PATIENT FACT SHEET

Managing Pelvic Pain

This fact sheet was developed in collaboration with The Society of Reproductive Surgeons

Many women have pain in their pelvis (lower part of the belly) from time to time, usually during their period. How-
ever, if you have daily pelvic pain, it could be a sign of a bigger problem with your bladder, bowels, reproductive organs, or pelvic muscles. Many conditions cause pelvic pain, including endometriosis, adhesions, chronic appendicitis, or hernias.
Sometimes medication is necessary to treat the problem; other times surgery is needed. Your doctor will evaluate you to determine the problem and what kind of treatment may be of benefit.

EvaluationYour doctor will ask you whether it is painful for you to go to the bathroom, walk, sit, climb stairs, or drive a car. If
you have pain during these activities, your problems may be in your bladder, bowels, or the muscles of your pelvis, hips, or lower back. Your doctor will press on these muscle areas to determine exactly where the pain is orginating. Problems such as endometriosis can cause pain because there may be tissue from the endometriosis on different organs within and outside of the pelvic cavity, which includes the ovaries, bladder, behind the uterus, and bowel. Some doctors may suspect these problems during a pelvic exam.

Conservative treatment
Conservative treatment means treatment without perform- ing surgery. Your doctor may first try to treat your pelvic pain with birth control pills and/or non-narcotic pain med- ications. If these options do not work, you may be given medications that take away the estrogen in your body, therefore placing you in a short-term, menopause-like state. Decreasing the estrogen in your body will decrease the endometriosis implants and pain.

Diagnostic laparoscopy:

Finding out what is wrong Laparoscopy is a type of surgery that is performed with a telescope that is attached to a camera (laparoscope). The laparoscope is inserted into one to four small incisions in your belly. During a laparoscopic surgery, your doctor will be able to view your pelvic organs to see if they, or any other conditions, are contributing to your pain. Some of the conditions your doctor may find are endometriosis, adhe- sions (scar tissue), appendicitis (infection of the appendix), or a hernia. Sometimes, even finding out that everything is normal can be helpful in choosing further treatment.
The two most common problems that can be treated with a laparoscopy are endometriosis and pelvic adhesions:

Endometriosis:

Endometriosis can cause daily pelvic pain, painful periods, and pain during bowel movements or sex. Having endometriosis can also make it harder for you to get pregnant. At the time of your laparoscopy, your doctor will attempt to remove the endometrial tissue that is seen with an electric current or laser. Treatment will help to decrease or eliminate your symptoms and may make it easier for you to become pregnant.

Pelvic adhesions (scar tissue): Adhesions in and around the pelvic cavity may form if you have endometriosis, a pelvic infection, surgery on your pelvis, a cyst on an ovary, or have had surgery on your pelvis. Scar tissue causes organs that normally are separate from each other to become attached. For example, your ovary can be attached to your bowel, and your doctor will separate the adhesions with laparoscopic scissors to help relieve pain. This seems to work best when the adhesions are not too severe.

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