Pelvic Pain | Chronic Pelvic Pain | Pelvic Pain Diagnosis

Pelvic Pain

Definition and Frequent causes of Pelvic Pain

Endometriosis and Adenomyosis

Interstitial Cystitis

Pelvic Congestion Syndrome or Pelvic Varicosity Pain Syndrome

Vulvodynia

Pelvic Floor Muscle Spasm

Other Causes of Pelvic Pain

Surgical Procedures We Perform

Definition and Frequent causes of Pelvic Pain

Chronic pelvic pain is defined as having pain for at least 6 months duration anywhere from the umbilicus to the thighs and includes the abdomen, the low back and buttocks, the pelvis, the vulva, and the vagina. Below are some of the most common causes of chronic pelvic pain that are treated in our facility. Most patients with pelvic pain do not have just one cause of their pain, but have multiple pain generators and improvement of pain is dependent on identifying and treating all pain generators. For a more comprehensive perspective on chronic pelvic pain, please see the International Pelvic Pain Society Website at www.pelvicpain.org.

Endometriosis and Adenomyosis

Endometriosis is when tissue that is normally found on the inside lining of the uterus is found outside of the uterus. This tissue can be found, or implanted, in various places in the pelvis and abdomen such as the ovaries, the outside surface of the uterus, the lining (or peritoneum) of the pelvis, the bowel or rectum, or on the outside of the bladder. Although a physical exam can suggest endometriosis, it is diagnosed by laparoscopy. There are both medical surgical options for treatment of endometriosis and excision of endometriosis is our preferred method of surgical treatment. Adenomyosis is when the tissue lining the inside cavity of the uterus is found in the musculature of the uterus and can cause painful, heavy periods. The diagnosis may be suggested by ultrasound, but can be difficult to make. Various medical treatments are available, but may require removal of the uterus or hysterectomy.

Interstitial Cystitis

Interstitial cystitis (IC) is a chronic painful bladder condition that affects many women and is a common cause of pelvic pain in combination with other pelvic pain generators. It is an inflammatory process characterized by many symptoms such as bladder urgency, frequency, urinating at night, pain with a full bladder, painful intercourse, bladder spasms, and pain in the vagina. IC is a disease that varies in spectrum from very early stage, with few urinary symptoms, to advanced stage. The diagnosis can be made in the office with a bladder questionnaire and a bladder sensitivity test. Frequently, cystoscopy with hydrodistension is also used to make the diagnosis. Interstitial cystitis is treated with medications that aid to renew the protective bladder lining (Elmiron®), as well as other medicines that help decrease the pain and the inflammation in the bladder. Oftentimes, bladder instillations are used to treat Interstitial Cystitis.

Pelvic Congestion Syndrome or Pelvic Varicosity Pain Syndrome

Pelvic Varicosity Pain Syndrome (PVPS) which is formerly known as Pelvic Congestion Syndrome is an under treated condition characterized by pelvic pain that may be debilitating due to dilated, painful veins in the pelvis. Although the exact cause is not known, it can be seen with other causes of pelvic pain. The symptoms include pain that is worse while standing and is improved while lying down, aching after intercourse, painful menses, and throbbing pain in the lower abdomen that is sharp and shooting and frequently can alternate between the right and left lower abdomen. PVPS is diagnosed by performing a special x-ray test called a pelvic venogram that shows how dilated the pelvic veins are. It is treated with several medical and, sometimes, surgical therapies.

Vulvodynia

Pain on the outside skin of the genitalia is called vulvodynia. It may be generalized or localized to the vaginal entrance (vestibulitis). Vulvodynia is a complex pain syndrome and may be a primary pain process, but may also be a secondary cause of pain from other conditions such as Interstitial cystitis, Endometriosis, or Pelvic Floor Muscle Spasm. There are many causes of vulvodynia including chronic infections, inflammatory skin conditions, Pudendal Nerve Neuralgia, and other pelvic pain generators. Symptoms include a chronic burning or raw sensation around the vagina and/or rectum, pain with intercourse, and pain while wearing tight clothing or using tampons.

Pelvic Floor Muscle Spasm

Pelvic floor tension myalgia is when the pelvic muscles surrounding the vagina and anus are tender and in spasm. This condition causes painful intercourse and can also cause and aching discomfort for hours after intercourse. Pelvic floor myalgia may be a primary source of pain or secondary from other conditions such as vulvodynia, interstitial cystitis, endometriosis, or pelvic varicosity pain syndrome. Although difficult to treat, pelvic floor muscle spasm can be helped with pelvic floor stretching exercises and with physical therapy.

Other Causes of Pelvic Pain

Here is a list of other possible causes of pelvic pain that we treat in our practice:

Irritable Bowel Syndrome
Hernias (Inguinal, Femoral, Ventral, Umbilical, Sciatic, Obturator, Perineal, Spigelian)
Trigonitis
Adhesions
Adenomyosis
Ovarian Remnant Syndrome
Adhesions from Pelvic Inflammatory Disease
Ovarian Cysts
Degenerating Uterine Fibroids
Muscular pain and Muscle Spasm
Trigger points
Pudendal Nerve Neuralgia
Retroverted (or Tilted) Uterus
Nerve Entrapments and Peripheral Neuropathies
Neuromas
Pelvic Girdle Malrotation
Pelvic Relaxation
Cervical or Endometrial Polyps
Colitis
Coccydynia (pain in the tailbone)
Clitorodynia (pain in the clitoris)
Myofascial pain
Fibromyalgia
Porphyria

Surgical Procedures We Perform

Laparoscopy is a surgical procedure whereby a lighted telescopic lens is placed into the body through small (usually 1-2 inches) incisions. Cystoscopy is using a similar device to visualize the inside of the bladder and hysteroscopy is visualizing the inside of the uterus. More than 90% of the surgeries that we perform are done with these techniques in order to minimize the amount of tissue injury that occurs during surgery, hence the term "Minimally Invasive Surgery." Here is a partial listing of the surgical procedures we frequently perform to help patients with chronic pelvic pain:

Cystoscopy with hydrodistension (to look for Interstitial cystitis and other bladder pathology)
Hysteroscopy
- Removal of polyps
- Removal of fibroids
- Endometrial resection
Removal of adhesions
Diagnostic laparoscopy
Excision of Endometriosis, including advanced stages of endometriosis (simply using cautery or laser vaporization of endometriosis is not as effective as excision)
Hysterectomy (removal of the uterus) with and without the removal of the Fallopian tubes and ovaries
- Total Laparoscopic Hysterectomy
- Laparoscopic Supracervical Hysterectomy (not removing the cervix)
- Vaginal Hysterectomy
- Laproscopic assisted vaginal hysterectomy
Myomectomy (removal of uterine fibroids)
Hernia Repairs
- Inguinal
- Ventral
- Sciatic
- Obturator
- Perineal
- Spigelian
Removal of ovaries
Oophoropexy (transposition of the ovaries)
Extensive Lysis of Adhesions
Ureterolysis
Removal of Ovarian Remnants
Uterine Suspension
Appendectomy
Cecopexy (transposition of the cecum)
Removal of ovarian cysts
Pelvic Prolapse Surgery
- Repair of cystocele or rectocele
- Paravaginal Defect Repair
- Vaginal Vault Suspension
- Tension-free vaginal tape placement for incontinence
- Enterocele repair
- Xenograft placement