July 2014

I believe that although pelvic pain and pelvic-floor disorders are common, they are not normal. Women should not feel that they have to suffer the consequences of motherhood, surgery or trauma. Women deserve to be listened to, cared for and cured.

 

July 31, 2014

Q:

What are the causes for pelvic pain at night and what can be done for it?

A:

The same causes that can bring about pelvic pain during the day can also affect you at night. This can include musculoskeletal causes of pelvic pain such as pelvic-floor muscle or myofascial pain, which may be caused by the position you sleep in. It could also be painful bladder syndrome, which can be associated with urination at night (nocturia), urinary urgency and frequency.

Ovarian cysts, uterine fibroids, endometriosis and other primary gynecologic problems can occur at night, depending where you are at in your cycle. It is really important that first and foremost you get evaluated by your gynecologist. You should also have regular checkups, including a Pap smear. This will rule out any potential cancerous process as being the cause of your symptoms.

As physicians we will ask lots of questions about other symptoms that you may be having, such as night sweats, weight loss, vaginal bleeding, etc. Once the diagnosis is made, there are numerous treatments that can be done to help you with your nighttime pain. Whether it is physical therapy, hormonal management or using pain medication at night, all of these may be options. Please don’t allow this to continue;  sleep is critical to your overall health. Get in to see your doctor!

July 28, 2014

Q:

How is pelvic pain diagnosed?

A:

Pelvic pain is diagnosed through a careful history taken by the doctor about when and what started your pain, what your pain is like now, what makes it better and worse and what testing and treatment you have already undergone.

A detailed physical examination of the abdomen, the musculoskeletal and neurologic systems as well as  a pelvic exam can diagnose or lead to a more accurate diagnosis. Tests like an MRI, ultrasound or CT scan or even bloodwork may be ordered depending on what is learned from the history and physical examination to make a more definitive diagnosis. Sometimes surgery such as a diagnostic laparoscopy can help make a diagnosis.

We try not to say that your diagnosis is “pelvic pain” but to be more specific. Saying this only tells us where in your body the pain is located, it doesn’t tell us the cause. Pelvic pain diagnoses such as endometriosis, vulvodynia, irritable bowel syndrome, pelvic-floor myofascial pain and bladder pain syndrome better define your pain and provide direction for a more focused treatment plan.

July 21, 2014

Q:

I am a 59-year-old woman and in the past I had a 2 pound tumor removed from my uterus. A few years ago they said I had another one growing. I go for my Pap test every year and I tell them that I get cramps and pain all the time, but they just seem to ignore the situation. What do you suggest I do?

A:

I would suggest getting a second opinion if your symptoms persist. It may be that the pain is coming from something else that deserves further work-up and treatment.

July 17, 2014

Q:

I had a total hysterectomy last May and I’m still having discomfort!! It just seems like everything is loose and not right. I thought I would feel great, but that’s not the case. What is your advice?

A:

My advice is to first let the doctor who operated on you know (if you have not already) that you are having persistent discomfort. Then if you still do not get an answer, I would recommend getting further evaluated by a specialist in physical medicine and rehabilitation (PM&R) like myself. There are many other structures in the pelvis other than the uterus that can be the source of your pain: muscles, nerves, ligaments and joints. It is even possible that the pain is radiating from other areas like the hips or low back. A urogynecologist, a specialist in female pelvic medicine and reconstructive surgery, can also evaluate you and determine if you have pelvic-organ prolapse as a possibility for your feeling of “looseness.” A good pelvic-floor physical therapy rehabilitation program may be all you need.

July 14, 2014

Q:

Why does my pelvis hurt when I walk?

A:

Usually, when activity brings out pain or makes it worse, it is because there is a musculoskeletal (muscle, bone, joint or ligament) problem that is a component of your overall pain. Even in patients with organ-based pelvic pain (like endometriosis), we are diagnosing pelvic-floor muscle problems. The musculoskeletal pain can come from the pelvis, low back and or even the hips and this deserves further evaluation. Specialists in physical medicine and rehabilitation (these fields are also known as PM&R or physiatry) like myself are trained to diagnose these types of problems. Often physical therapy can help with movement-based pain.

July 14, 2014

Q:

I had a partial hysterectomy this past September. My uterus was removed. I thought the pelvic pain would cease, but it only feels worse. I have an appointment the 22nd to see a specialist at the Pelvic Pain Clinic and I can’t wait for some sort of relief.

A:

It is likely that there are other reasons why you have persistent pain, possibly nerve or muscle pain. I am very glad you have an appointment with us at Loyola so we can help you sort this out and start to feel better.

July 11, 2014

Q:

Can having a thickened lining of the uterus cause chronic pelvic pain?

A:

For this answer, we turn to Dr. Linda Yang, a gynecologist who is Dr. Fitzgerald’s colleague in Loyola’s Chronic Pelvic Pain Program. Here is her response:

A thickened uterine lining is more commonly associated with abnormal vaginal bleeding or menstrual period irregularities and typically does not cause pelvic pain. However, other parts of the uterus may be thickened, such as the uterine muscle wall and this finding may occur in women with a condition called adenomyosis. Women with adenomyosis may report painful periods, pain during intercourse or chronic pelvic pain.

