Table of Contents

Q 23. 1 I have pain in my pelvic area. Is this a common problem?

Pain is the most frequent reason for patients to seek medical advice and pelvic pain is a common reason for gynaecological consultation. Pelvic pain may be acute (sudden onset), chronic (long-standing) or recurrent (intermittent).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 2 What are the common causes of pelvic pain in women?

        The more common causes of lower abdominal and pelvic pain are summarised in Table 23.1. Physical pain may arise from the vagina, cervix, the uterus, the ovaries or the Fallopian tubes (Figure02-01.htm). The pain can also be of  non-gynaecological origin arising from the bowel, bladder or the musculo-skeletal system.

Table 23.1 The more common causes of pelvic pain and lower abdominal pain.

Organ
Disorder / Disease
Question

Number
Vagina
Vaginitis
22.6

Prolapse
30.1
Cervix
Cervicitis
21.3
Uterus
Fibroids
23.14

Intrauterine contraceptive device
17.1

Endometrial polyp
24.6
Fallopian tubes
Ectopic pregnancy
12.23

Pelvic inflammatory disease
20.2
Ovaries
Endometriosis
23.21

Mittelschmerz (Ovulation pain)
13.7

Ovarian cyst
23.8
Peritoneum
Endometriosis
23.21

Pelvic congestion
23.30

Peritonitis
23.9

Retrograde menstruation
23.6
Bowel
Appendicitis

Crohn’s disease
23.35

Constipation
23.43

Diverticulitis
23.35

Gastroenteritis (Acute diarrhoea and vomiting)

Irritable bowel syndrome
23.34

Ulcerative colitis
23.35
Bladder / urinary tract
Renal colic (kidney stones)

Urinary tract infection
29.2
Musculo-skeletal system
Ligament and muscle pain.
23.4
Psychological

03.10
There are times when despite careful investigation, a physical explanation for the pain cannot be found. Sometimes the pain may be psychosomatic (a subconsciously mediated physical manifestation of a mental disorder).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?

– Home Page

Q 23. 3 What are the more common gynaecological causes of pelvic pain?

Dysmenorrhoea (pain associated with menstruation) is the commonest type of gynaecological pelvic pain in young women. Pain may occur at the time of ovum (egg) release about 14 days before the next period is due; this pain is called mid-cycle pain or Mittelschmerz. Cysts (fluid filled sacs) within the ovaries occur frequently and indeed naturally throughout the reproductive years; these may be called physiological or functional cysts. Sometimes, bleeding may occur into a physiological cyst resulting in acute pain. Pelvic pain may be an indication of a problem during early pregnancy (Q12.1; 12.23).

Other gynaecological causes of pelvic pain include pelvic inflammatory disease (Q 20. 2), fibroids (Q 23.14) and endometriosis (Q 23.18). Utero- vaginal prolapse (Q 30.1) may cause a dragging pelvic ache or pain.

References:

Criteria that indicate endometriosis is the cause of chronic pelvic pain (1998 – 3018)

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?

Constipation is probably the commonest cause of pelvic pain. Many patients have irritable bowel syndrome (Q23.34). Typically there is a story of intermittent diarrhoea and constipation.

Infection in the urinary tract (e.g. cystitis) is another common cause of lower abdominal and pelvic pain. If a “mid-stream urine” sample shows evidence of infection, the problem should respond to an appropriate antibiotic.

The musculo-skeletal system (the bones, muscles, tendons and joints) may be the source of pain in the pelvic area.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 5 What are primary and secondary dysmenorrhoea?

Primary dysmenorrhoea is pain starting about the time that the monthly bleeding begins. Secondary dysmenorrhoea begins a few days before the onset of the period. It tends to be associated with disease processes including pelvic inflammatory disease (Q 20.2), fibroids (Q 23.14), pelvic congestion (Q 23.30) and endometriosis (Q 23.18). Typically, primary dysmenorrhoea starts within a few months of the menarche (first period) whereas secondary dysmenorrhoea starts later after the disease process has developed.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 6 What is retrograde menstruation?

Most of the blood shed with the endometrial lining during a period is passed out through the cervix and then the vagina. During a period, if the internal pelvic organs are inspected by a gynaecologist (e.g. laparoscopy – Q 23.24) there is almost invariably a little blood that has tracked up through the Fallopian tubes. This blood may irritate the peritoneum (Q2.4) resulting in pain (peritonism).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 7 How can dysmenorrhoea be treated?

Most teenage girls experience some pain with their periods. It may be distressing for a teenager to discover that womanhood may involve physical pain as well as emotional upheaval. Usually mild analgesics (pain-killers), such as paracetamol, are all that are required. If this proves inadequate, early medical assessment is advisable. Uncomfortable pelvic examination of young teenagers by the doctor can usually be avoided; an ultrasound picture (Q4.9) to check that the womb and ovaries appear healthy can provide reassurance to all concerned. Stronger analgesics (Q24.17D) or mild hormone treatment should be considered. The hormone treatments include progestogens (e.g. Duphaston or Provera – Q24.17B) or perhaps one of the combined oral contraceptive pills (Table 16.1). A positive attitude, encouragement that there are a variety of treatment options and reassurance that the girl can continue with a full and active life, should be emphasised.

A sixteen-year old girl was referred because of debilitating primary dysmenorrhoea and slightly heavy periods. Through the first two consultations, her mother in the presence of her daughter, emphasised her anxieties about endometriosis. The mother had suffered with ‘endometriosis’ for many years eventually requiring hysterectomy (hysterectomy) although not even this provided relief from her pain. Investigation, including ultrasound but not laparoscopy, showed no obvious abnormality. Initially, the mother was reluctant to agree to medical treatment without the laparoscopy (Q23.24) as “we may be missing something”. Eventually, she accepted that the majority of women have some degree of endometriosis and that the combined contraceptive pill may prove effective for minimal endometriosis, retrograde menstruation or unexplained primary dysmenorrhoea. The girl was not in favour of laparoscopy particularly when we explained that the procedure carries a one in a thousand chance of damage necessitating laparotomy. The pill was prescribed and three months later the girl came to the clinic by herself. The pain had vanished with the medication and she was very happy.

Bibliography:-

A levonorgestrel-releasing intrauterine system for the treatment of dysmenorrhea associated with endometriosis: a pilot study. (1999) 3491

The treatment of secondary dysmenorrhoea will depend on the underlying cause (Q 23.5).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 8 What are ovarian cysts?

