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Pelvic Pain
Pelvic Pain

What is Pelvic Pain

Pelvic pain is a common symptom that can have many different causes. If you’ve experienced any type or duration of pelvic pain that has affected your quality of life, finding the underlying cause can give you the most effective path to pain relief. 

Pelvic pain is characterized by sharp or dull pain or discomfort in the lower abdomen or pelvis. It can be constant or intermittent and range from mild to severe. In some cases, pain can radiate to the lower back, buttocks or thighs.  

Organs that can contribute to pelvic pain when they are not functioning properly include the intestines, the bladder, the reproductive organs and the pelvic muscles and joints. No matter what you may have been told, severe or chronic pelvic pain is not normal. 

For women who are concerned about their duration or level of pelvic pain, it’s best to discuss your symptoms with a GYN specialist to rule out any conditions that may be contributing to pain. For those diagnosed with a GYN condition that is likely causing pelvic pain, the specialists at CIGC can help you find relief. 

Pelvic Pain Treatment Options

Because there are many different causes of pelvic pain, treatment options will vary widely.  

Pelvic pain from fibroids: These noncancerous growths in the uterus can put pressure on pelvic organs, causing pain that increases as fibroids grow. Pelvic pain on the right or left side of your pelvis could indicate the location of a fibroid. Fibroids causing pelvic pain can be surgically removed through a myomectomy or hysterectomy. 

Pelvic pain from endometriosis: This condition causes tissue from the uterus to grow outside of it. Many women with endometriosis report chronic pelvic pain as one of their main symptoms. Endometriosis excision is the most effective treatment for the condition. 

Pelvic pain from ovarian cysts: These fluid-filled pockets can grow on one or both ovaries, causing dull or sharp pain on one or both sides of the lower abdomen. For best pain relief results, ovarian cysts should be surgically removed. 

Pelvic pain from adenomyosis: This condition causes tissue from the uterus to grow into the uterine wall. Women with adenomyosis typically have severe pelvic pain associated with heavy bleeding during their cycle. The recommended treatment for adenomyosis is a minimally invasive hysterectomy. 

In some cases, pelvic pain can be relieved through nonsurgical methods offered in The CIGC Wellness CenterThese methods may include pelvic floor physical therapy, acupuncture, physical training, psychotherapy, nutritional counseling and pain management. Speak with an expert about the best treatment for your needs. 

Pelvic Pain Treatment

Treatment Before Diagnosis

Endometriosis

If pelvic pain is caused by endometriosis, laparoscopic surgery (endometriosis excision) is indicated, especially if fertility is desired. Medical therapy should usually not be used, since it does not diagnose the extent of disease, and cannot assess the best option for medical therapy.

Infection

In general, the following infectious causes of pelvic pain are treated with antibiotics rather than a surgical procedure:

  • Pelvic inflammatory disease (PID): This condition is treated with a combination of broad-spectrum antibiotics, because the specific bacteria causing the infection is often unknown
    • In some instances, the patient has to be admitted to the hospital for IV antibiotics
  • Urinary tract infection (UTI): Oral antibiotics are prescribed for specific bacteria found on urine analysis
    • A simple bladder infection can be treated with three to five days of oral antibiotics. Recurrent bladder infections sometimes require daily antibiotic therapy for suppression. Hospitalization and IV antibiotic therapy are required in cases of complicated kidney infections.
Gastrointestinal
  • Irritable bowel syndrome (IBS): Modifications in diet, behavioral changes, medications, and psychotherapy are used alone or in combination, depending on the severity of the symptoms
Urological
  • Interstitial cystitis/painful bladder syndrome: None of the currently available therapies for this disorder are curative
    • Ongoing physical and pharmacologic therapies are prescribed to control the symptoms
The following conditions are treated with surgery:
  • Endometriosis: Laparoscopic resection of endometriotic implants is accomplished using two to three small incisions
    • For women who have completed childbearing and in cases of severe endometriosis, removal of the uterus and ovaries is an effective option
  • Pelvic/ovarian mass: This includes the removal of a mass with or without the removal of the ovary
    • The preservation of the ovary depends on several factors, including the age of the patient, the size of the mass, whether there is any viable ovary remaining, and the possibility of malignancy
  • Fibroids: The removal of fibroids (myomectomy) or removal of the uterus (hysterectomy) are surgical treatment options
  • Adenomyosis: Laparoscopic hysterectomy (removal of the uterus) is the treatment of choice for women with significant symptoms from adenomyosis
  • Adhesions: Laparoscopic cut down of scar tissue (lysis of adhesions) is most effective in patients with dense adhesions and adhesions involving the bowel
    • In cases of mild adhesions, cutting down of adhesions may not treat the pain and other causes of pain need to be considered. If scar tissue is caused by multiple cesarean deliveries, the removal of the uterus may be necessary to avoid adhesion reformation and repeat surgery.
  • Pelvic congestion syndrome (PCS): Surgical treatment options include the removal of the uterus and ovaries, embolization of the ovarian veins, sclerotherapy, and surgical ligation of the ovarian veins
    • There are only a few observational studies and case reports that studied the effectiveness of these treatment options