July 9, 2014

Q:

I currently have pain in the vaginal area that is like a burning, tingling sensation. It hurts when I sit, apply pressure and bend over, or sometimes for no reason at all. Intercourse is definitely out of the question because the pain level is off the chart. It also only hurts on the left side of the inner thigh, labia and pelvic area. Please help! I’m not sure what else to do. I know it’s not in my head.

A:

I am so sorry to hear about your pain. This deserves further evaluation. It could possibly be nerve pain or pelvic-floor muscle pain. We would definitely like to see you in our Chronic Pelvic Pain clinic. You can call (708) 216-2180 if you would like to schedule an appointment.

July 9, 2014

Q:

I am a patient of a Loyola hepatologist. I have liver cancer and other health conditions. I had a hip replacement in 1999 and four months later had to have it done again. I have had problems with it the last few years, but now I have a hernia about 3 inches by 1 inch in the groin area. It is really painful. I need help with it. Is the timing right to treat this?

A:

If the hernia is painful, you should contact your primary care doctor who can refer you to a general surgeon for further evaluation and imaging. If what you think is hernia pain is on the same side as the hip replacement, I would also recommend that you return to your orthopedic surgeon for X-rays of the hip if that has not been done in the last year.

July 9, 2014

Q:

I have heavy, irregular and painful periods. I had normal results from my ultrasound. However, I know how I feel every month. I feel that something is wrong. Could it be an ovarian cyst or uterine fibroid?

A:

For women with menstrual abnormalities, pelvic imaging studies are necessary to evaluate for structural problems in the uterus and ovaries. Pelvic ultrasound is the study of choice and is very reliable in detecting abnormalities such as an ovarian cyst or a fibroid tumor in the uterus. For women who have had reassuring ultrasound results, like yourself, in which the presence of an ovarian cyst or uterine fibroid has been excluded, it would be helpful to evaluate for other causes of your symptoms. There may be other reasons for your heavy, irregular and painful periods that cannot be detected by ultrasound alone. Your gynecologist can review other testing options to determine the best treatment for your menstrual irregularities.

July 8, 2014

Q:

What is pelvic pain?

A:

Pelvic pain is pain that can occur from the top of your hip bones, also known as iliac crests, extending to the bottom of the buttock muscles. It can include the lower abdomen and the region of the body called the pubis.

July 8, 2014

Q:

What are some of the reasons why women have pelvic pain?

A:

Women can have pelvic pain for many reasons. There is a difference between what we call acute or new pain and chronic pelvic pain. To be chronic, patients have to have pain for more than six months. As doctors, we think about different causes for pelvic pain depending on how long it has been going on. We also try to determine whether the pain is related to your period, an infection, a certain activity or just suddenly comes on without any particular event. Pain can be caused by problems of the internal organs like the uterus, ovaries, bladder or the bowel, but it can also be related to problems with the nerves, the bones, joints, ligaments and/or the pelvic muscles. Problems with the low back and even the hip joints can lead to pain into the pelvic area. This is why as physicians we work together as a team to understand all the possible different causes. There are some diagnoses that are common for women who have chronic pelvic pain. These include: interstitial cystitis or painful bladder syndrome, endometriosis, vulvodynia, irritable bowel syndrome, pudendal neuralgia and pelvic-floor myofascial or muscle pain.

July 5, 2014

Q:

What are the Kegel muscles and what do they have to do with pain?

A:

The Kegel muscles (pronounced like “bagel,” but with a “k”) were first found to be important by Dr. Arnold Kegel, who was a gynecologist practicing more than 50 years ago. These muscles are also known as the pelvic-floor muscles. They attach the front part of the pelvis (the pubis) to the tailbone. They are responsible for making sure there is no bladder (urine) or bowel (stool) leakage. They also help hold up the organs of the pelvis and are the muscles that contract in sex. Recent research has shown that these muscles are also the floor of the core muscles. They have been found to be very important muscles for protecting the low back and bony pelvis during activity. They are skeletal muscles just like any other muscle in your body. And just like any other muscle, they can be a source of pain. As we continue to do more research, we have found that these muscles are often the culprit in pelvic pain after labor and delivery and in chronic pelvic pain. Just like we can rehabilitate other muscles in physical therapy, the pelvic-floor muscles, if they are responsible for pain, can be treated with what is known as pelvic-floor physical therapy. This is a type of physical therapy that involves performing internal examinations to stretch and retrain the muscles. The therapy is done by highly trained (typically female) physical therapists. Loyola has experienced pelvic-floor physical therapists who work closely with our physician team to treat pelvic pain.

July 2, 2014

Q:

Is there anything that can be done about pain in pregnancy or after delivery?

A:

Although pain in pregnancy is common, it is not normal – especially if it stops the patient from working, taking care of her children or performing normal activities. Many women are told to just deal with the pain because it will go away after delivery. In fact, 25 percent of women who have low back or pelvic pain in pregnancy go on to have chronic pelvic pain after delivery. Many women are told by their health-care providers that their pain is either “sciatica” or round-ligament pain. Actually, true problems with the sciatic nerve occur in less than 1 percent of pregnant women. The most common reason for pain in pregnancy is sacroiliac joint and ligament pain. Pain in the front of the pelvis that is often thought to be round-ligament pain can actually be pain of the pubic symphysis joint. There is good research to support that physical therapy and prescribed exercise can help with treating pain in pregnancy and after delivery. We also use ice and sacroiliac joint belts. Currently at Loyola we are doing research to understand what type of pain medication and even injections could be helpful to patients with pregnancy-related pain.