Brooklyn GYN Place

Pelvic Pain

Pelvic pain is localized in the lower part of abdomen and pelvis. In woman pelvic pain results from conditions of the urinary system, the reproductive system or it may even have a musculoskeletal cause.

Depending from its cause, pelvic pain can be:

• Acute – Acute pelvic pain is characterized by a sudden, sharp or brief pain
• Chronic – chronic pain is usually more moderate and it is present over a long period of time

Depending from its source, pelvic pain can also be:

• Consistent
• Intermittent
• Mild
• Moderate
• Severe

Pelvic pain may also be sharp or dull and even radiate to:

• Lower back
• Buttocks
• Thighs

In some cases, pelvic pain occurs only during sexual activity or while urinating.

What causes pelvic pain?

As mentioned before, pelvic pain in woman results from conditions that affect the urinary system, the reproductive system or the musculoskeletal system.

Pelvic pain that results from the reproductive system can be caused from:

• Menstrual cramps – many woman experience menstrual cramps before and during menstrual periods. Menstrual cramps are usually mild to moderate, however in some cases menstrual cramps are severe.
• Ovulation – is the process of producing the egg in the female reproductive system. The pain is usually mild to moderate, while in some cases it can be severe. The ovulation pain in the pelvis occurs in the middle of the menstrual cycle and lasts only a few hours.
• Sexually transmitted diseases – STD like gonorrhea or chlamydia
• Endometriosis – is a condition that affects woman in their reproductive life. It is one of the main causes of infertility among woman. Pelvic pain caused by endometriosis usually occurs around the time of the period or while having sexual intercourse.
• Pelvic inflammatory disease – is the infection of the reproductive system. The bacteria usually get inside the uterus travelling from the vagina and cervix. The signs and symptoms of pelvic inflammatory disease include pelvic and abdominal pain, high fever, vaginal bleeding and vaginal discharge.
• Miscarriage – is the spontaneous loss of pregnancy before the 24th week. Miscarriage usually occurs before the 13thweek and it is characterized by vaginal spotting and vaginal bleeding, abdominal cramps, abdominal pain and pelvic pain.
• Ectopic pregnancy – is the pregnancy outside of the uterus. The symptoms can get worse over the days, or the pain might also have a sudden onset. Vaginal bleeding is also often present.
• Ovarian cysts – are sacs created inside the ovary, which are filled with fluid. Most of the ovarian cysts are benign and do not cause any symptoms. However, in some cases the pain caused by ovarian cysts is severe.
• Ovarian cancer, etc.

Other conditions that cause pelvic pain include:

• Urinary tract infections – is considered the infection of the bladder, urethra, ureters or the kidneys. Pelvic pain is also accompanied by frequent urination, a burning sensation while urinating, a persistent urge to urinate, etc.
• Chronic constipation – occurs when bowel movements are irregular and there is a difficulty with passage of stools. The problem persists for couple of weeks and usually there are less than three bowel movements in a week.
• Appendicitis – is the inflammation of the appendix. Usually the pain starts in the middle of abdomen and travels to the lower right side of the abdomen. Other signs and symptoms of appendicitis include nausea, vomiting, constipation, frequent urination, etc.
• Pelvic floor muscle spasm, etc.

How Is the Cause of Pelvic Pain Determined?

Your Doctor will ask you questions that will help him/her to determine the cause of pelvic pain. Your doctor will also run some tests, like:

• Blood test
• Pregnancy test
• Stool test
• Abdominal and pelvic X-Ray
• Ultrasound of the abdomen and pelvis
• Hysteroscopy
• Lower endoscopy
• CT-Scan

How is pelvic pain treated?

The treatment of pelvic pain depends from its cause. The treatment usually varies from certain medications, including Laparoscopic surgery treatment if necessary.

Source: http://www.brooklyngynplace.com/pelvic-pain-obgyn-physicians-downtown-brooklyn-nyc/

Dr. Amir Marashi, MD

Brooklyn GYN Place

142 Joralemon Street, Suite 4CF

Brooklyn, NY 11201‎

(Brooklyn Heights)

718-624-0604

Finding an endometriosis specialist is crucial to getting proper treatment for the disease. Important to see a well qualified and well-trained minimally invasive GYN surgical specialist who is board-certified and fellowship-trained. Dr. Marashi is an internationally recognized board-certified gynecologist and renowned specialist in minimally invasive laparoscopic endometriosis surgery.

