What is chronic pelvic pain?
Pain is a relative entity, every very individual perceive pain differently. With this in
mind, chronic pelvic pain is presence of dull aching or stabbing pain below the umbilicus for at least six months.
What causes pelvic pain?
Endometriosis is the most common cause of cyclical pain in reproductive age group woman. This is because of the inflammatory reaction due to the presence of ectopic endometrium.
Pelvic inflammatory disease causes pelvic pain by infection entering into the abdomen (from vagina via fallopian tubes). Due to the inflammatory reaction in the pelvis, there is adhesion formation, which is inturn responsible for infertility.
Most common cause of pain with an ultra sound finding of a “bulky” uterus is adenomyosis. This condition causes heavy bleeding associated with pain during menstruation.
Acute pain can be caused due to fibroid degeneration or fibroid twisting its pedicle. Large fibroids can cause pain due to the pressure they exert inside the abdomen(to neighbouring organs).
Ectopic pregnancy where pregnancy occurs outside the uterine cavity (commonly within the fallopian tubes) can cause acute pelvic pain because of sudden rupture of the fallopian tube. Thus its prudent that all women who present with acute pelvic pain (in reproductive age group) must undergo a pregnancy test.
What investigations can help diagnose pain?
Ultrasound is a cheap and fantastic tool to identify various pathologies responsible for pain. In some cases a CT or MRI may be warranted for additional diagnostic insights.
This did not diagnose my abdominal pain. What next?
In situations where non-invasive investigations fail at a diagnosis, Ahystero- laparoscopy will definitely give a diagnosis in most situations.
What’s Laparoscopic pre sacral neurectomy ?
This is a surgical treatment for patients for pain relief associated with adenomyosis and endometriosis. This extremely skilled procedure involves removal of nervous tissue (sacral nerve plexus) from near the sacral promontory. Sometimes success rates decline after several years due to the regrowth of the nerve fibers.
What is laparoscopic uterosacral nerve ablation?
This procedure involves removing a small segment of the uterosacral ligament on which the nerve fibers are located. This helps alleviates pain in some patients who do not respond to medical treatment.