Persistent Pain after Excision Surgery – by Nancy Petersen, RN
By Lisa Graham Magnuson on Sunday, November 17, 2013 at 10:23am
Lets talk about persistent pain: Once you have had advanced excision by a specialist, and have persistent pain, there are a number of factors to consider. First in other than speciality hands, persistent pain most often is missed disease. Second, in speciality surgeons hands it can mean new disease, adhesions, pelvic floor dysfunction, painful uterus, IC of the bladder, and or other disorders completely unrelated.
So one has to go about sorting out what is going on. Diagnositic studies of bladder and bowel can be helpful in ruling out disorders of those organs, however endo of the bowel rarely shows up on diagnostic studies. So normal studies may not eliminate endo but will eliminate (usually) other disorders. Pelvic floor evaluation by a womens health certified pt can be helpful in finding issues taht may be related to muscle spasm, hip disorders, even unequal leg length which can lead to hip and back pain, painful sex. Pelvic floor pt can be very helpful in addressing these issues. Sometimes vaginal muscle relaxers are worth a try, and sometimes specialists will do botox or other injections to ease discomfort with these issues.
Uterine ultrasounds can help in identifying adenomyosis of the uterus which can be a big factor in pelvic pain and or heavy bleeding. Some GYN’s have found that they are more likely to find adenomyosis if they do the ultrasounds themselves. If adenomyosis is an issue, then discussion of management can follow. This will sometimes entail suppressive (hormone) therapy to stop periods until a pregnancy is desired, or until menopause, or until such time as a hysterectomy seems appropriate. (saving ovaries if at all possible because long term estrogen replacement for bone and heart health are fraught with issues, and may not be protective and may increase risks of cancer).
I say after ruling out other possibilities, if you have had excision with a specialist and still have or develop new symptoms that seem like endo, go back to that specialist. A re-look laparoscopy would seem like a good idea. And who better to look that a doctor who has been there before, has advanced endo skills and compassion for pelvic pain? Second opinions are always a possibility, but if you have a good surgeon to start with who is listening and compassionate, then I would encourage a second look with that doctor.
Stay focused on what you have to do for yourself to get the best outcome