Reproductive Surgeon, OB/GYN
161 N. Binkley, Ste 201 Soldotna
260-6914
Chronic pelvic pain (CPP), which refers to pelvic pain of more than 6 months duration, affects over 15% of American women between the ages of 16-50 (at least one in seven women). More than 60% of these patients are unaware of the reason for their pain. At least 15% of these women experience lost time from paid work and over 45% report lost work productivity. The symptoms associated with CPP and its presenting complaints are highly varied including cyclic pain, daily pain that worsens at certain times of the month, frequent pelvic aches or aches in the lower abdomen or lower back, painful intercourse exacerbating the pain, and the list goes on! Endometriosis (defined as uterine lining tissue outside its usual location) is by far the most common cause of CPP affecting over 70% of these women and over 90% of adolescents with severe menstrual cramps.
Unfortunately, this condition is too often undiagnosed or miss diagnosed. Those who suffer from CPP sadly are more likely to also suffer from a history of sexual abuse, domestic and physical violence, depression, sexual dysfunction, and emotional neglect. They also have more physical complaints and suffer from more health and psychological problems. The diagnosis of CPP is complicated in that at least half of these women also have significant genitourinary symptoms or irritable bowel symptoms or both. Often these symptoms mask the true underlying pathology, but may also need treatment. In many women suffering from CPP the cause of the pelvic pain often goes unrecognized or may not be treated correctly. Severe menstrual cramps are present in over 80% and painful intercourse in over 40%.
Other causes of CPP include pelvic adhesions or scar tissue from previous surgery, pelvic inflammation or infection, or scar tissue caused by the endometriosis itself. The longer these adhesions are present the more blood vessels and nerve tissue they develop. Over time they also become thicker and less elastic leading to restricted motion or expansibility of the abdominal and pelvic organs and pain. Often this pain is reproducible on careful and gentle pelvic examination. Specific tender areas may be located as well as masses or nodules that will need therapy.
Thorough evaluation of CPP requires a detailed pain history and a gentle and careful physical exam. Sometimes ultrasound is performed if the pelvic exam is difficult or the presence of an ovarian cyst needs to be defined as normal or abnormal (large size, persisting after menses onset when benign cysts nearly always resolve). Laboratory testing is also of limited value. A blood test called a CA-125 is elevated over “20” in at least 54% of patients with endometriosis; making it useful only if it is “abnormal”. Bowel and bladder symptoms need to be thoroughly evaluated as appropriate.
Pain medicine, anti-inflammatory medications, and empiric therapy such as birth control hormones or ovarian hormone suppression have been advocated as first line forms of treatment; however, these therapies need to be carefully tailored to the patients needs as they are directed at treating only the symptoms and may only reduce the pain or suppress it for a short time, or worse, they could rob the woman of an accurate diagnosis and treatment. Laparoscopy (looking telescopically into the abdomen under anesthesia) remains the only definitive way to diagnose and treat endometriosis and pelvic and abdominal adhesions. Various tools and instruments such as KTP laser are then used to resect the abnormal tissue, the endometriosis, and/or adhesions. This is performed to definitively treat or remove all visible abdominal and pelvic pathology likely to be related to the pain symptoms. This requires patient and accurate and expedient treatment and potential relief from the CPP as well as restoration or preservation of fertility if desired. Hysterectomy is another issue. For more information or to pursue evaluation call Dr. Thompson’s office at 260-6914.
Orthopedics