A cyst is like a balloon filled with fluid. The majority of cysts in the ovary are physiological (natural or functional). As ova (eggs) start to mature they develop in follicular cysts. These generally reach up to 2.5 cms diameter. Occasionally they can reach 4 or 5 cms diameter. The vast majority of small cysts will disappear without treatment. Sometimes these cysts continue to release hormones delaying the onset of the next period. The question of pregnancy then arises. If there is associated pain, the possibility of an ectopic pregnancy (Q12.23) needs to be considered. Modern pregnancy tests are very sensitive and a negative result excludes this diagnosis.

        Endometriosis may result in chocolate filled cysts of the ovaries (Q 23.18). In polycystic ovary syndrome (Q 7. 2) the cysts are small varying from 2-8 mm. They are not cysts that need to be removed and they do not seem to cause pain.

True ovarian cysts may continue to increase in size. Every sort of tissue within an organ has the potential to form a tumour, which can be benign or malignant. As the ovaries contain most tissue types including eggs that have the potential to produce every tissue, there is a greater variety of tumours of the ovaries than for any other organ. With increasing age of the patient there is a greater chance of an ovarian cyst proving to be malignant. When there is concern that an ovarian cyst could be malignant a blood test for a tumour marker (Ca-125) may provide guidance (Q32.25).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 9 How do ovarian cysts cause pain?

Moderate sized cysts may undergo torsion (twisting) and this cuts off their blood supply causing acute pain. Bleeding into an ovarian cyst, even a physiological cyst, can be the cause of pain. A cyst may rupture (burst) releasing blood or fluid that irritates the peritoneum (peritonism – Q23.6). Some of the clinical manifestations of peritonism, notably pain and tenderness may be similar to those found in peritonitis (inflammation of the peritoneum). Peritonitis, which is a dangerous condition, has the additional evidence of infection including an elevated temperature and a high white blood cell count. An endometrioma (a collection of old blood associated with endometriosis – Q 23.18) can be associated with pain, although at times even large collections may be pain free.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 10 How are ovarian cysts diagnosed?

        Ovarian cysts can cause discomfort and occasionally pain in the pelvis or bladder pressure symptoms including increased frequency of micturition (bladder emptying - Q29.9). An ovarian cyst may be recognised during a routine pelvic examination or if it is particularly large it can be felt on examination of the abdomen. The majority of patients referred to me with an ovarian cyst have had the diagnosis made from an ultrasound examination that was requested to investigate pelvic pain. Most of these cysts will prove to be physiological and will resolve without treatment.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 11 How are ovarian cysts treated?

If the cyst is physiological, it will disappear spontaneously within a few weeks or months. If the cyst seems to be simple (no structures within the cyst), it can be drained through a fine needle under ultrasound guidance or at laparoscopy (Q23.24). Larger cysts may need surgical removal.

For young women, the aim of treatment is to be as conservative as possible. When there is acute severe pelvic pain associated with an ovarian cyst in a young woman emergency surgery may be required. The objective is to remove the cyst and conserve the remainder of the ovary. When a woman in her forties or beyond presents with pain associated with an ovarian cyst serious consideration would need to be given to removing both ovaries and the uterus (Q32.33A). Ultrasound examination is required to provide further details of the swelling. Areas of solid tissue associated with the cyst(s) reduce the chance of the cyst being innocent. An exact diagnosis can only be provided by full detailed microscopic assessment (histopathology) of the cyst.

References:

Clinical management of functional ovarian cysts: a prospective and randomized study (2000)

Follow up of women with simple ovarian cysts detected by transvaginal sonography in the Tokyo metropolitan area. (1999 – 2648)

Role of puncture and aspiration in expectant management of simple ovarian cysts: A randomised study (1996-1487).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?

As the womb enlarges, there is often some associated discomfort so there may be nothing wrong. At the other extreme, the pregnancy may have implanted outside the womb (ectopic pregnancy – Q12.23) which can be dangerous. It is, therefore, essential that you seek medical advice.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 13 What is pelvic inflammatory disease and how can it be treated?

Pelvic inflammatory disease and its treatment have been discussed in chapter 20.

References:

Clinical aspects of pelvic inflammatory disease (1997-2069).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 14 What are fibroids?

Fibroids are tumours developing in the muscle of the womb. They are the commonest tumours in women and they are generally benign. The exact cause of fibroids is unknown. They are more common in women of Afro-Caribbean origin. Fibroids tend to grow during reproductive years and to become smaller after the menopause indicating that the sex hormones (oestrogens and progestogen) must be implicated.

Some fibroids distort the cavity of the womb (submucosal Figure 23.1) resulting in menstrual disturbance. Occasionally, these submucous fibroids can be squeezed out to appear at the cervix. Other fibroids migrate to the outer surface of the uterus (subserous) and may press on other pelvic structures such as the bladder. Small fibroids do not generally require treatment although it is probably wise to assess them at intervals to check that they are not growing.

References:

Leiomyomata: Heritability and cytogenetic studies (3298-2001).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 15 I have fibroids. What difficulties might they cause for me?

The majority of fibroids are small and cause no problems. Fibroids may be present in 50% of women so that the fact that they co-exist with a symptom such as pelvic pain does not necessarily prove cause and effect (Q 4.3).

Heavy periods are often associated with fibroids. In one study, 30% of women presenting with heavy periods had fibroids seen on hysteroscopy (Q24.8). There was, however, no difference in the incidence of fibroids in the group with heavy periods and another group who did not have heavy periods. Many women who present with heavy periods are found to have fibroids but proof that the fibroids are the cause of the problem is lacking. There have been very few studies to confirm that removing fibroids reduces heavy periods.

Bleeding between periods (intermenstrual bleeding – IMB) can be related to a submucous fibroid (Figure 23.1).

Pelvic pain, like heavy periods, is a frequent problem and may co-exist with fibroids. They are not usually the cause of pain unless they are being squeezed out through the cervix or they are attached to the outer surface of the uterus and start twisting (torsion). If there is any doubt, it may be helpful to undertake a pelvic examination at the time that the pain is present. On occasion, a fibroid may lose part of its blood supply resulting in degeneration and acute pain. Degeneration of a fibroid is more common during pregnancy but can occur at other times.

Infertility and recurrent miscarriage investigation frequently demonstrate fibroids. It should not be assumed that the fibroids are the cause of the problem.

Bladder symptoms including increased frequency of bladder emptying may be due to large fibroids pressing on the bladder (Q29.9).

Occasionally abdominal enlargement may be the presenting symptom of large fibroids.

The risk of malignant change of a fibroid is extremely small. The figure often quoted is one in a thousand but this is probably derived from examination of fibroids that have been removed and excludes the majority of fibroids that have not been removed. Rapid enlargement of a fibroid could indicate the possibility of malignant change.

References:

The facts about fibroids: Presentation and latest management options.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 16 How are fibroids diagnosed?

