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Detecting the Cause of Pelvic Pain......Summary: But for millions of women, pelvic pain isn't something that goes away. Moreover, the problem often is more than physical. Depending on their needs, they're treated or referred to other specialists. "Typically, chronic pelvic pain is a physical problem that has also created a psychological one. Symptom: Physically painful intercourse.
Take a couple of aspirins and lie down for half an hour- it usually works for menstrual pain. But for millions of women, pelvic pain isn't something that goes away. It accounts for one in 10 visits to the gynecologist and over one billion dollars each year in medical costs. Tragically, many women never get an accurate diagnosis of what is wrong. "There are many possible causes of pelvic pain," says Craig Sobolewski, M.D., gynecologist and director of the chronic pelvic pain program at Lehigh Valley Hospital and Health Network.
"What makes it so tricky is that pain felt in one area doesn't necessarily originate there." Just as a heart attack can cause pains in the arm, pain in the pelvis can be gynecologic, gastrointestinal, urinary, muscle- or bone-related, or even from appendicitis.
Moreover, the problem often is more than physical. "Many women with chronic pelvic pain have a history of sexual abuse or major depression," Sobolewski says. Even without those issues, pain that goes on for months or years can become all-consuming, disrupting work, sexuality and family life.
How do specialists like Sobolewski respond? First, by recognizing that chronic pelvic pain requires a team approach. "There are two parts to every pain," he tells his patients, "the physical part and the way you perceive it psychologically-the 'volume knob.' Our job is to treat both."
One of Sobolewski's key diagnostic tools is laparoscopy, a procedure in which long, thin instruments are inserted into the pelvis through tiny incisions. The specialist views the area on video while performing diagnosis and treatment. With today's fiberoptics, these instruments can be so narrow the patient needs only local anesthesia. Sobolewski is applying this new microlaparoscopy in a process called "conscious pain mapping."
"The patient is sedated, but remains awake to give feedback as the surgeon gently probes to produce the exact pain she has been feeling," he says. "In many cases, the source turns out to be something that couldn't be detected otherwise."
Besides a physical exam, patients in the chronic pelvic pain program also get a psychological screening. Depending on their needs, they're treated or referred to other specialists. "The biggest thing our patients need is support," Sobolewski says. "Typically, chronic pelvic pain is a physical problem that has also created a psychological one. Given the holistic way our program works, we're able to assure each patient that we'll stick with her until we figure out what the problem is-and make her as well as we possibly can."
Three Cases of Pelvic pain:
1.) Vicky, age 23, mother of two who asked her doctor for a tubal ligation.
Symptom: Pelvic pain for more than a year after having her fallopian tubes closed with tiny clips (easier to reverse than surgery). Diagnosis: "Conscious pain mapping" revealed that the clips had not completely severed the nerves. Treatment: A simple laparoscopic procedure.
2.) Marian, age 38, mother of three.
Symptom: Physically painful intercourse. Diagnosis: Tests showed that touching her cervix triggered Marian's pain. The conclusion: the cervix was probably injured during her last childbirth, causing chronic inflammation and irritation. Treatment: A series of anesthetic/steroid injections.
3.) Lee, age 44, coping with the stress of a household move.
Symptom: Pelvic cramps unrelated to menstrual cycle. Diagnosis: An exam and medical history pointed to irritable bowel syndrome, a common stress-related disorder. Treatment: Relaxation techniques, dietary changes and a temporary anti-spasm medication.
WHAT'S NORMAL and WHAT'S NOT:
A.) NORMAL PAIN:
1.) Occurs on monthly cycle
2.) Relatively constant pain level
3.) Responds to non-narcotic medication such as Motrin
B.) ABNORMAL PAIN:
1.) Occurs any time
2.) Pain gets progressively worse
3.) Does not respond to medication
If your's experiencing what you believe is abnormal pain, see your doctor.