Endometriosis

Endometriosis is a disease that affects women, usually between the age of 25 and 40. Endometriosis is one of the main causes of infertility among woman.

It never appears before puberty and always ends at the time of menopause, due to a lack of ovarian hormones. The incidence of endometriosis is higher in infertile woman, between 25-40 %, while in general population endometriosis has an incidence of 3 – 10 %.

Endometriosis is characterized by the growth of uterine tissue outside of the endometrium. This uterine tissue grows inside of the myometrium or even outside of the uterus.

Internal Endometriosis – When the uterine tissue grows inside of the myometrium it is called Adenomyosis or Internal Endometriosis.

External Endometriosis – When the uterine tissue grows outside of the uterus it is called External Endometriosis. The uterine tissue can be found almost in every part and organ of the body, but it is more common in the ovaries, peritoneum, rectum, intestine, vagina, vulva, bladder, liver, etc.

Until today the real cause of endometriosis is not known. However, there are several theories that try to explain it. The most acceptable theories include:

• Metaplasic theory
• Implantation theory
• Metastatic theory
• Surgical scar implantation
• Immune system disorder

Risk Factors of Endometriosis

• Never giving birth
• Uterine abnormalities
• A history of pelvic infections
• A family history of endometriosis(mother, sister, aunt, etc)

Signs and Symptoms of Endometriosis

• Pelvic pain – severe pain during menstruation, pain in the lower part of the abdomen
• Dyspareunia – pain during sexual intercourse
• Menorrhagia – occasional heavy periods
• Menometrorrhagia – bleeding between periods
• Abdominal pain
• Rectal pain
• Bleeding from anus

However, signs and symptoms depend from the affected part of the body. If, for example the endometrial tissue grows in the nose, the affected woman will have nose bleeding every time she has the menstrual cycle. If the endometrial tissue develops in the bladder, supra pubic pain, blood in the urine and an urge to urinate will be present.

See more about symptoms of endometriosis

If the endometrial tissue develops in the intestines, diarrhea, constipation, blood in the stool and even painful bowl movements will be present.

Four Stages of Endometriosis

• Stage I – minimal, lesions are only superficial and few filmy adhesions are possible.
•  Stage II – mild, deep lesions are present in cavum Douglasi, the extension of the peritoneal cavity between posterior wall of the uterus and rectum.
• Stage III – moderate, presence of endometrioma’s on the ovary and more adhesions.
•  Stage IV – severe, large endometrioma’s, extensive adhesions.
• 

Infertility is the biggest problem of endometriosis. It is well known that endometriosis is one of the main causes of infertility among woman in their reproductive age. Endometriosis affects the fertility by destroying the anatomy of the ovaries and pelvis, affecting the quality of the eggs and the implantation process, by changing the hormonal system, creating multiple adhesions, etc.

How is endometriosis diagnosed?

• Pelvic examination 
• Pelvic ultrasound
• Laparoscopy 
• Magnetic resonance imaging (MRI) 
• Tumor markers CA – 125

Endometriosis is a disease that can’t be cured. However, medical or surgical treatment can help ease the symptoms and even help the woman get pregnant. First a conservative treatment is recommended. If medical treatment results without success then surgical treatment is necessary.

Medical Treatment of Endometriosis:

• NSAID – for the pain
• Hormonal therapy– like hormonal contraceptives and Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, Danazol.

Surgical Treatment of Endometriosis:

• Conservative surgery
• Radical surgery – hysterectomy and the removal of both ovaries (see: Laparoscopic Treatment of Endometriosis)

Assisted reproductive technologies are used in cases when there are difficulties conceiving.

Source: http://www.brooklyngynplace.com/endometriosis-obgyn-physicians-downtown-brooklyn-nyc/

Dr. Amir Marashi, MD

Brooklyn GYN Place

142 Joralemon Street, Suite 4CF

Brooklyn, NY 11201‎

(Brooklyn Heights)

718-624-0604