The diagnosis depends on the story, clinical findings and investigations. The doctor can usually feel the fibroids when examining the uterus. If they are on the side of the uterus they need to be distinguished from a tumour of the ovary. Ultrasound is helpful in confirming the nature of the swelling. When there is intermenstrual bleeding, hysteroscopy (Q 24. 8) is indicated to see if there is any abnormality within the uterine cavity such as a submucous fibroid or polyp.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 17 How could my fibroids be treated?

In general treatment is only required if there are symptoms. The fact that fibroids are found during routine examination does not generally mean that action is indicated although you may wish to have check ups for reassurance that the fibroids are not enlarging unduly. When there are small fibroids and heavy periods, medical treatment should still be considered before resorting to surgery.

If fibroids become particularly large they may require surgical removal. Gynaecologists generally assess the size of the uterus by comparing it to the size expected during a pregnancy. As an approximate guide, if the uterine size is larger than 16 to 18 weeks size, surgery is probably indicated. In younger women who wish to retain their fertility, the fibroids can be shelled out of the womb (myomectomy). If fertility is not a requisite, hysterectomy (hysterectomy) is likely to be the preferred operation. It has been estimated that once in every hundred myomectomies uncontrollable bleeding occurs and in such circumstances hysterectomy becomes necessary as a life-saving procedure.

GnRH analogues (Q33.16) reduce oestrogen and progesterone levels and they are frequently used to reduce the size of the fibroids pre-operatively. On average, fibroids will be reduced by about a third of their size after three months and perhaps by a half after six months. GnRH analogues can be used by themselves for a maximum of six months as there is a risk of bone thinning (osteoporosis) and the oestrogen protection against arterial disease would also be lost (Q26.23). If myomectomy is not performed the fibroids rapidly return to their pre-treatment size. There has been recent suggestion that GnRH analogues could be continued for more than six months provided oestrogen is replaced in the form of HRT (Q27.27); early studies indicate that the oestrogen replacement does not reduce the benefits of the GnRH on fibroid size. GnRH analogues are expensive, precluding long-term use unless there are exceptional circumstances. When fibroids are associated with heavy periods, GnRH analogues for a few months pre-operatively will provide two advantages: In addition to shrinking the size of the fibroids, they should stop the periods, allowing anaemia to be corrected thus reducing the likely requirement for blood transfusion.

Uterine artery embolisation is a new treatment for fibroids. The uterine arteries provide about 50% of the blood supply to the uterus. A fine catheter is introduced into an artery in the right groin. Poly Vinyl Alcohol particles are placed into the uterine arteries, under x-ray control, with the objective of starving the blood supply to the fibroids. The starved fibroids should then disappear or become smaller. After the procedure there may be pain and for three or four weeks there may be bleeding. Patients usually stay in hospital for a couple of days and may return to work after two weeks.
Success rates of 85% are being achieved. A few patients stop seeing their periods. The main complication of fibroid embolisation is infection requiring hysterectomy in about 1% of cases.

Twenty patients have become pregnant following fibroid embolisation with no obvious problems to date. Deaths from fibroid embolisation (1:2500) are uncommon and appear to be less than for hysterectomy (1:1600). Fibroid embolisation is still undergoing trials to determine its benefits and risks.

References:

Laparoscopic bipolar coagulation of uterine vessels: A new method for treating symptomatic fibroids (2001-3262).

Fibroid embolisation: A technique not without significant complications. (2000) 3224

Uterine artery embolization for symptomatic uterine myomas (2000-3318).

A clinical trial of the effects of tibolone administered with gonadotropin-releasing hormone analogues for the treatment of uterine leiomyomata. (1998 – 2933)

Transcatheter uterine artery embolisation to treat large uterine fibroids. 2531 (1998)

Preliminary experience with uterine artery embolization for uterine fibroids. 1997 – 3002

Preliminary experience with uterine artery embolization for uterine fibroids. 1997 – 3002Outcome of hysteroscopic resection of submucous myomas for infertility (1995-797).

Arterial embolisation to treat uterine myomata (1995-2088).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 18 What is endometriosis?

The lining of the womb is called endometrium; if endometrial-type tissue is found outside the womb it is called endometriosis. Endometriosis is most commonly found in the pelvis notably on the ovaries and behind the uterus (Figure 23.2). It can involve the bowel and urinary tract. The diagnosis is confirmed by direct visualisation usually by laparoscopy (Q23.24). There is a very large spectrum in the severity of endometriosis: It may consist of no more than a few tiny spots or at the other extreme, there may be extensive disease with cysts filled with a chocolate-like material and scar tissue around the pelvis. The chocolate cysts are derived from blood released by the endometriosis at the time of menstruation. Endometriosis is essentially a condition occurring in the pelvis. There are rare occasions when it may occur elsewhere such as in the lung.

There have been numerous classifications to describe the severity of the condition. The American Society for Reproductive Medicine revised the classification in 1997 to take account of the latest observations. A score is obtained according to the number of sites and the size of each deposit. Assessment of the severity of endometriosis using the revised American Fertility Society classification allows a degree of comparison although a study of the laparoscopic videotapes of 20 patients with endometriosis showed considerable variation of scoring between observers and also by the same observer on re-evaluation of the same patient.

                     Staging of Endometriosis

Stage (Severity)
Score
I (Minimal)
1-5
II (Mild)
6-15
III (Moderate)
16-40
IV (Severe)

40

When there is severe endometriosis, there can be little doubt that there is a disease process. The relevance of minimal and mild endometriosis is more often a matter of debate. Some suggest that endometriosis is so commonly found in association with pelvic pain that the possibility of its presence should always be considered. Others are more sceptical as to its significance. At a meeting of the European Society of Human Reproduction and Embryology in 1991, a group of experts concluded that “Endometriosis does not exist; all women have endometriosis.”

There is no way of looking at endometriosis and deciding whether or not it is the cause of symptoms. Ultimately a trial of therapy may seem appropriate. If symptoms respond our goal has been achieved. If symptoms do not respond the assumption must be that cause and effect have been refuted and a different causation must be sought (Q 4. 3). Even when symptoms respond to treatment, this does not necessarily confirm that the endometriosis has been causative; suppression of the menstrual cycle could not only affect the endometriosis but also other conditions that are cyclically related including bowel disturbance as in the irritable bowel syndrome (Q 23.39). The failure of symptoms to respond should be recognised as evidence that the endometriosis is probably not a factor in the pain.

References:

Endometriosis-associated pelvic pain: Evidence for an association between the stage of disease and a history of chronic pelvic pain (1997-1782).

Peritoneal endometriosis and ‘endometriotic’ nodules of the rectovaginal septum are two different entities (1996-1468).

