Women's Health

Pelvic pain

09/28/2007

Question:

Two years ago (29 years old), I was having some cramping, pelvic pain-ultrasound revealed small cyst on ovary. Symptoms never really went away, but improved for about 6 months. A little over a year ago I was having Endometriosis- like symptoms (worse before period- worse than normal cramping, lower abdominal and pelvic cramping, incredibly irritated cervix-felt raw, feeling of uti constantly-ovary pain, lower back pain, painful urination. PCP said I was border line for a UTI 3 months in a row.) I was also feeling like my husband was hitting something during penetration.
Went to Gyno. who felt it was most likely Endometriosis and put me on birth control. Tests did not reveal UTI. She also suggested another ultrasound which revealed no cyst, but plenty of puss. My dr. also noticed lumps in my breast. I had a mammogram and then breast sonogram and the lumps were acceptable to the radiologist.
She also had me see a GI for some mucous and blood in stools with constipation and an urologist for the bladder irritations. GI had me keep a food diary- no foods had a great affect (except occasionally coffee and white wine). She gave me Zelnorm for possible IBS (without performing any tests) but after a 6 weeks of it not working, told me to stop taking it and said she felt Endo. was the cause. Urologist checked bladder with Cystocope. She saw a healthy pink bladder with a dent on one side that may have just been the bowel.
As expected, birth control took 3 months to work and pains started to decrease to a tolerable level after that, including some of the constipation and all of the mucous in stole.
Around March, I was taking the BC at different times of the day for a week and then I stopped taking it for two weeks. By April, of course, I had spotting without a period-a normal result of being off the pill- but my doctor did a pap and also found an endometrial polyp (benign) and a saline sonogram showed a cervical polyp. The pain continued to get dramatically worse-all of the old symptoms had returned and then some. But my period was on its routine schedule. I was back on the pill.
Before the surgery, I ended up in the hospital for similar uti symptoms that got more extreme than usual, a very heavy pelvic feeling with standing. The ER felt it was dehydration from a long plane ride and a uti. A ten-day antibiotic did not stop uti symptoms and I asked my doc to do a catheter when she did the D&C scheduled for that week. There was no uti present.
I had the D&C to remove the cervical polyp in June, the day before my period. The pelvic pain (fullness) continued to get worse. My doctor did a post-surgery check-up and found that my uterus was more left than usual. My dr. wanted to put me on Lupron, but I was very hesitant since we didn`t even know that Endometriosis was the problem. I decided to get a second opinion.
I also went to a second GI Specialist so that I could have them run tests, since the first one did not do this. The mucous and some of the constipation had returned. The dr. did a colonoscopy and found a healthy bowel. He biopsied some tissue and found it to be normal.
The second opinion Gyn. doctor said that she could usually feel scars when she did a manual exam on a person with Phase 3 or 4 Endometriosis and that they tend to show the pain more than I did. The dr. pushing up only got a 5 from me on the pain scale and about an 8 when pushing down toward the bowels. She asked me if it was the same exact pain I felt on a daily basis-and it was so sharp, I couldn`t say for sure that it was.
She felt it is a Phase 1 or 2 Endometriosis and suggested that a laparoscopy not be done at this time because it is not as successful on phase 1 or 2 Endo. and she also suggested I go to Physical Therapy for possible Myofascial Pain/ Pelvic Floor disorder or as she felt that might help alleviate the pelvic pressure. She did not notice anything unusual about the position of the uterus. After this appointment, I began having extreme straining with constipation which has continued to this day.
I found that the Physical Therapy centers that deal with these issues do not have evening hours and I needed to wait to have more time in at my job to take any more sick days off so I decided in the meantime, to get another opinion- this time from a urogynocologist. The pain was worse when he did the exam-ranging from 7 to 9. He also suggested that I do the physical therapy as he could feel knots in the pelvis. (I should note that both of these doctors are from the same hospital-different departments.)He felt it was unlikely I had endometriosis at all because it has become a constant pain and he pointed out that Endo. is usually bad before a period. (I have not had my period since the D&C). I asked if any tests should be run and he said since I had a sonogram in April for the polyp, he didn`t feel it was necessary to run more tests.
I am going to do the physical therapy because I know that area is really tense and painful. And I think it would be helpful for some of the pain. I have not had a period since my D&C (it has been 31/2 mos.), although I do have cramps around the time that I should. I am still having the pelvic congestion and pain, cervical irritation, constipation, etc. I also occasionally run small fevers (99-100) after walking up steps or other small activities. (I`ve had to really scale back my physical activities- I used to love backpacking, boating, hiking, and yoga.)I get chills- often from the pelvic area up and overall fatigue- often so that my muscles feel like they just aren`t getting enough oxygen (which one dr. speculated is probably just from being in pain). I get hip pain, which I`ve had from the beginning and sometimes a sharper pain that seems to shoot from the left ovary to the lower back-which just started a few months ago and is not debilitating because it is quick.
I have some questions: Has physical therapy been known to cure all of this or should I see another dr. while going to physical therapy? Also, is it odd that nobody is doing a diagnostic laparoscopy or running any blood work or anything? Can a pelvic floor disorder cause the muscles to tighten up so much that you don`t have your period?

Answer:

Has physical therapy been known to cure all of this or should I see another doctor while going to physical therapy? Not really.

Also, is it odd that nobody is doing a diagnostic laparoscopy or running any blood work or anything? Yes, that is odd.

Can a pelvic floor disorder cause the muscles to tighten up so much that you don`t have your period? Not really.

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Response by:

Glen F. Aukerman, MD
Professor
OSU Center for Integrative Medicine
Department of Family Medicine
College of Medicine
The Ohio State University