Pelvic Pain

Pelvic pain has numerous causes, may be mild or severe and include: pelvic inflammatory disease, ovarian cysts/polycystic ovarian syndrome, endometriosis, adenomyosis, fibroids, ectopic pregnancy, appendicitis, bladder/kidney infection, irritable bowel syndrome and diverticulitis.

 

 

Pelvic inflammatory disease (PID) is an infection of the lower abdomen (pelvis), which causes pain and cramping. It may also be accompanied by a fever and is an infection of the uterus, fallopian tubes and ovaries.

 

Untreated PID can lead to scarring of the reproductive organs, which may result in infertility. If you would like more information from the Centers for Disease Control, please click below:

 

 

 

Ovarian cysts may cause you pelvic pain, often on one side or the other. During the reproductive years, most cysts are “functional,” meaning they come and go with ovulation and changing hormone levels.

Cysts may be detected during a pelvic exam, but they may need to be confirmed by transvaginal ultrasound. Often these cysts spontaneously disappear or may dissolve with medication. Some may be drained with vaginal ultrasound; others may require a surgical procedure to evaluate and treat them.

 

Image 1: OVARIAN CYST:  This ovarian cyst was previously seen on vaginal ultrasound.

 

 

Polycystic Ovarian Syndrome (PCOS) is a common endocrine disorder seen in women during the reproductive years. PCOS accounts for almost half of cases of infertility. As many as 1 in 20 women have PCOS; possibly over 5 million women living in the U.S may be affected.

 

The cause of PCOS is still unknown, but many factors likely contribute to the disorder.

 

Symptoms vary—some women have many, others may have only one. Our patients with PCOS commonly have these findings: absent or irregular menstrual periods, infertility, acne, insulin resistance, family history of diabetes, abnormal weight gain, ovarian cysts, pelvic pain, inappropriate luteinizing and follicle stimulating hormones and excessive/unwanted hair growth.

 

Image 1: POLYCYSTIC OVARIES:  Several small cysts are present beneath the thickened surface of the ovary

 

Image 2: LASER LAPAROSCOPIC DRILLING OF PCOS: Releasing the cystic fluid containing testosterone, helps treat the hormonal abnormalities of PCOS, often resulting in the return of normal periods and fertility.

 

 

Endometriosis is commonly found in infertile patients. It is evidenced by finding endometrial tissue growing outside the uterus and implanting inside the pelvic cavity. Endometriosis is a commonly causes pelvic pain, painful periods, menstrual cramps, and/or pain with intercourse. It is usually suspected from the patient’s history, clinically confirmed with pelvic exam (possibly with ultrasound), and then definitively diagnosed by direct viewing with laparoscopy. Endometrial implants can cause inflammation and scarring, thereby, blocking egg passage, fertilization or embryo implantation. Endometriosis is often suspected by family history, but usually confirmed with an outpatient procedure called laparoscopy. With this outpatient procedure, ovarian causes of pelvic pain can be detected with appropriate treatment of ovarian cysts. Often, laser treatment can be used to eradicate disease at the time of diagnostic laparoscopy. If the disease is severe, more extensive inpatient treatment may be needed to maximize the preservation of normal tissue. Treatment of endometriosis often helps women more easily achieve a viable pregnancy and have a healthy child.

 

Image 1: NORMAL PELVIS:  No gynecological abnormality is seen with this laparoscopic view of the pelvis

 

Image 2: ENDOMETRIOSIS-STAGE II:  Endometrial glands have begun to grow on the surface of the ovaries

 

Image 3: ENDOMETRIOSIS-STAGE II-ENDOMETRIOMAS:  The endometrial glands have invaded the surface of the ovaries to produce ovarian cysts. This chocolate syrup-like fluid contains old blood secreted by the endometrial glands.

 

Image 4: ENDOMETRIOSIS-STAGE IV:  Bowel endometriosis may cause a change in bowel habits related to the menstrual cycle.

 

 

A ruptured appendix, previous pelvic surgery, pelvic infection or an IUD may cause pelvic adhesions. This painful scar tissue may contribute to infertility or be a cause of chronic pelvic pain. Pelvic adhesions or tubal disease are often suspected from history, but need to be confirmed by laparoscopy. Laser therapy, either at the time of outpatient laparoscopy or inpatient Micro laser treatment, is usually successful in reducing your pain and improving fertility.

 

Image 1: PELVIC ADHESIONS:  Laparoscopic view of filmy pelvic adhesions, which may cause pain or infertility.

 

Image 2: PELVIC ADHESIONS:  Additional adhesions interfere with the normal pelvic anatomy.

 

Image 3: INTERCEDE:  An adhesive barrier is placed after laser laparoscopy to prevent the recurrence of pelvic adhesions.

 

 

Fibroids are benign uterine growths made from cells of the uterus, and occur in 20-25% of women. Some fibroids are as small as a pea, while others can take up most of the pelvis. In addition, women may have only one fibroid, while others may have multiple.

 

There is little known as to what causes fibroids; however, we do know that estrogen and fertility medications fuel their growth.

 

Symptoms of fibroids may include heavy/frequent periods, pelvic pressure/pain, back pain, urinary/bowl changes, miscarriages and infertility. If fibroids are present during pregnancy, they can impede embryo implantations and continuation of the pregnancy.

 

The diagnosis of fibroids may include pelvic examination, ultrasound, SIS(saline infused sonogram), laparoscopy, hysteroscopy and possibly MRI.

 

 

Adenomyosis is caused when glandular endometrial tissue that normally lines the uterus begins to invade into the walls of the uterus, causing severe cramping, heavy menstruation and painful periods and/or pain with intercourse. Treatment options vary and will be determined based on individual patient circumstances.