The reproducibility of the revised American Fertility Society classification of endometriosis (1993-1062).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 19 How common is endometriosis?

Endometriosis is a frequent finding. An incidence of 10-25 % of all women having endometriosis is commonly quoted but if the pelvis is carefully scrutinised, the incidence is probably much higher. When there is pelvic pain or infertility an incidence of more than 60% is quoted. Recent observations, however, suggest that endometriosis is present in most if not all women at some stage. Minimal endometriosis is probably a natural process and not a disease. Endometriosis is often found coincidentally in women without symptoms.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 20 What causes endometriosis?

Sex hormones must play a significant role in endometriosis as the condition is not found before the onset of menstruation and is rare after the menopause. Removing the ovaries usually cures endometriosis.

The origin of endometriosis remains an area of debate. No single theory explains all aspects of endometriosis so there is presumably more than one cause. The implantation theory remains the most likely explanation for the majority of occurrences. During a period, although most of the blood is passed out through the vagina, some passes in a retrograde fashion up through the Fallopian tubes and into the peritoneal cavity (Figure 23.2). Some of this blood will contain live endometrial cells, which can implant on to structures around the pelvis. This would explain why the most common sites of endometriosis are the ovaries and the pouch behind the uterus where the fluid will collect as a result of gravity. As a result of effective contraception and reduction of breast feeding, women today experience a ten-fold increase in the number of periods they experience compared to their great-grandmothers. This may explain the increased incidence of endometriosis.

If deposition of live endometrial cells in the peritoneal cavity is a common, monthly occurrence, why do the majority of women have just a few tiny spots of endometriosis at most, whilst others have severe disease? It is likely that there are a variety of mechanisms which can facilitate the development of endometriosis and others that remove endometriotic deposits. The effectiveness of these mechanisms must vary between individuals. It would seem that there is a normal dynamic process so that small endometriotic deposits develop and are then removed by natural processes. The tiny spots of endometriosis so frequently seen at laparoscopy may be a normal event that nature will usually remove without intervention. Some experts now question whether minimal endometriosis is a disease or just a normal biological process.

Studies of twins have shown that there is a genetic predisposition to endometriosis. At one time it was thought that Caucasian women were more susceptible than others but the latest data shows that the only group with a genuine increased incidence is the Japanese.

References:

Endometriosis: Candidate genes (2001-3299).

Phenotypic and functional studies of leukocytes in human endometrium and endometriosis. (1998 – 2606)

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 21 How can my endometriosis be treated?

Medical treatment takes account of the dependence of endometriosis on sex hormones by reducing oestrogen levels or by creating a largely progestogenic or androgenic (Q2.9) environment. It is not yet clear whether treatments designed to reduce menstrual flow exert their benefit by reducing the activity of the endometriotic deposits or by suppressing retrograde menstruation (Q23. 6) and hence deposition of endometrial cells.

• Reducing menstrual flow by the combined oral contraceptive pill or with the LNG-IUS (Q14.26) for example may be beneficial.

• Progestogens (Q33.10) or danazol (Q33.13) can be prescribed daily for several months to suppress the menstrual cycle.

• Endometriosis tends to disappear after the menopause. A relatively new set of drugs called gonadotrophin releasing hormone analogues (GnRH – Q33.16) provide a temporary menopause like state and they have proven value in the treatment of endometriosis. They should usually be used for a maximum of six months at a time as there is concern that prolonged suppression of oestrogens may have an adverse effect on the bones and arteries. In some circumstances it may be appropriate to continue GnRH analogues in combination with add-back HRT therapy (Q27.27).

• Exercise is associated with a reduction of oestrogen and sometimes helps.

It is acceptable to provide a trial of medical treatment for presumed endometriosis without performing a diagnostic laparoscopy first (Q23.24).

Some gynaecologists treat endometriosis by laser during laparoscopy. Studies are currently underway to compare the relative merits of GnRH analogues and laser therapy. Almost invariably, removing the ovaries will cure endometriosis and this may be the operation of choice combined with hysterectomy (hysterectomy) once your family has been completed.

The relationship between endometriosis and pelvic pain is open to debate. It is a common observation that the severity of symptoms and the severity of the endometriosis do not correlate. Some with severe pain have just a few tiny spots of endometriosis whilst others with severe endometriosis may be symptom free. In a series of 33 patients having a second laparoscopy for persistent pelvic pain after laser therapy, more than half had no evidence of residual endometriosis. We should therefore be cautious in assuming that when endometriosis is discovered that it is necessarily the cause of pain. Failure of symptoms to respond to treatment may suggest that the endometriosis is not the cause of the pain rather than that the treatment of the endometriosis is not effective.

References:

Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis (2001-3245).

Long-term use of gonadotropin-releasing hormone analogs and hormone replacement therapy in the management of endometriosis: A randomized trial with a 6-year follow-up (2000-3323).

A gonadotrophin-releasing hormone agonist compared with expectant management after conservative surgery for symptomatic endometriosis. (1999 – 2711)

Low-dose danazol after combined surgical and medical therapy reduces the incidence of pelvic pain in women with moderate and severe endometriosis. (1999 – 2772)

Add-back therapy and gonadotropin-releasing hormone agonists in the treatment of patients with endometriosis: Can a consensus be reached? (1999 – 2560)

Effectiveness of tibolone on hypoestrogenic symptoms induced by goserelin treatment in patients with endometriosis (1997-1617).

Progestins for symptomatic endometriosis: A critical analysis of the evidence (1997-1929).

Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis (1996-1588).

Prognostic application of magnetic resonance imaging in patients with endometriomas treated with gonadotrophin-releasing hormone analogue (1996-1347).

Treatment of endometriosis with the antiprogesterone mifepristone (RU486) (1996-1101).

The need for add-back with gonadotrophin-releasing hormone agonist therapy (1996-1514).

Comparison of the gonadotropin-releasing hormone agonist goserelin acetate alone versus goserelin combined with estrogen-progestogen add-back therapy in the treatment of endometriosis (1995-1085).

Gonadotropin-releasing hormone analogue (goserelin) plus hormone replacement therapy for the treatment of endometriosis: A randomised controlled trial (1995-944).

A multicentre comparative study of gestrinone and danazol in the treatment of endometriosis (1995-656).

Endoscopic versus laparotomy management of endometriomas (1994-403).

Very low dose danazol for relief of endometriosis-associated pelvic pain: a pilot study (1994-392).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 22 How can my doctor determine the cause of my pelvic pain?

