pelvic pain
summary and diagnosis
Chronic and acute pelvic pain is any pain in the pelvic area that starts and lasts for a short period of a few minutes all the way up to a few days. It can be caused by uterine fibroids, endometriosis and pelvic and bowel adhesions. The diagnosis of chronic pelvic pain helps to differentiate the cause of the pain and allows a treatment plan to develop.
The diagnosis of pelvic pain can be difficult. A thorough pelvic examination is the first step. This requires assessment of the size of the uterus and the ovaries. The mobility of the pelvic organs can check for scar tissue. Also important in the exam is the assessment of the ligaments attaching the uterus, the area between the rectum and the vagina, and the rectal exam.
Ultrasound is a useful tool to evaluate the lining of the uterus, as well as the size of the uterus and the presence of fibroids. It can also detect ovarian cysts and the presence of fluid collections in the pelvis. Other imaging methods can also be used, such as MRI and CT-Scan to evaluate the pelvis. Lab tests such as blood counts are also helpful in the diagnosis of pain.
In the past, myomectomies were performed wither laparoscopically or abdominally. While an abdominal myomectomy has the advantage of more easily removing fibroids that are deep in the uterine wall and discovering left over myomas, the incision is much larger than a laparoscopic myomectomy. In a laparoscopic myomectomy, incisions are smaller but is is difficult to remove those fibroids found in the submucous or deep in the uterine walls.
pelvic pain treatment
Treatment of chronic pain can range from non-surgical options such as Motrin type drugs and birth control pills. GnRh analogs are powerful drugs to suppress hormones and are a temporary option to treat conditions such as fibroids and endometriosis. When conservative options don't treat chronic pain, surgery may be necessary. The best options are minimally invasive surgery in which small incisions are used to enter the pelvis. This allows the introductions of lasers and instruments to treat endometriosis, fibroids, cysts and adhesions.
One of the biggest advances in minimally invasive surgeries is the daVinci Surgical Robot. The daVinci uses 3D/HD camera technology for better visualization of the pelvic anatomy. The instrumentation is "wristed" which allows for better access for excision of fibroids, adhesions and endometriosis.
To find out more about these treatments, check out our navigation bar on the right of this screen.
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