private treatment and adaptive living equipment, further worsening financial conditions.

Coping strategies and support systems

Cognitive behavioural therapy (CBT) and CBT-like therapies, either self-led or through the NHS (UK), are available to FCHS patients to manage chronic illness-related mental health issues. Patients can be educated on their disease, and how to communicate their disease and challenges around their illness with their peers to help prevent and manage distress. Medical professionals often provide relaxation techniques to promote mindfulness, and reduced stress and anxiety.⁶

Summary

• Fitz-Hugh-Curtis Syndrome (FHCS) is a rare complication of chronic pelvic inflammatory disease (PID) that causes inflammation of the liver capsule, leading to symptoms like abdominal pain, fever, and nausea. Diagnosing FHCS can be challenging due to symptom overlap with other conditions
• Chronic pain associated with FHCS can severely impact a woman's daily life, leading to significant mental health issues, such as anxiety, depression, and frustration, which can contribute to "secondary suffering"
• Physical health deterioration in FHCS patients includes decreased physical activity and social withdrawal due to fatigue and pain, resulting in a lower quality of life
• Emotional and psychological challenges are prevalent, with FHCS patients often grieving lost life goals, and experiencing stress-induced psychiatric disorders, like depression and anxiety
• Social and interpersonal relationships suffer as FHCS patients struggle to maintain communication and social engagement, leading to feelings of isolation, and increased vulnerability to mental health issues
• Coping strategies and support include cognitive behavioural therapy (CBT), patient education, and relaxation techniques aimed at managing mental health, and promoting better communication about the illness