A full history, examination and possibly some investigations will be required (Q4.4). The story and examination findings may allow your doctor to make a diagnosis and initiate treatment. Although pain related to the menstrual cycle suggests a gynaecological problem, it is not always the case (Q23.39). Symptoms relating to the bladder or bowel may suggest that the problem is not gynaecological. Frequently, there may be a variety of symptoms and clinical skill is required to determine the more significant symptoms and prioritise investigations.

The more common conditions can often be diagnosed by your general practitioner. Specialist advice is usually sought when there is difficulty establishing a diagnosis, when there has been a poor response to initial treatment, if the pain is particularly severe or if specialist investigations such as laparoscopy (Q23.24) may be required.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 23 What tests might be recommended by my gynaecologist to investigate my pelvic pain?

If there is a suggestion that there may be infection within the genital tract swabs may be sent to the laboratory for culture. Swabs taken from the lower genital tract including the cervix may not be representative of bacterial status higher up the genital tract. Some bacteria (e.g. mycoplasma hominis) are increasingly being recognised as having clinical significance but few laboratories have the facilities to culture them.

A pregnancy test would be appropriate if there is any possibility that you have conceived. Ultrasound (Q4.9) can provide a picture of any swellings in the pelvic organs such as cysts in an ovary or fibroids. Sometimes direct visualisation of the pelvic organs by the gynaecologist (laparoscopy -Q23.24) may be required.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 24 What is laparoscopy?

About thirty years ago, fibre optic technology was introduced. It was found that light could be transmitted along a flexible tube composed of thousands of glass fibres. Fibre optics has revolutionised medical diagnostic options. With fibre optics, it is possible to look into a body cavity with a variety of telescopes with the light source outside the body. Prior to fibre optics, the light would have to be within the body cavity with risks of heat damage to adjacent structures.

For thirty years, gynaecologists have been introducing a thin telescope (laparoscope – Figure 18.1) into the abdomen to visualise the pelvic organs. Under a general anaesthetic, a small cut is made at the lower edge of the umbilicus (navel). A guarded needle is introduced into the abdominal cavity, which is then filled with about three litres of gas (carbon dioxide). The laparoscope can then be passed through and the gynaecologist can observe the womb, ovaries and Fallopian tubes as well as the surrounding areas. Laparoscopy may be indicated for persistent pain and also at times in the assessment of sudden (acute) pelvic pain. Sometimes minor surgery can be undertaken with the laparoscope (minimally invasive surgery – Figure 18.1).

Although we now have a wealth of experience with laparoscopy, the investigation should not be undertaken lightly; as with any operation there can occasionally be complications (Q 4.21) with damage to internal structures (about 1 in a thousand). Occasionally the gas is inadvertently introduced into the abdominal wall and the procedure may have to be abandoned or the surgeon may decide that a mini-laparotomy is required.

When laparoscopy was introduced around 1970, research showed that it frequently changed the provisional diagnosis. Since that time new investigation options, such as ultrasound and sensitive pregnancy tests, have increased our ability to evaluate the pelvis and exclude problems such as an ectopic pregnancy. These have decreased the need for laparoscopy.

A 1978 survey of laparoscopy found that 52% of laparoscopies were to investigate pelvic pain. Another study found that 86% of laparoscopies for pelvic pain revealed no abnormality.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 25 What are pelvic adhesions?

When there is any form of inflammation, there is a natural response to form scar tissue. This scar tissue is designed to fill in any gaps and to leave the damaged area as small as possible. When the skin is damaged either as a result of surgery or injury such as a burn, the resulting scar tissue is obvious. The same process may occur internally when there has been infection (Q20.2), endometriosis (Q23.18) or surgery in the pelvis. Adhesions are areas of scar tissue that stick one structure to another. The ovaries, for example, should normally be reasonably mobile but they may adhere to the back of the uterus, to the pelvic side wall or to the bowel.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?

Adhesions can sometimes be a cause of pelvic pain. If you have a history of surgery, pelvic infection or endometriosis pelvic adhesions are common late sequelae. The problem is that adhesions may be present but they are not necessarily the cause of the pelvic pain. Surgical division of the adhesions may, therefore, sometimes alleviate the pain but no guarantee can be given. Furthermore, even with minimally invasive surgery (Q 4.24), further adhesions may develop following adhesiolysis (surgical division of adhesions).

References:

Adhesions and chronic pelvic pain: A review. (1995 – 2896)

A randomized clinical trial on the benefit of adhesiolysis in patients with intraperitoneal adhesions and chronic pelvic pain (1992-591).

Q 23. 27 Does a retroverted uterus cause symptoms?

A retroverted uterus is a common finding and only rarely does this uterine position result in symptoms. Sometimes the uterus is retroverted because of other abnormality in the pelvis such as endometriosis. The symptoms, such as pelvic pain, are due to the other condition and not the retroversion.

Q 23. 28 Does a retroverted uterus cause symptoms?

A retroverted uterus is a common finding and only rarely does this uterine position result in symptoms. Sometimes the uterus is retroverted because of other abnormality in the pelvis such as endometriosis. The symptoms, such as pelvic pain, are due to the other condition and not the retroversion.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 29 How is a retroverted uterus treated?

At one time operations designed to antevert the retroverted uterus (ventrosuspension) were frequently undertaken in the belief that this could cure virtually every gynaecological symptom including infertility, menstrual disturbance, pelvic pain and backache. Scientific validation of the benefits of such surgery were not undertaken. Nowadays, surgery to antevert the uterus is rarely performed. When symptoms develop relatively late in the reproductive years they are more likely to result from disease processes such as endometriosis, fibroids or prolapse.

It is generally considered prudent to introduce a “Hodge” vaginal pessary as a test (Figure 23.4). This pessary is designed to temporarily keep the uterus in an anteverted position. If the symptoms resolve with the pessary and return when the pessary is removed there would be some evidence that surgery may be beneficial. There are several operations to antevert the uterus. They tend to shorten the round ligaments; these are attached to the top corners of the uterus and reach the pelvic side wall. The ligaments may be stitched to the ligamentous tissue at the front of the abdominal wall. These operations are relatively simple to perform but as with any operation, they are not without potential complication (Q 4.22).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 30 What is pelvic congestion?

Pelvic congestion is characterised by dilated veins around the pelvis that may be diagnosed at ultrasound or laparoscopy. The dilated veins may be related in some way to varicose veins more usually seen in the legs. Pelvic congestion can be associated with pelvic conditions such as infection.

Pelvic congestion may respond to medroxyprogesterone acetate administered continuously over six months at a dose sufficient to prevent menstruation.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?

Dyspareunia is a very distressing problem, which may have dire effects on a relationship. Two types of dyspareunia relating to their site are recognised.

• Superficial dyspareunia is pain around the entrance to the vagina.

