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Don’t Get Defeated by Discomfort: Chronic Pelvic Pain

March 17, 2017 10:00 AM with Dr. Frank Tu

Many women believe that the frequent pain or discomfort they feel will eventually go away on its own, or that it isn’t severe enough to see a doctor. In truth, chronic pelvic pain is a common issue that can be a symptom of a more prevalent condition, such as menstruation, endometriosis, fibroids and more. That does not mean that women must suffer in silence. Dr. Frank Tu, MD, MPH, Director of Gynecological Pain and Minimally Invasive Surgery, leads NorthShore’s continued research on this topic, and he will be sharing his expertise and answering questions about chronic pelvic pain, including insight into its related conditions, as well as the latest available in diagnosis and treatment.

Dr. Frank Tu (NorthShore) - 9:43 AM:
Good morning everyone! We're looking forward to an active discussion about women's pelvic health, and particularly about pelvic pain!

Kathryn (Moderator) - 9:52 AM:
Our pelvic pain chat with Dr. Tu will start in approximately ten minutes. You can submit your questions now, or at any point during our chat.

Kathryn (Moderator) - 10:00 AM:
Our pelvic pain chat with Dr. Frank Tu is now open. We're taking your questions now.

  Vicky (Chicago, IL) - 10:02 AM:
I am experiencing abdominal pain every month. Usually two weeks after my period, and it will last about one week, sometimes longer, like 10 days. The pain happens once or twice each day during that week, and it is really painful. The pain is around the belly button. What can be a better way to treat this?
Dr. Frank Tu (NorthShore)
Hi Vicky, You might be having some ovulatory pain, or "mittelschmerz" related to the ovary normally producing follicles at this time of the month. The swelling can be uncomfortable for some women but is itself not dangerous. Simple treatments like NSAIDs are tried by many women. If its intense, and you aren't trying to get pregnant, trying a birth control pill to suppress the cyclical changes and ovarian stimulation is also an option.

  Joanne (Mount Prospect, IL) - 10:07 AM:
I had my first and only daughter delivered via c-section. While I have always had heavy periods and painful intercourse it was magnified 100 times after she was born. My OB said it could be scar tissue, but its beginning to impact life. Any thoughts?
Dr. Frank Tu (NorthShore)
Hi Joanne, We hear a number of women describe changes with their body after having a baby, and perhaps more if they had a c-section. The heavy periods could be due to a condition where the c-section incision might have some residual areas that haven't perfectly healed. These minor defects are called "isthmoceles" and can potentially be treated through a minor ablative procedure through the cervix. An saline infusion ultrasound can sometimes help diagnose this. It sometimes can explain the pain with sex as well. However, many women do have painful sex separately from tight pelvic floor muscles related to childbearing. It might be good to have those examined by an ob/gyn and then have a pelvic floor PT help with some basic strengthening and coordination exercises. A lot of our patients do really well with just a little touch of rehab. NorthShore has several of these women's health PT specialists that work with our doctors.

  Tati (Chicago, IL) - 10:13 AM:
I've currently had an IUD in place for about a year now. I feel like ever since getting this in place, I constantly have extreme pelvic pain. Is this a normal symptom of getting an IUD?
Dr. Frank Tu (NorthShore)
Hi Tati, Sorry to hear about this side effect after the IUD. Its a good birth control choice for many women, but some women find it irritating. It might be wise to have the position checked by an ob/gyn, which may include an ultrasound also to make sure it isn't sticking partly into the uterine muscle. Sometimes if it is a little misplaced, a gyne can adjust it slightly. One option if it turns out to otherwise be in the right place, would be to remove it, which can be done as a brief clinic procedure. You then could either try another smaller IUD (Skyla comes to mind), or a different form of birth control. Also, have you tried a brief trial of anti-inflammatories?

  Stephanie (Des Plaines, IL) - 10:18 AM:
What are the chances of a fibroid coming back once removed? Also, if a fibroid was removed from inside the uterus, does this impact the chances of getting pregnant?
Dr. Frank Tu (NorthShore)
Hi Stephanie, We expect about 1 in 4 women with a fibroid removed to have a future recurrence. Some fibroids are removed to actually improve a woman's chances of getting pregnant. This is especially true if the fibroid is inside the uterine cavity, and distorting the normal endometrial lining. On the other hand, if you are having trouble getting pregnant after a myomectomy (removal of a fibroid), it might be good to have a quick diagnostic procedure to make sure no scar has built up inside the cavity.