Laparoscopic Uterosacral Nerve Ablation (LUNA)

This procedure involves the destruction of the uterine nerve fibers located in the uterosacral ligament. A 2-cm segment of the uterosacral ligament is removed. This procedure is used in patients with unexplained pelvic pain, and the removal of the uterine nerves is thought to help relieve the pain. Some studies have shown that patients with unexplained painful menses remained pain free for 12 months following the procedure. Other studies showed that in patients with endometriosis, the addition of LUNA to the surgical treatment of endometriosis did not improve the pain2. Success rates for this procedure decline rapidly over several years, possibly due to the regrowth of nerves.

Laparoscopic Presacral Neurectomy

This procedure involves resection of the group of nerves (sacral nerve plexus) located in the pelvis that are thought to cause pelvic pain. This procedure is technically more difficult than LUNA because of the presence of large vessels and ureters near the area of dissection. This procedure is considered most effective for relieving pelvic pain located in the middle of the pelvis versus the right or left side. LPSN is more effective than LUNA for unexplained menstrual pain. As with LUNA, success rates decline over several years due to the regrowth of nerves3.

Alternative Treatment Options for Chronic Pelvic Pain

Treatments for trigger-point pain and for unexplained pelvic pain include physical therapy, trigger-point injections, local anesthetic patches, acupuncture, psychotherapy, behavioral and relaxation feedback therapies and nerve stimulation.

The CIGC Difference

The CIGC laparoscopic pelvic pain specialists have made a commitment to diagnosing conditions that can cause pelvic pain, and performing the most minimally invasive procedures with advanced, modern techniques. Even the most complex GYN surgeries at CIGC are performed with exceptional outcomes.

DualPortGYN® and LAAM-BUAO® (laparoscopic-assisted abdominal myomectomy) were developed to improve patient outcomes of GYN surgery. DualPortGYN and LAAM® take advantage of advanced surgical techniques that enhance the safety of each procedure.

Specialists Not OBGYNs

The majority of the care provided by an OBGYN is obstetrics, with a small percentage of the practice devoted to surgery. We partner with OBGYNs to ensure patients get the best possible care. Treating pelvic pain requires extensive experience and high surgical volume to ensure patients have the best possible outcomes.

The CIGC surgical specialists are board-certified and fellowship-trained, and have undergone extensive training in the advanced techniques and procedures involved in laparoscopy. CIGC laparoscopic procedures for pelvic pain are far superior to the open or robotic procedures. Our procedures have a short recovery period, minimal scarring, and minimal discomfort, meaning you are back on your feet quickly.

Patients looking to make the best decision for themselves need to conduct extensive research and be their own advocate. Our patients share their success stories. Please refer to the testimonials section for more information.  

Ready for a Consultation

If you’re suffering with pelvic pain, our specialists are ready to provide an evaluation of your symptoms and conditions and recommend an appropriate solution.

References

1 Steege JF, Siedhoff MT. Chronic pelvic pain. Obstet Gynec. 2014 Sept;124(3):616-29

2 Daniels J, Gray R, Hills RK, et al. Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial. JAMA. 2009 Sep 2;302(9):955-61

3 Kwok A, Lam A, Ford R. Laparoscopic presacral neurectomy: a review. Obstet Gynecol Surv. 2001 Feb;56(2):99-104