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Advanced Gynecological Care: Pelvic Pain and You

November 19, 2018 2:00 PM with Dr. Sonia Dutta

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Often times we associate Advanced Gynecological Care with post-pregnancy or after some sort of trauma, but the truth of the matter is young or old, anyone could have the need for that level of care. Sonia Dutta, MD, Obstetrics & Gynecology at NorthShore, will share her expertise and answer your questions about Advanced Gynecological Care. Topics will include - but are not be limited to - pelvic floor therapy, and bladder and bowel incontinence.

Pelvic Pain

 

Ben (Moderator) - 1:59 PM:
Welcome to the Advanced Gynecological Care: Pelvic Pain and You chat. The chat is now open and you can submit questions at any time.

  Jasmine - 2:01 PM:
Hi, I've had pelvic and lower back pain which goes down my legs and affects my feet occasionally, Physio thinks I have 'pelvic instability' but I believe its something more. I had a difficult birth with my son 14 months ago and its stemmed from that - he was delivered with forceps and they had to turn him inside me, I also suffered with SPD in my pregnancy so im concerned that putting me in stirrups aggravated something. Could this be an injury of some sort? What issue is common from this?
Sonia Dutta
Hi Jasmine, The first thing that we worry about when someone says that they have lower back pain that goes down the legs and to the feet is whether or not her sciatic nerve is affected. Often times a simple exam in the office can determine this but at times an MRI/CT of the back may be needed. With regard to your difficult pregnancy and delivery - at times this can lead to a condition known as levator spasm or pelvic floor tension myalgia. In this condition, the muscles of the pelvic floor become very aggravated and can lead to pelvic pain. The typical treatment is pelvic floor physical therapy - often within 3 months of regular treatment with the therapists and performing the prescribed exercises at home can lead to at least a 50% improvement in pain. Hope this information was helpful!

  Dee (Wilmette) - 2:07 PM:
I have been told that I have a growing calcium formation on my bunions (both my feet). Whats' the best process to take the calcium formation out and who is a competent podiatrist to do this procedure ??
Sonia Dutta
Hi Dee, Unfortunately, podiatry and bunions are not my expertise. I know that NorthShore has an excellent podiatry department. You can call 855.929.0100 to make an appointment or check out their website at https://www.northshore.org/orthopaedics/specialties/podiatry/ to learn about their services. Best, Sonia Dutta, MD

  Kat (Arlington Hts) - 2:12 PM:
I suffered a 4th degree tear during childbirth 18 years ago which resulted in a rectovaginal fistula and bowel incontinence. Surgery to repair the fistula 8 months later was about 75% successful but not without lasting psychological effects. What can I expect as I age and lose muscle tone? If I do need additional surgery due to the repair breaking down, what can I expect as far as "less intrusive surgical options"?
Sonia Dutta
Hi Kat, So sorry to hear that you had to go through that - it is understandable that such an event can be traumatic for years afterwards. As you suspected, it is possible that the incontinence can return over time, but it's not a 100% chance. The best thing to do to prevent accidents is to keep your stool consistency normal and bulky. I often advise my patients to take fiber supplementation every with either Fibercon, Benefiber or Metamucil. The other preventative option is pelvic floor physical therapy - we have EXCELLENT physical therapists who can teach you exercises to keep up your pelvic floor muscle tone. With regard to surgery, I truly would not expect that you should need surgery unless your fistula returned (which is unlikely). There are some third line options for treatment of fecal incontinence such as an implantable sacral nerve stimulator or hyaluronic acid injections into the anus - but ideally we would start with stool bulking agents and physical therapy first.

  Jamie - 2:21 PM:
Hello Dr. Dutta, After a vaginal birth with 2nd degree tear, I had urinary incontinence, tailbone bone for 2 months, and was told I have a mild rectocele. I did a course of pelvic floor PT and received a home exercise program. Prior to the birth I enjoyed running; is it OK to return to running? Does a rectocele ever go away completely without surgery? Should I continue doing my exercise program forever? Thank you!
Sonia Dutta
Hi Jamie, You can 100% return to running or any form of exercise that you would like to try/enjoy! We actually encourage all of our postpartum patients to return to their normal activities once they are 6 weeks out from delivery. With regard to your rectocele, to be honest, they never truly go away. Given that you underwent physical therapy and performed the exercises at home, it is very likely that it will stay the same. The chances of it progressing significantly (throughout the course of your life) are about 30%. In terms of your exercise program - it is up to you if you continue them or not. I tend to recommend continuing the exercises for the inevitable future because it will certainly decrease your risk of worsening incontinence or prolapse. Hope that answers your questions!

