Obstetrics & Gynaecology

Chronic pelvic pain is pain below the belly button and between the hips. It is considered chronic if you have had it for at least 6 months, and it's not related to pregnancy. The type of pain varies from woman to woman. In some women, it is a mild ache that comes and goes. In other cases, the pain is so steady and severe that it affects your lifestyle. Chronic pelvic pain can have various causes. It can be a symptom of another disease, or it can be a condition on its own.

Pelvic pain can be a sign that there might be a problem with one of the reproductive organs in a woman’s pelvic area. It might be a symptom of infection or might arise from pain in the pelvis bone or in non-reproductive internal organs. It can very well be an indication that there might be a problem with one of the reproductive organs in the pelvic area (uterus, ovaries, fallopian tubes, cervix, and vagina).

Symptoms

The pain is usually not localised to one area, and would typically spread across the entire pelvic area. The pelvic pain can be described as the following:

• Severe and steady pain
• Pain that comes and goes (intermittent)
• Dull aching
• Sharp pains or cramping
• Pressure or heaviness deep within your pelvis
• Menstrual cramps and pain
• Unusual vaginal bleeding, spotting or discharge
• Pain during intercourse

Possible causes of pelvic pain in both men and women include:

• Appendicitis
• Bladder disorders (such as urinary tract infections)
• Sexually transmitted diseases
• Kidney infection or kidney stones
• Intestinal disorders
• Nerve conditions (such as pinched nerves of the spine)
• Hernia
• Pelvis disorders (such as tightness and spasm of pelvic muscles)
• Broken pelvic bones
• Psychogenic pain (pain related to stress or psychological traumas from the past)

Possible causes of pelvic pain in women include:

• Ectopic pregnancy
• Miscarriage
• Pelvic inflammatory disease
• Painful bladder syndrome (This condition is associated with recurring pain in your bladder and a frequent need to urinate. You may experience pelvic pain as your bladder fills, which may improve temporarily after you empty your bladder)
• Musculoskeletal problems (conditions affecting your bones, joints and connective tissues — such as fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis) or hernia — can lead to recurring pelvic pain)
• Ovarian cysts or other ovarian disorders
• Fibroids
• Endometriosis
• Cancer (cervix, uterus, or ovaries)

When diagnosing the cause of pelvic pain, we will review the symptoms and medical history. Some diagnostic tools might include:

• Blood and urine tests.
• Pregnancy tests in females of reproductive age.
• Vaginal or penile cultures to check for sexually transmitted diseases such as gonorrhea and chlamydia.
• Abdominal and pelvic X-rays.
• Diagnostic laparoscopy (procedure allowing a direct look at the structures in the pelvis and abdomen).
• Hysteroscopy (procedure to examine the uterus).
• Lower endoscopy such as colonoscopy or sigmoidoscopy (insertion of a lighted tube to examine the inside of the rectum and part or all of the colon).
• Ultrasound (test that uses sound waves to provide images of internal organs).
• CT scan of the abdomen and pelvis (scan that uses X-rays and computers to produce cross-sectional images of the body).

How is pelvic pain treated?

The treatment of pelvic pain varies by what the cause is, how intense the pain is, and the frequency. Sometimes pelvic pain is treated with pain-relief medicines (such as aspirin, ibuprofen, or Tylenol), including antibiotics, if an infection is the source of the pain. If the pain results from a problem with one of the pelvic organs, the treatment might involve surgery or other procedures. Hormone treatments might help in some cases as well. Some women find that the days when they have pelvic pain may coincide with a particular phase of their menstrual cycle and the hormonal changes that control ovulation and menstruation. When this is the case, birth control pills or other hormonal medications may help relieve pelvic pain.

Contact us to find out more about various treatments for pelvic pain.

Menorrhagia is the medical term for menstruation with abnormally heavy or prolonged bleeding. Irregular menstrual bleeding, and pain during periods are also causes for concern.
Some of the common reasons for menorrhagia and irregular periods include:

• Endometriosis
• Pelvic inflammatory disease
• Bleeding disorders (Certain inherited bleeding disorders, such as von Willebrand’s disease prevents blood from clotting properly, and can cause abnormal bleeding)
• Cancer (Cervical cancer and uterine cancer can cause heavy menstrual bleeding)
• Polycystic ovary syndrome (PCOS) (A hormonal disorder that can cause small cysts, or fluid-filled sacs, to develop in the ovaries, causing irregular periods)
• Pregnancy complications (A miscarriage or ectopic pregnancy can cause heavy bleeding)
• Premature ovarian failure: (This occurs when a woman’s ovaries stop working before age 40, leading to irregular periods and possible infertility)
• Uterine fibroids (Noncancerous tumors made up of muscle tissue can grow in the walls of the uterus, the lining inside the uterus (endometrial cavity), or on the outside of the uterus)
• Uterine polyps (Overgrowth of endometrial tissue can form growths called polyps inside the uterus)
• Hormonal imbalances (Can be due to PCOS or is often related to the perimenopausal period when normal cycles in monthly hormones become out of balance)