  Dania (Washington, DC) - 10:22 AM:
Is pelvic pain, including both muscular pain around the pelvic region and vulvodyna, a common symptom for women with fibromyalgia and/or small fiber neuropathy? If yes, are there treatments that can better help this population of women?
Dr. Frank Tu (NorthShore)
Hi Dania, Fibromyalgia involves complex changes in how men and women's brains and nervous systems recognize and interpret pain throughout the body. So muscle and skin pain in the pelvic floor and vulvar areas are more common in women with fibromyalgia. This doesn't affect all fibromyalgia sufferers fortunately. Use of oral nerve medications (tricyclic antidepressants or gabapentinoids) and physical therapy can be a big help for many women with pelvic floor or vulvar pain issues. Start with those, but there are other approaches too, like topical therapies or even vaginal muscle relaxant suppositories.

  Melissa (McHenry, IL) - 10:27 AM:
What would be some reasons why my underwear is causing me genital pain (if possible)?
Dr. Frank Tu (NorthShore)
Hi Melissa, Great question. First, is the underwear plain cotton material? Some women are irritated by non cotton undergarments. Secondly, if they are really tight, compression of some of the branches of the pudendal nerve where the seams or elastic of your underwear is might be causing subtle nerve irritation. It might be good to check for any compression sites and find more comfortable underwear. Also some of our PT colleagues here at NorthShore will advise women who sit a lot to take regular breaks and move around to maximize blood flow to the pelvic area.

  Natalya (Buffalo Grove, IL) - 10:34 AM:
Hello! I'm pregnant, about 11 weeks, and am starting to feeling pelvic pain on my right side. I can say I felt the same before when I had my periods. What might this be?
Dr. Frank Tu (NorthShore)
Hi Natalya, Congratulations! Pain in early pregnancy may be related to some stretch on the growing uterus. I assume that you've already had an early scan and they've seen the pregnancy is growing in the uterus? You may hear some women describe this as round ligament stretch. I do think that for some women there may be some early changes that could be related to elevated relaxin levels (those help the pelvic girdle "loosen" to help with delivery at the end of pregnancy. And those tend to peak around 3 mths into pregnancy. You might have this checked out to see if any of your pain is related to changes in pelvic stability. A good PT can really help many women with the aches of pregnancy and prevent post delivery issues. Good luck!

  Nicole (Mishawaka, IN) - 10:43 AM:
I been having problems since I had my endometrial lining was burned out. I have bad cramps and I bleed lightly. My stomach hurts all the time. My period lasts 5 days, but it is spot bleeding. What can I do to address this?
Dr. Frank Tu (NorthShore)
Hi Nicole, It sounds like you had an endometrial ablation. Sorry to hear it's led to some new cramps. The symptoms sound like you may have some trapped pockets of still hormonally sensitive tissue inside the "ablated" uterine cavity. Many women with ablation don't experience this, but a portion-- maybe 5-10% will have some symptoms like this. When these islands of tissue are activated and swell, then break down with bleeding, just as they normally would be by surges in sex hormones, the small menstrual fluid that is trapped causes painful pressure inside the trapped pockets. Two approaches can help - either shut down the cycle with hormones (birth control pills), or have an additional treatment. At NorthShore for women who don't do well with the pill, we consider resecting those islands of tissue with a hysteroscope, or we offer a laparoscopic hysterectomy. Usually one of these treatments gets a good result.

  April (Johnson Creek, WI) - 10:52 AM:
Should you be passing big clots after surgery to get rid of endometriosis?
Dr. Frank Tu (NorthShore)
Hi April, Did you just have surgery in the last few days? There might be temporary changes related to instruments used to move the uterus around during laparoscopy. But with big clots call and see if you need to be evaluated by your operating surgeon in the next day or so for a quick check, to make sure there isn't a small tear in the cervix. Hopefully its just a minor, temporary change. Also make sure and let them know if you have started any new hormonal medications.

  Krista (Chicago, IL) - 10:55 AM:
I was told I "may have PCOS." Is there a way to confirm that I do have this besides having a trans-vaginal ultrasound?
Dr. Frank Tu (NorthShore)
Hi Krista, PCOS or polycystic ovarian syndrome is usually based on three criteria in the US. You need to have at least 2 of 3 key signs a) signs of excess testosterone effect (hair growth more than expected, like face, chin, or severe acne), b) problems with having regular periods every month or so, and c) presence of multiple small follicles on the ovary on ultrasound which reflects failed ovulation due to the hormone imbalances that cause PCOS. Its good to have this diagnosed early if you have signs of this, because it can lead to diabetes eventually in some women, which good diet and exercise might help prevent. The lack of regular ovulation also interferes with getting pregnant for many PCOS sufferers.

Kathryn (Moderator) - 11:02 AM:
This will be the end of our chat. Thank you very much for your questions - we will work on additional content to address unanswered inquiries.

For more information on pelvic pain, or to speak with a specialist like Dr. Tu, contact the Center for Pelvic Health.

Dr. Frank Tu (NorthShore) - 11:03 AM:
Thanks again to everyone for a great dialogue. I hope you enjoyed the session, and if you need to get further assistance, you can make an appointment with a physician in our Division at 847 677 1400. Have a great weekend!

This chat has ended.

Thank you very much for your participation.