There are many causes and many types of pelvic pain. Some common and some 'rare' conditions are mentioned below. While some of these conditions are mentioned as 'rare' or 'elusive' (hard to detect), the conditions are neither rare (they occur in up to 30% of patients) and are not 'elusive' since there are several tests to detect some of the causes of pelvic pain.
Pelvic pain, due to infection, happens over a million times a year, in the U.S. Typically called PID (Pelvic inflammatory Disease) or jokingly revised as (Pus In 'Der) since pelvic infections have pus from infection, and unfortunately later will often have scar formation. While the second set of words for PID sounds 'funny' it accurately describes the acute pain (now from the infection and the pressure of the pus) and the pain many women suffer later (from the scar tisue that forms).
The scar tissue can scar up tubes and cause sterility; it can cause a tubal pregnancy, from the same scarring; and it can also wrap scar tissue around other pelvic organs (tubes, ovaries, and the pelvic veins and arteries), and can penetrate into the abdominal organs, and wrap around and strangulate a bowel (without surgery the woman dies). So, when someone has PID there's the short term (immediate) problem, and then the (later) potential for many other symptoms and problems further on down the road.
Pelvic Mass (yes it may be Cancer or...something else)
Fibroids are benign (non-cancerous) tumors which occur in the wall of the Uterus. The only way possible to have Uterine Fibroids is to be deficient, low in, or lacking the hormone Progesterone. The level of progesterone hormone can be quickly and easily checked with a standard blood test. Treatment is available through our office using prescription strength natural progesterone hormone. And no, that tube of 'natural' progesterone you get at the supplement or vitamin shop is not the same. The entire tube of over the counter progesterone is equal to one single dose of prescription stregnth progesterone therapy.
With natural progesterone hormone replacement, the tumor growth slows or halts. However, once a woman is 'low' on progesterone, she'll have problems getting and staying pregnant and will remain 'low' unless she continues the natural supplement. Listen to the name: Pro (in favor of) gest (gestation=pregnancy) one (first in the series of active progesterone hormones). Progesterone prevents the formation of Uterine Fibroids and prevents or slows further growth (which occurs by having unopposed estrogen overgrowth of the tissue of that particular section of the wall of the uterus). Progesterone balances the effects of estrogen. Without balance in hormones, problems occur. That brings us to our next topic.
Endometriosis is growth of endometrial tissue (tissue that normally lines the inside of the uterus) to areas outside of the uterus. Endometrial tissue will bleed each time a woman cycles, which causes pain when the overgrown tissue is outside the uterus.
Often, endometrial tissue is outside the uterus and remains in the area surrounding the pelvic organs (ovaries, tubes, bladder, veins and arteries, tendons and ligaments, and other support structures of the pelvic region). However, endometrial tissue can go anywhere in the body: it can travel to the upper abdomen and cause various cyclic pains anywhere in the belly. It can travel to the chest and cause active bleeding in the lungs. It can travel to the neck, and even to the brain, causing seizures which, again, are cyclic and in rhythm with a woman's menstral cycle. Needless to say, these are horrible problems to have...but there is a simple way to control them.
Using our friendly hormone, Progesterone, we can cause the overgrown and bleeding endometrial tissue to become progressively smaller, and to stop bleeding. Over the years we've treated several hundred women with severe cyclic pelvic pain using natural progesterone, to become pain free! The problem with endometrial tissue overgrowth is the same as the problem with uterine tissue overgrowth: estrogen says 'grow, grow', progesterone says, 'only so much, and if too much, shrink back down'. What a 'nice' and 'pro' active hormone progesterone is for women and for women with these problems!
Perhaps by now, you've figured out: when the body says to produce many cysts, say caused by too much estrogen, (but only a single small cyst should form, rupture and release an egg, if progesterone was present in adequate amounts), then here we have another pelvic problem, brought to many women in pain, due to not having enough progesterone. Remember: estrogen says 'grow, grow', and progesterone says 'only so much'. So when a woman has a golf ball or orange or grapefruit sized ovarian cyst, it's due to too much estrogen and not enough progesterone.
In fact, progesterone will encourage only one cyst to grow, and after a certain small size is reached, it causes that small cyst to rupture and release an 'egg' from inside. That egg is collected and sent down the fallopian tube, so that 'Sammy sperm' can enter that egg and cause the reproduction of the human race! That fertilized egg then implants in the progesterone and estrogen rich endometrial wall (with a great blood supply). Forty weeks later, with enough progesterone, we have a new human! That's another 'neat trick' brought to you by progesterone!
So, when a woman has 'ovarian cysts' she usually is low in progesterone. Again, this is a problem which can be prevented from happening by using prescrition stregnth natural progesterone hrmone!
One very rare bird. Often occurring in women from families who have a history of ovarian cancer, or in women who've had significant radiation exposure or toxic chemical exposure. If suspected, again, a simple blood test called a CA-125 can be performed. If positive, then further work-up for ovarian cancer is performed. The pain associated with ovarian cancer is generally specific to the ovaries, unless the cancer is caught late: then the symptoms could be anywhere. But the history of ovarian pain, earlier, remains.