Superficial dyspareunia may be due to vulval problems (Q 31.1), vestibulitis (Q 31.13) or vaginal problems such as vaginitis (Q 22.6). Another possible cause is vaginismus where there is tension or spasm of the muscles around the vaginal entrance. The spasm may be such that the couple believe that there is an obstruction requiring surgical correction. Sometimes there is deeper pain and vaginismus is a protective mechanism. More frequently there is no disease but a functional problem due to an earlier sexual encounter, fear of pregnancy or inadequate arousal.

• Deep dyspareunia is pain deep inside the vagina and pelvis.

Endometriosis (Q 23.18) and pelvic inflammatory disease (Q 20.2) may produce deep dyspareunia. Local inflammation within the womb (endometritis) may be due to an intrauterine contraceptive device or infection after childbirth or a miscarriage. The womb is tender to touch. Ovarian cysts (Q 23.8) and ectopic pregnancy (Q12.23) can present with pain at intercourse. When ovaries are conserved at hysterectomy (hysterectomy), they may become stuck in adhesions near the vault of the vagina resulting in dyspareunia.

Deep dyspareunia may not necessarily be related to gynaecological problems. The urethra and bladder are close to the front wall of the vagina and the rectum, lower colon and small bowel are behind. Disease in these organs, including irritable bowel syndrome (Q 23.34), may cause pain during intercourse. Bowel symptoms together with dyspareunia may alert the clinician to this diagnosis.

The majority of women presenting with deep dyspareunia and pelvic pain will have no detectable disease. During sexual arousal (foreplay) the inner two thirds of the vagina expands and the uterus, ovaries and Fallopian tubes are lifted up. If arousal is not complete deep penetration can cause pain.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 32 How can dyspareunia be treated?

Dyspareunia may result in apareunia (love-making has stopped – or never commenced) and relationships may be put in jeopardy. Dyspareunia and reduced libido are about the most sensitive of symptoms that a woman may experience and support and understanding are essential. If a psychological or marital problem is suspected an appropriate counsellor or psychiatrist may be required to provide support. The story, examination findings and appropriate investigations will indicate the underlying cause of the problem. When a specific cause is found appropriate treatment can be instituted.

Sometimes pelvic congestion may occur if there has been a high degree of arousal but not orgasm. Lubricants, such as KY jelly may help when natural lubrication is inadequate.

Local trauma (physical damage) either arising childbirth or from injudicious sexual activity will usually heal with time. Sometimes healing tissue (granulation) may require cauterisation with a silver nitrate stick in the clinic (this is not painful). Infections such as a folliculitis (“a boil”), candida (Q 22. 6) or trichomonas (Q 22.6) will respond to appropriate medication. Superficial dyspareunia may be the first sign of infection of the Bartholin’s duct (Q 31. 9).

Frequently, there is a feeling that the vagina is too small. Gentle clinical examination should be able to distinguish whether there is a physical problem. When examination shows no physical problem, vaginal dilators (sometimes called trainers) are often successful. These come in six sizes. The smallest dilator (No.1) is gently introduced and the woman taught to remove it and re-introduce it for herself. She can then use it at home for ten or fifteen minutes twice daily. When she can use the smallest trainer without difficulty she can move up to the next size. Encouragement, reassurance and frequent review may be required initially. Occasionally surgical correction may be indicated if the vaginal introitus is small or if the difficulties are not overcome by the dilators. The operation most commonly employed is a Fenton’s procedure. A small incision is introduced in the direction of the vagina at the introitus. The incision is closed horizontally to increase the vaginal diameter.

References:

Amielle vaginal trainers – A patient evaluation. (1998 – 2521)

Vaginal dilator therapy – An outpatient gynaecological option in the management of dyspareunia. (2000 – 3153)

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 33 What is a pelvic mass?

A mass is medical term for a swelling. It is a non-specific term, applied to a swelling found during physical examination or during the course of investigation including ultrasound and radiology (x-ray). The mass may be due to inflammation, (e.g. an abscess) or a tumour, which can be benign (e.g. a fibroid) or malignant. On occasion, the mass may be present from birth but is first observed later in life. The kidneys, for example, normally develop as a pair, one on either side in the area of the loins but one kidney may develop in the pelvis (pelvic kidney).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 34 What is irritable bowel syndrome?

Irritable bowel syndrome (IBS) is the most common condition to affect the bowel. It is the bowel function that is abnormal as there is no structural abnormality. There have been a variety of names including spastic constipation, chronic irritable bowel syndrome, spastic colon, spastic colitis and mucous colitis. There is a spectrum of severity ranging from very minimal symptoms to distressing discomfort and pain. IBS may last a few years then disappear by itself.

When food is swallowed, it passes down to the stomach. Here it becomes a fluid that passes through to the small intestine where most of the nutrients are absorbed. The remaining waste products are collected in the colon and rectum, which is emptied during defaecation.

The intestine is a smooth muscle tube with a special inner lining facilitating nutrient absorption. The normal bowel propels its contents along by orderly, smooth-muscle contraction waves called peristalsis. When peristalsis is irregular, the patient may experience discomfort or pain, intermittent diarrhoea and constipation, bloating and flatulence (wind) and these are the typical symptoms of IBS.

Q 23. 35 How can we find out if I have irritable bowel syndrome (IBS)?

Until the last few years, the diagnosis of irritable bowel syndrome was made only after full and extensive investigations showing no structural abnormality. Nowadays, full investigations are only required if there is doubt about the diagnosis from the clinical presentation. Typically, there must be more than three months of recurring or continuous abdominal pain or discomfort that is usually relieved after a bowel action (defaecation). The pain may be mild and infrequent or so severe that there is accompanying sweating or faintness. No single symptom is unique to IBS. There may be a change in frequency of bowel action or change in stool consistency. Abdominal bloating or distension and passing mucus on the stool are also common.

All of the symptoms of IBS can occur with other bowel diseases and disorders and it is, therefore, important that the diagnosis should be made by a doctor. Examples of chronic bowel inflammatory diseases that could cause pain include Crohn’s disease, ulcerative colitis and diverticulitis. Tumours of the bowel become more common as we get older so that an important consideration in deciding how far to investigate the symptoms is your age.

Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?

Surveys indicate that at any one time 15% of the adult population are affected by IBS. It is an intermittent disorder and most people are affected by it at some time in their lives. Although 15% of the population will have had symptoms bad enough to require consultation, the majority of those with IBS never consult their doctor. Women report symptoms twice as often as men. Symptoms may start from the age of fifteen although the diagnosis is most frequently made between the ages of 30 and 40. The disorder can occur in childhood and in older age groups. IBS seems to be the most common disorder encountered by gastrointestinal specialists. Over the age of 40 – 45 years there is an increased chance that symptoms compatible with IBS may be due to other and more serious diseases of the bowel and more active investigation is usually required.