  Margaret (Glenview, IL) - 2:28 PM:
What are your thoughts about Botox as a treatment for bladder incontinence? Effective? Safe? What other options?
Sonia Dutta
Hi Margaret, In my experience, Botox is definitely a safe and effective procedure in the appropriately selected patient - a man or women with bothersome overactive bladder (with or without incontinence) who has failed medications (due to side effects or lack of efficacy). The biggest complication from Botox is urinary retention, which is where a bladder cannot empty 100% of the way - this happens in up to 5% of women. The other options for overactive bladder include bladder retraining (where you teach your bladder to hold more and more urine over time), pelvic floor physical therapy (where a therapist helps improve pelvic muscle tone and therefore bladder function), medications, percutaneous tibial nerve stimulation (an enhanced form of acupuncture that we perform in the office) and sacral neuromodulation (a type of bladder pacemaker that is implanted into your back).

  Jane (Chicago, IL) - 2:37 PM:
In to mid to late morning I experience the following. Even though I have emptied my bladder, I feel as if I have the urge to urinate. This can continue for several hours. I have seen some improvement by doing kegels. What kind of non-medication treatments are available for this? Would pelvic floor PT help?
Sonia Dutta
Hi Jane, Predictable urgency at certain times of day can happen for a variety of reasons - it is important to make sure that you do not have a low grade infection because treating this with a short course of antibiotics may be all that it takes to make the urgency go away. Sometimes, this can also happen because of coffee consumption in the morning as caffeine is a known bladder irritant. With regard to what are non-medication treatments... you are correct! Pelvic floor physical therapy may be an option! Also, I know that you are looking for non-medication options, but Azo/pyridium (an over the counter medication that turns your urine orange but also functions as a bladder pain medication) may be helpful. If the symptom is due to bladder irritation alone, this medication will likely help significantly.

  Marie (Grayslake, IL) - 2:44 PM:
I have an IUD and while I very rarely get my period, I know when my cycle is. I will get random, shooting pain throughout my whole cycle. It only recently started and I have had my IUD for over 4 years. Is this normal? Should I be concerned?
Sonia Dutta
Hi Marie, With a Mirena IUD, although you are not having periods, your ovaries are still ovulating every month - I imagine that this is what you are aware of every month. Typically, you should not have severe pain with ovulation. If the pain does not resolve with over the counter Tylenol or Motrin/Advil/Ibuprofen, I would suggest that you follow-up with a gynecologist so that we can perform an exam and determine if you need an ultrasound to evaluate your ovaries, uterus and location of the IUD.

  Tonya (Skokie, IL) - 2:49 PM:
I seem to have developed chronic pelvic pain, and I can't think of any sort of trauma that would have caused it. I have an appointment with my Dr. but....what can I expect from this first visit? What kinds of tests will be run to figure out what is causing my pain? Will those tests hurt?
Sonia Dutta
Hi Tonya, Typical first appointments with a gynecologist for evaluation and management of pain include a very detailed history to see what events lead up to you developing pain and what interventions you have already tried up until now. When it comes to the exam, we are all very aware that anything we do can lead to worsening of your pain. We are here to help you, not to cause more distress or I. We generally start with an evaluation of the nerves, pelvic floor muscles and pelvic organs. If at any point any of this causes pain, just let us know because we will either take a break or make modifications as necessary. With regard to necessary tests, depending on your exam, a decision will be made regarding your need for additional interventions such as an ultrasound, CT scan or MRI. Generally, these tests should not cause significant pain.

  Carrie (Chicago, IL) - 2:55 PM:
Should I be taking over-the-counter pain relievers for my pelvic pain?
Sonia Dutta
Hi Carrie, I would definitely start with over-the-counter pain relievers for pelvic pain. One of our first questions is always: "Have you tried Tylenol and/or Motrin/Ibuprofen/Advil?" which is then followed by: "Did they help? If so, how much?"

Ben (Moderator) - 2:58 PM:
That's all the time we have today for questions. Thank you, Dr. Dutta, for your time and expertise!
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