So why not test 'everyone' with or without symptoms, with the CA-125 lab test? Limited resources exist. Take the test, about $35, run it on about 100,000 women to find the one person with ovarian cancer: doing so would cause us to burn $3.5 million. That's $3.5 million that didn't just show up out of thin air. That's money the insurers have to pay for cancer treatment; or for a heart attack; or for a person in the ICU on a ventillator. Once it's spent, the money is gone gone. Just because we have the ability to perform a test does not mean it should be performed on 'everyone'. Like all tests, the CA-125 lab test should be run because of clinical suspicion, family history, or other valid indications.
This condition is very rare to at any age. The condition of uterine prolapse occurs when the uterus physically falls from it's normally stable site (held in place by a number of ligaments in the pelvic cavity) and falls below this usual stable location and falls outward towards or beyond the vaginal entrance. This condition is easily evaluated and identified on physical exam. While treatments vary, many women opt for hysterectomy, as the condition generally occurs later in life.
Chronic Pelvic Pain: Pelvic Congestion Syndrome
From Johns Hopkins University: about 30% of all women experience chronic pelvic pain during their lifetime. Chronic pelvic pain is defined as 'non-cyclic pain lasting more than 6 months'. This condition, unfortunately, is often called 'elusive' or 'rare': yet with 30% of all women being affected by the condition, it's may things, but it is not rare!
Evaluation and Work-up
A physical exam with pap test is performed, to also include tests for gonorrhea and chlymidia (two common infections causing PID); routine lab tests are performed, to include a CA-125; imaging studies are done using ultrasound, CT, or MRI for cross section evaluation imaging to insure no tumor is present and to evaluate for varicose veins in the pelvic cavity.
If the clinical symptoms of chronic pelvic pain are present, then certain questions follow: Is the pain worse when sitting or standing; are there associated varicose veins in the thigh, buttocks, vaginal or perineal areas? Is the pain point tender near one ovary or the other (lower right and lower left quadrants of the pelvis/belly)? Is there associated back or leg pain? Is there pain with sex or pain after sex that lasts for hours to days in duration? Is there frequent urination? Is there irregular, difficult or painful menstrual cycles? Are the symptoms worse at the end of the day?
Confirming the Diagnosis of Pelvic Congestion Syndrome
As noted above: dilated or varicose veins are identified on either ultrasound, CT, or by MRI. Once identified, this forms the confirmation of the venous congestion (pressure) causing the symptoms.
Pathophysiology (the science behind how this happens)
In order to have normal function, we must have abnormal function, of the body. Several conditions or scenerios can cause varicose veins to form in the pelvis.
So, what's a varicose vein? Veins have one way valves, so that blood, flowing against gravity gets pumped with each beat of the heart, along a blood vessel, held back from falling in the wrong direction (of gravity) by valves. Valves are leaflets of tissue which act like two hinged doors which swing together in the middle (of the blood vessel): these are what stops the blood from collecting and staying at your feet. Pretty neat? Most people have heard about or seen varicose veins in an older person's legs.
Several conditions can cause the blood vessel to become injured, to grow larger than their normal size, and to get a moderate amount of blood 'stuck' in them, causing pain from the pressure on tissue and nerves in that area. These are called varicose veins! As the blood vessel grows abnormally larger, the valves do not grow. Soon the flow of blood fails to progress, and the stuck blood causes a 'congestion' or collection of blood in the area.
One such scenerio is a physical injury or hit to the pelvis. It could be from a baseball bat, a foot, or from a traffic accident. Also, during pregnancy, when there's a massive increase in blood volume (because of the baby), the extra volume will distend (enlarge) some weakened vessel walls.
We see some women develop 'varicose veins' in their legs after they've had a baby. The same exact condition can develop in the blood vessels in the pelvis: this is where the person feels pain in the pelvis, and the pressure on the nerves of the back and legs is nearby. That's how the condition happens and why it happens.
The 'history of treatment' is why the condition was called 'elusive' of 'rare'. Back in the 'dark days' (about 15 or more years ago), there was a medication and a hormone which some doctors claimed 'treated' the condition. Both claims were false; both treatments were failures. If the only treatments are failures, then why diagnose the specific condition- if you can't do much more than provide large doses of pain medication? That's why it was called 'elusive' because the condition 'eluded' or escaped any 'modern' medical treatment (back in the 'dark days').
Fortunately, new treatment has emerged and is 80 to 85% effective in improving or resolving the condition. However, because of WHO does the treatment, very few people have heard of the treatment or have heard of the group of providers who perform the treatment.
Radiologists are famed for reading and intrepreting x-ray, ultrasound, CT and MRI images. In radiology there is a group of providers called 'Interventional Radiologists' (IR's). IR's are the main group of physicians who perform treatments on patients, who while being watched, in real time, (using imaging techniques), are, at the same time, being treated with another radiologic treatment (intervention) to destroy an area of abnormal or damaged tissue.
Such is the case with Pelvic Congestion Syndrome. While being imaged by the IR, the treatment consists of inserting a very small coil into the thrombosed (abnormally enlarged) varicose vein in the pelvic area. A small energy charge is sent through this coil by the IR, and the vessel is destroyed. The body will reabsorb the damaged vessel, and the pain asociated with the varicose (enlarged) vein in the pelvis is gone.
Does this condition describe you or someone you care about? One in three women will have this condition. Our evaluation and work-up provides the best outcome available! Stop by the office for an evaluation, there's no reason to tolerate the pain!