Signs and symptoms of menorrhagia may include:

• Soaking through one or more sanitary pads or tampons every hour for several consecutive hours
• Needing to use double sanitary protection to control your menstrual flow
• Needing to wake up to change sanitary protection during the night
• Bleeding for longer than a week
• Passing blood clots larger than a quarter
• Restricting daily activities due to heavy menstrual flow
• Symptoms of anemia, such as tiredness, fatigue or shortness of breath

The tests involved in diagnosing heavy bleeding and painful periods include:

• Blood tests to look for signs of iron deficiency, thyroid disorders, or blood-clotting abnormalities
• Ultrasound (Diagnostic tools that look out for any abnormalities)
• Pap smear (Sample of cells from the cervix that are examined under a microscope for infection or changes that can lead to cancer or already are cancerous)
• Endometrial biopsy
• Magnetic resonance imaging (MRI) scans
• Hysteroscopy (Examination of the inside of the uterus using a hysteroscope, a slender, lighted device inserted through the vagina and cervix. This allows direct visualization of the inside of the uterus)

Contact us to find out more about the various surgical and non-surgical treatments for abnormal and painful periods.

The medical term for painful intercourse is dyspareunia, defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Treatments focus on the cause, and can help eliminate or lessen this common problem.

Some common causes of dyspareunia include the lack of foreplay and lubrication. The presence of skin disorders, urinary tract infections, inflammation of the vagina, vaginismus, endometriosis, cystitis, pelvic inflammatory diseases and uterine fibroids are also some of the possible reasons for pain.

Talk to us to find out more about the causes and treatments.

Urinary retention (UR) can be defined as the inability to voluntarily void urine, and categorized as acute UR, chronic UR or incomplete bladder emptying. UR is common in elderly men but symptomatic UR is unusual in women. UR is one of the most prevalent presenting urologic complaints in the emergency department. Typically, it is diagnosed when there is a high post-void residual volume. Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neurologic, or others. The most common cause of urinary retention is benign prostatic hyperplasia (prostate gland enlargement, a common condition in older men, where an enlarged prostate gland causes uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder). UR might also arise from postpartum complications in women.

Reference: https://my.clevelandclinic.org/health/diseases/15427-urinary-retention

“Endo belly” is a term used to describe the uncomfortable, often painful, swelling and abdominal bloating that’s associated with endometriosis. This bloating is often painful and firm to the touch. In fact, some people may describe their endo belly as looking like a pregnant belly.

Endometriosis is a condition in which tissue that’s similar to the lining inside the uterus, called the endometrium, is found outside the uterus where it doesn’t belong.

Research estimates endometriosis affects more than 10 percent of reproductive-aged women. Along with pain, infertility, and heavy menstrual bleeding, endometriosis can also cause gastrointestinal symptoms, such as diarrhea, nausea, constipation and bloating. Endometriosis pain can be severe, interfering with day-to-day activities.

Causes

Endometriosis-related abdominal bloating may result from gastrointestinal issues related to endometriosis as well as issues such as inflammation, cysts, and fibroids.

Endometriosis is a condition in which tissue that’s similar to the lining inside the uterus, called the endometrium, is found outside the uterus where it doesn’t belong. For example, this other tissue may grow on the outer surface of the uterus, the fallopian tubes, or the ovaries. Although the tissue typically resides in the reproductive system, it can also spread to the bowels, bladder, or lining of the abdominal cavity.

Inside the uterus, this tissue normally builds up and sheds each month during the menstrual period. The endometrial-like tissue also builds up and sheds, but it does not have a way to exit the body, causing people with endometriosis to experience gastrointestinal symptoms, such as diarrhea, nausea, constipation and bloating.

Endometriosis can cause abdominal bloating for a number of reasons stemming from:

• Endometrial-like tissue that builds up and causes the abdomen to become inflamed.
• Endometrial-like tissue that covers or enters the ovaries, trapping blood and giving rise to ovarian cysts.
• Digestive issues such as gas and constipation caused by endometriosis.
• Small intestinal bacterial overgrowth and fibroids that are more prone to be present in people with endometriosis.