Q 23. 37 What causes IBS?

IBS is considered to be a functional disorder. A functional disorder has no known anatomical (structural) or physiological (the way organs work) cause. It seems that there is a disorder of bowel motility. At times, this activity is increased leading to diarrhoea and at other times it is reduced leading to constipation. Some patients trace the origin of their problem to an episode of gastroenteritis (sickness and diarrhoea/food poisoning). The bowel is sensitive to emotional states including anger and anxiety.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 38 What is the pain associated with IBS like?

The pain seems to be associated partly with the intermittent increased bowel activity (peristalsis) and at other times with constipation. The pain with the peristalsis is colicky – it comes and goes in waves. It may be felt anywhere in the abdomen. There may also be a more constant pain associated with distension of the lowest part of the colon, which is in the left lower quadrant of the abdomen, just before the faeces enter the rectum. There may be pain in the right lower quadrant where the contents from the small intestine enter the large intestine (caecum).

Sometimes there may be associated headaches or migraine. One variety of IBS is called abdominal migraine. Fatigue is a frequent problem in IBS sufferers.

Q 23. 39 Can IBS be mistaken for gynaecological problems?

A study in South Manchester in 1989 found that 52% of women presenting to a gynaecological clinic with pelvic pain had symptoms suggestive of irritable bowel syndrome. Only 8% of those with symptoms suggestive of IBS had a proven gynaecological disorder. One cause of pain associated with intercourse (dyspareunia) is IBS.

There may be a relationship between hysterectomy and IBS. A study in Sheffield found that 22% of women had symptoms of IBS before surgery (this is no different from the general population). Following hysterectomy (hysterectomy), 60% of those with IBS symptoms had improved or were symptom free.

The bowel is sensitive to progesterone, which is secreted from the ovary after egg release during the second half of the menstrual cycle (luteal phase – Q2.13). Progesterone levels increase in pregnancy and this plays a part in the sluggishness of the bowel. Many women are aware of a change in bowel habit during the second half of the menstrual cycle or during their periods. Some studies, but not all, confirm that during the luteal phase the transit time for food to pass through the bowel increases leading to abdominal distension and constipation.

 A 45 year old secretary was referred for treatment of pelvic pain before her periods. At laparoscopy the pelvic organs appeared perfectly healthy. It became apparent that her bowels became sluggish before her periods. Regulan (Q23.40) was commenced before her periods and her pain improved quickly.

A nineteen year old young lady was referred to me for a third opinion and for hysterectomy! She had chronic pelvic pain which was very severe around the time of her periods. When I saw her on the first occasion she was accompanied by her family who stressed the devastating pain that she was experiencing and that the only humane option was for me to remove her womb.

At the age of seventeen she had a laparoscopy and was found to have spots of endometriosis. The endometriosis had been treated by laser, danazol and the pill and she had also received antibioitics. None of these treatments had any effect on her pain. When we reviewed the story, it became apparent that she was having increased frequency of bowel actions at the time of her periods and she had pain on opening her bowel.

Whilst we felt every sympathy for this young lady’s pain, we felt that other avenues to hysterectomy should be persued. Colpermin and Regulan were prescribed to be taken as required and particularly from a few days before menstruation and continued through the period. When she attended for her first review, the problem had resolved. Clearly the pain had been from her bowel which is sensitive to the hormone changes that occur around the time of menstruation.

References:

Daily gastrointestinal symptoms in women with and without a diagnosis of IBS (1995-1992).

Does the menstrual cycle affect anorectal physiology? (1994-1995).

Irritable bowel syndrome in the gynecological clinic. Survey of 798 new referrals (1989-1985).

Gynaecological consultation in patients with the irritable bowel syndrome (1989-1986).

Bowel function and transit rate during the menstrual cycle (1989-1994).

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 40 How can my IBS be managed?

Firstly, the diagnosis may provide reassurance that there is no other serious problem. There is no single treatment that will cure all symptoms or all patients. Treatment will depend on your symptoms. Correction of a poor quality diet may resolve IBS particularly when the diet is lacking in fibre. Excess caffeine and alcohol should be removed from your diet. You may be aware that certain foods exacerbate your symptoms and these should be avoided.

Codeine phosphate is a moderately strong painkiller that has a role in the management of diarrhoea. It may have a place occasionally when diarrhoea predominates in IBS.

Anti-spasmodic agents reduce the smooth muscle activity of the bowel; they are usually taken before meals. Mebeverine (Colofac MR®– Solvay) one tablet three times daily, and peppermint oil (Colpermin® – Pharmacia & Upjohn) one or two capsules three times daily are well tried preparations. Kolanticon® (Peckforton) has the antispasmodic dicyclomine in combination with the antacid, aluminium hydroxide, and dimethicone, an antiflatulent; 2 to 4 teaspoonfuls four hourly is the recommended dose.

There have been suggestions that Candida (thrush) may be a factor in IBS. Scientific studies, however, have not shown any consistent relationship between Candida and IBS so that dietary measures to reduce Candida seem to be without foundation.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 41 What other treatments are available for IBS?

Certain foods may appear to trigger IBS symptoms; it may be worthwhile excluding individual foods on a trial basis to see if this helps. Some find that they are particularly sensitive to caffeine and sorbitol and symptoms abate when these are withdrawn from the diet. Some people have lactose intolerance; lactose is found in milk and other dairy products. Others may be intolerant of gluten, which is found in wheat, rye, barely and oats. If there is a suspicion that there may be a food intolerance, the suspected item can be removed from the diet for about ten days. A doctor or dietician should be consulted to ensure that appropriate measures are undertaken.

        Between 40 and 60% of patients suffering from IBS have psychological disturbance. A change in lifestyle with reduction of stress may prove beneficial. Stress management is worthy of consideration – there are many books on this subject. Hypnotherapy and psychotherapy may have a place. In some circumstances agents such as antidepressants may be considered. The tricyclic antidepressant imipramine reduces bowel activity and may be helpful when diarrhoea is the significant problem. The serotonin reuptake inhibitors (Q25.5) increase bowel muscle activity and may be preferable if constipation is a feature.

Q 23. 42 What can be done to reduce the amount of bowel gas (flatulence)?

Eating slowly may reduce the amount of gas swallowed. Fizzy drinks are rich in gas and can contribute to flatulence. Some foods tend to increase gas production. These include beans, milk and wheat germ. Some fruits and vegetables may increase flatulence including bananas, apricots, raisins, celery, carrots, cabbage, and broccoli. Herbal teas are thought to be beneficial. Charcoal, which can be purchased from health food shops as tablets or biscuits, will absorb some of the gas. Medicines containing dimethicone or simethicone may also be considered. Examples are Asilone (SSL) and Maalox Plus Suspension (Rhone.Poulenc.Rorer).

