Persistent Pelvic Pain
A laparoscopic hysterectomy holds many advantages over other methods.
Overview
A lot of the women we see at Central Gynaecology have trouble with pelvic pain. If it has been present for more than 6 months, and especially if it is present more days than not, then it is called persistent (or chronic) pelvic pain. From the outset, it should be recognised that this is often due to several causes, which may be interrelated.
Possible causes
Common issues we will look out for include:
Endometriosis
Painful bladder syndrome/Interstitial cystitis
Vulvodynia/vestibulitis
Irritable bowel syndrome
Pelvic muscle pain and dysfunction
Pudendal nerve pain (neuralgia)
Chronic vaginal infection or irritation – for example, due to thrush, chlamydia, or after menopause
Sometimes, something such as an ovarian cyst might be found, but in general, cysts cause reasonably rapid onset of pain and often resolve by themselves. In some cases, some of the above issues might have already been diagnosed, and the tendency is to try and fit all the symptoms into one category (“it’s my endo”). In our experience, this is usually a mistake and might explain why some women have had several surgeries for endometriosis, but never really got a lot better.
What to do
The first step is to take a careful and thorough history.
In some cases, particularly when the problem has been there for a long time, if there have already been several operations are done and/or several different practitioners involved, the history and examination might have to be spread across two visits. Please bring any copies of operation notes or letters you have from previous doctors.
We can help
If you are experiencing persistent pelvic pain and would like to talk to us about how we can help, please feel free to contact us. You can also request an appointment online.
Frequently when we break the issues down and start thinking about the sources of pain more holistically we can make some real progress.
Be prepared for it to take some time – a complex problem is unlikely to be solved with one simple solution, be that a drug or an operation.
However, we will take your symptoms seriously and try our best to help make some progress.
Further reading
Related conditions
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Adenomyosis occurs when the inside lining of the uterus is found within the muscular wall of the uterus, enlarging it.
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When endometrial tissue, which should only be found in the uterus, also grows outside the uterus, causing severe pain.
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IBS symptoms include cramping abdominal pain, diarrhoea and constipation, and these can alternate in the same patient.
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A number of different types, with different symptoms and treatments. Often they resolve on their own without intervention.
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Characterised by pain with bladder filling and emptying, along with increased frequency and passing urine at night.
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Pain is sporadic, not linked to the menstrual cycle, and can be brought on by sex, prolonged sitting, exercise, or randomly.
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The ongoing pain and discomfort of the vulva. Factors relating to the body’s nerves, hormones or immune system are involved.
Treatments
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A procedure to remove a woman’s uterus. This can be achieved via either abdominal keyhole surgery, abdominal incision, or performed through the vagina.
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A small plastic contraceptive device is placed inside the uterus with strings extending out through the cervix. Can be used to treat adenomyosis and endometriosis.
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This entails keyhole surgery where a camera is placed through the belly button to view the pelvis, enabling abnormal tissue and cysts to be removed.
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IBS treatment will depend on the triggers that have been identified and may include: dietary help with FODMAPs; probiotics and occasionally specialized antibiotics may help.
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Keyhole surgery where a camera is placed through the belly button to view the pelvis, enabling the cyst to be removed from the ovary.
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Figuring out and avoiding triggers with close dietary management, reducing inflammation with specific anti-histamines.
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Treatments can include topical medications to reduce nerve impulses, Botox to associated muscles in spasm, physiotherapy, waxing/shaving, synthetic underwear).