Pelvic pain

Pelvic Pain

Endometriosis: A cause of pelvic pain

Pelvic pain is often the common complaint which brings a patient to the Doctor. However, this type of pain is not as simple as we used to think. It is quite complex and is defined as ‘an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described in terms of such damage’ (IASP, 2015). Pain can be acute or chronic.

Gynaecological causes of pelvic pain are numerous and they include ovulation, dysmenorrhea, ectopic pregnancy, pelvic inflammatory disease, fibroid with degenerative changes, endometriosis, just to name a few.

Endometriosis is the presence of endometrial tissue outside the cavity of the uterus and is one of the causes of pelvic pain affecting an estimated 10-15% of women of reproductive age. 2 It is a gynaecological condition characterized by cyclical pain that occurs along with menses (dysmenorrhea).

When the endometrial tissue is present in the brain or the lungs the patient may experience cyclical seizures (catamenial seizures) and hemoptysis (coughing out blood). All these occur along with menstruation as the endometrial tissues in these abnormal places also respond to hormones and undergo cyclical changes like the normal endometrial lining of the uterus.

The diagnosis of endometriosis is a bit challenging as up to 20% of these women will also have other conditions that may cause chronic pain such as irritable bowel syndrome, painful bladder, pelvic inflammatory disease, migraine, etc. 1 Thus, because so many other conditions must be ruled out, the diagnosis of endometriosis is often delayed and may be as long as 11years. 4 Delayed diagnosis may lead to further complications such as adhesion of the
uterine tubes which further worsens fertility prognosis.

Abdominopelvic ultrasound has been shown to be inaccurate in the diagnosis of endometriosis as most of patients will come out with a normal scan. 5 Laparoscopy remains the gold standard for the diagnosis of endometriosis. However, it must be done by an expert to avoid false
negative results. 1

With laparoscopy other causes of pelvic pain apart from endometriosis can also be diagnosed and possibly treated. Laparoscopy also has an
added advantage of been therapeutic. Thus, in the hands of a qualified Gynaecologist the diagnosis and treatment can be done simultaneously. This helps reduce the number of hospital visits, and reduce the cost of care. A study conducted in Canada among 342 women who were infertile revealed a higher chance of getting pregnant after operative laparoscopy compared to diagnostic laparoscopy. 6

In conclusion, endometriosis is one of the causes of chronic pelvic pain in women of reproductive age, often associated with infertility with significant impact on physical and social well-being. A meticulous history and
examination complemented with laparoscopy by a specialist Gynaecologist will ensure timely diagnosis and prompt treatment. Furthermore, endometriosis is important part of the story of chronic pelvic pain, but a multi-disciplinary team of physiotherapist, dietician, and pain physician are required for management of chronic pelvic pain.

We are very proud to provide complete care to patient with understanding her problem, wishes, priorities and personalised treatment.

Bibliography

  1. Pugsley Z, Ballard K. Management of endometriosis in general practice: the pathway to diagnosis. The British
    Journal of General Practice. 2007;57(539):470-476.
  2. Yi KW, Shin JH, Park MS, Kim T, Kim SH, Hur JY. Association of body mass index with severity of  endometriosis in Korean women. Int J Gynaecol Obstet. 2009;105:39–42. doi: 10.1016/j.ijgo.2008.11.001
  3. Hsu AL, Khachikyan I, Stratton P. Invasive and non-invasive methods for the diagnosis of endometriosis. Clinical obstetrics and gynecology.2010;53(2):413-419. doi:10.1097/GRF.0b013e3181db7ce8.
  4. Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Montazeri A. Clinical diagnosis of pelvic
    endometriosis: a scoping review. BMC Women’s Health. 2015;15:39. doi:10.1186/s12905-015-0196-z.
  5. Moore J, Copley S, Morris J, et al. A systematic review of the accuracy of ultrasound in the diagnosis of
    endometriosis. Ultrasound Obstet Gynecol. 2002;20:630–634
  6. OLIVE D, PRITTS E. The Treatment of Endometriosis. Annals of the New York Academy of Sciences. 2002;955(1):360- 372. doi:10.1111/j.1749-6632.2002.tb02797.x.

 

Comments ( 9 )

  1. / Like
    Like!! I blog frequently and I really thank you for your content. The article has truly peaked my interest.
  2. / เพิ่มไลค์เพจ
    Likely I am likely to save your blog post. :)
  3. / ปั้มไลค์
    I believe you have noted some very interesting details, thankyou for the post. :)
  4. / zvodretiluret
    Thanks a lot for sharing this with all of us you really know what you're talking about! Bookmarked. Kindly also visit my web site =). We could have a link exchange agreement between us!
  5. / yeezy boost 350
    Thanks for your entire labor on this blog. My niece really likes going through investigation and it is obvious why. Most of us hear all about the dynamic ways you create very important steps through the blog and cause participation from some other people on this subject matter then my girl is really becoming educated a lot. Take advantage of the rest of the new year. You are carrying out a fantastic job.
  6. / off white hoodie
    I am just writing to make you know of the fabulous experience our girl developed viewing your web site. She noticed plenty of details, including what it's like to possess a marvelous coaching character to make men and women quite simply grasp various extremely tough subject areas. You really did more than my expected results. Thanks for showing these warm and helpful, safe, revealing and in addition unique tips about that topic to Sandra.
  7. / golden goose
    I needed to write you one little remark in order to say thanks as before for the remarkable advice you've provided in this article. It has been really generous of you to make publicly what a few individuals could have offered as an e-book to earn some cash for themselves, chiefly given that you might well have tried it if you ever decided. These principles also worked to be a great way to be aware that many people have similar eagerness just as my own to know way more with reference to this condition. I know there are lots of more enjoyable sessions up front for people who go through your blog post.
  8. / Adidas NMD XR1 Camouflage Main Dark Green
    Thank you so much for giving everyone an exceptionally spectacular chance to discover important secrets from this website. It is often very nice plus stuffed with fun for me personally and my office colleagues to search your site the equivalent of thrice per week to read the latest issues you will have. Not to mention, I am just actually astounded concerning the very good inspiring ideas served by you. Some 1 areas in this posting are in truth the most efficient we have all ever had.
  9. / air max
    My wife and i ended up being very thrilled that Emmanuel could deal with his researching because of the ideas he got when using the web page. It's not at all simplistic to simply possibly be handing out instructions which a number of people might have been trying to sell. We really do understand we have the writer to give thanks to for this. Those illustrations you made, the easy website navigation, the relationships you can assist to foster - it is mostly extraordinary, and it's really assisting our son in addition to us recognize that that theme is excellent, and that's exceptionally pressing. Many thanks for all the pieces!

Leave a reply

Your email address will not be published.