Q 23. 43 What is medically regarded to be constipation?

There is a wide variety of bowel action that can be regarded as normal. If a bowel action is occurring at less than three day intervals this is regarded as constipation. There should be no need to strain to empty the bowel – straining suggests constipation. Chronic constipation may be associated with haemorrhoids (piles) and prolapse of the rectum. The hard stools may tear the lining of the anus resulting in bleeding and fissures (splits).

Q 23. 44 What causes constipation?

A number of factors can result in constipation including:

• inadequate fluid intake

• inadequate fibre intake

• weight reducing diets

• poor abdominal muscle tone

• poor toilet habits (not answering the call to stool) or not allowing the bowel time to work

• progesterone (Q23.39) premenstrually and in pregnancy

• anal pain due to haemorrhoids or fissure

• underactive thyroid gland (hypothyroidism)

• high levels of calcium (hypercalcaemia)

• bowel obstruction due to adhesions (scars around the bowel) or a tumour

• medications including:

  1. iron preparations
  2. pain killers e.g. codeine containing tablets
  3. tricycyclic antidepressants
  4. steroids
  5. aluminium containing antacids
  6. progestogens

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 45 How can constipation be treated?

Simple measures, such as increasing fluid and fibre intake, may be sufficient. Fibre helps digestion by increasing the amount of water in the bowel content. One gram of fibre will increase the motion weight by 5grams because of the additional water that is retained. The lubrication within the bowel is improved and the peristalsis of the bowel is more effective in moving the contents along. There are two types of fibre: Soluble fibre is broken down in the large bowel whereas insoluble fibre is passed out in the stools. Soluble fibre is found in figs, apricots, tomatoes, oats, barely and rye. Insoluble fibre is found in wheat, rice, pasta, lettuce, spinach, peas, lentils, strawberries and rhubarb. Cereals, particularly bran, are rich in fibre. Soluble fibre has an important role in the stomach and upper intestine. It slows down digestion and absorption allowing the body to deal with nutrients at a relatively steady rate. Insoluble fibre is more important in the large bowel as it bulks up the stool and assists with excretion.

If a healthy diet does not overcome constipation problems, laxatives may be considered. There are laxatives that increase the bulk of the stool, soften the stool or stimulate the bowel action. Bowel stimulants may increase IBS pain. With time, laxatives may become less effective so that stronger agents may be required. It is, therefore, recommended that they be used only when necessary and that every effort to control the bowel by dietary means be explored. Bulking agents may relieve constipation. Fibre supplements such as a tablespoon of natural bran two or three times a day may be adequate. Ispaghula (Fybogel – Reckitt and Colman; Regulan – Procter and Gamble) are fibre supplements; one or two sachets in water each day is the usual dosage. Lactulose (Duphalac – Solvay) 2 or 3 teaspoonfuls once or twice daily is an osmotic laxative, which increases the fluid in the stool; this is a relatively gentle first choice agent. Bulking agents may relieve symptoms when there is either diarrhoea or constipation. It takes a while for these to help establish a normal bowel pattern so you should not give up too quickly.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?

Ideally we would wish to determine the cause of your pain and provide the specific remedy particularly if the pain is of recent onset. Chronic pain also involves attempting to provide specific treatment for the underlying cause but we also need to consider analgesics (pain killers – Q24.17D) and very occasionally low-dose antidepressants (Q31.12)

Q 23. 47 Where can I obtain more information?

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Q 23. 48 Could I have some useful Web sites?

Evaluation of the quality of Web sites is discussed in Q4.27. You may find that several general women’s health sites may help you (Q4.28). The following are more specialised Web sites on topics found in this chapter.

Q 23. 1 I have pain in my pelvic area. Is this a common problem?
Q 23. 2 What are the common causes of pelvic pain in women?
Q 23. 3 What are the more common gynaecological causes of pelvic pain?
Q 23. 4 What are the more common non-gynaecological causes of pelvic pain?
Q 23. 5 What are primary and secondary dysmenorrhoea – painful periods?
Q 23. 6 What is retrograde menstruation?
Q 23. 7 How can dysmenorrhoea – painful periods -be treated?
Q 23. 8 What are ovarian cysts?
Q 23. 9 How do ovarian cysts cause pain?
Q 23. 10 How are ovarian cysts diagnosed?
Q 23. 11 How are ovarian cysts treated?
Q 23. 12 I think I may be pregnant and I have some pelvic pain. What should I do?
Q 23. 13 What is pelvic inflammatory disease and how can it be treated?
Q 23. 14 What are fibroids?
Q 23. 15 I have fibroids. What difficulties might they cause for me?
Q 23. 16 How are fibroids diagnosed?
Q 23. 17 How could my fibroids be treated?
Q 23. 18 What is endometriosis?
Q 23. 19 How common is endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 20 What causes endometriosis?
Q 23. 21 How can my endometriosis be treated?
Q 23. 22 How can my doctor determine the cause of my pelvic pain?
Q 23. 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
Q 23. 24 What is laparoscopy?
Q 23. 25 What are pelvic adhesions?
Q 23. 26 I have chronic pelvic pain. Could this be related to adhesions?
Q 23. 27 What is uterine retroversion (retroverted uterus)?
Q 23. 28 Does a retroverted uterus cause symptoms?
Q 23. 29 How is a retroverted uterus treated?
Q 23. 30 What is pelvic congestion?
Q 23. 31 What causes pain associated with sexual intercourse (dyspareunia)?
Q 23. 32 How can dyspareunia be treated?
Q 23. 33 What is a pelvic mass?
Q 23. 34 What is irritable bowel syndrome?
Q 23. 35 How can we find out if I have irritable bowel syndrome?
Q 23. 36 Is irritable bowel syndrome (IBS) a common condition?
Q 23. 37 What causes IBS?
Q 23. 38 What is the pain associated with IBS like?
Q 23. 39 Can IBS be mistaken for gynaecological problems?
Q 23. 40 How can my IBS be managed?
Q 23. 41 What other treatments are available for IBS?
Q 23. 42 What can be done to reduce the amount of bowel gas (flatus)?
Q 23. 43 What is constipation?
Q 23. 44 What causes constipation?
Q 23. 45 How can constipation be treated?
Q 23. 46 How could we summarise the treatments that are available for my pelvic pain?
Q 23. 47 Where can I obtain more information?
Q 23. 48 Could I have some useful Web sites?
Women’s Health – Home Page

Leave a Reply

Your email address will not be published. Required fields are marked *