Dr. Garima is a well-known gynaecoloist in Gurgaon specialized in treating women’s pelvic health related problems. Lower abdomen area is considered as the pelvic area including uterus, vagina, lower intestines, rectum & urinary tract. Pelvic pain occurs in the lower abdomen area due to various reasons and under certain circumstances while they are menstruating, having intercourse, due to infection, and so on. Proper diagnosis may lead to knowing the exact reason for Pelvic Pain so as to control the pain and to prevent damaging pelvic organs.
Pelvic Pain & Endometriosis
Endometriosis refers to a situation when tissue similar to the endometrium (that lines the inside of the uterus) also grows outside the uterus. These growths or “patches” occur most often in the pelvis and lower abdomen.
The patches can be grown in the areas:-
- Ovaries, uterus and fallopian tubes
- Uterosacral ligaments
- Inside the walls of the pelvis over the ureters (the tubes running from the kidneys to the bladder)
- Pouch of Douglas
- Surface of the rectum and, less commonly the large and small intestine and appendix
- Bladder
- Vagina
- Lower Abdomen
The patches can rarely occur in the upper abdomen, diaphragm, lungs, nasal passages, pharynx, cesarean section scar, umbilicus or elsewhere in the body.
Women may experience little or no reaction due to patch or scar tissue growth. Extensive scar tissue can also develop around pelvis organs which are called adhesions.
Types of Endometriosis
- Endometrial implants are small patches of 1-2 millimeters
- Endometrial Nodules are little larger patches having size 2-3 millimeters and may grow up to 4 centimeters
- Endometriomas are called chocolate cysts which are dark brown in color due to the presence of old blood and are approx. 10 centimeters long.
- Adenomyosis grows in the wall of the uterus and is the troublesome non-cancerous tumor.
Endometriosis may be categorized into three parts as Mild, Moderate & Severe. Mild endometriosis refers as small patches around pelvic cavity with no scarring. Moderate endometriosis is widely spread larger patches with cysts & significant scarring and may present to other organs. Severe Endometriosis is larger & numerous patches with severe scarring.
Symptoms of Endometriosis
The most common symptom is the pain in the pelvis and lower abdomen area. This is the reason, it is called pelvic pain. Women having Endometriosis may have pain during following situations, although severity of pain may vary woman to woman:-
- Pain in one side or both side, around the abdomen, deep in the pelvic cavity, lower back or in the rectum
- Pain during Menstruation.
- Pain during social activities and standing or sitting work.
- Pain during or after intercourse
- Pain while passing urine if patches are attached to the bladder. Some may experience blood or aching in the bladder area during urinating.
Infertility and Endometriosis:-
Mild Endometriosis may not be the cause of infertility but 30-40% women may experience difficulty in getting pregnant as patches or scar tissue may release substances leading to:-
- decrease sperm movement
- affect normal embryo development
- Adversely affect placenta development
- Decrease the ability of the fallopian tube to capture the egg from the ovary after ovulation.
Moderate or severe endometriosis may also cause adhesions to form around a fallopian tube and ovary. These may block or narrow the fallopian tubes due to which fertilization becomes difficult.
Diagnosis of Endometriosis:-
To know the reasons for pelvic pain or severity of Endometriosis, Dr. Garima will ask numerous questions related to patient’s health history and severity of pain she is experiencing. A physical examination of lower or pelvic organs will be done to check for the abnormalities. Other tests involved are:-
- Lab Tests (Urinalysis)
- Blood tests
- Ultrasounds
- Laparoscopy
- MRI Scans
- Cystoscopy
- Colonoscopy
Treatments for Endometriosis:
Treatments may stop the disease or may stop the growth of patches causing pain. Out of the several treatments available, right choice of treatment will vary depending upon the following factors:-
- Severity of the symptoms
- Severity of Endometriosis and patches during diagnosis
- age of the women
- Pregnancy or planning to be pregnant
Mild and Moderate Endometriosis may treat through medication but to treat the severe or chronic Endometriosis, variety of treatments are available:-
Surgical Treatment
- Laparoscopy: The aim of laparoscopic surgery is to remove the patches, cysts, adhesions which will lead to reduce pain and improve fertility.
- Laparotomy (open surgery): It is done in case of severe Endometriosis
- Hysterectomy: If patients are suffering for long-term or chronic or painful Endometriosis, they may choose to remove the uterus, one or both ovaries and fallopian tubes.
Hormonal Treatment
Hormonal Treatment therapies are effective to cure the pain associated with the Endometriosis. It will not work for the chronic or severe Endometriosis, although it may treat the small lesions that a surgery may miss. Contraceptive pills can be taken to control the hormone and to get relief from the pain of endometriosis. A woman planning to get pregnant should not use contraceptive pills.
Daily Treatment with progestagen usually helps to relieve symptoms with rare side-effects. Progestagens can also be given as an injection once every 12 weeks. Pregnant women or planning to get pregnant should avoid Progestagens.
Dr. Garima Sawhney caters the patients according to the severity of the Endometriosis present in the women. She always tries to offer best of the treatments comprising a medication, hormones, physical therapy, surgery, counseling, lifestyle changes etc to reduce the pain. Dr. Garima will analyse the root cause of Endometriosis or pelvic pain and helps to improve the situation by using professional & expert approach. So if you are suffering from any pelvic pain, it is the right time to seek consultation through Dr. Garima Sawhney, Best pelvic pain specialist in Gurgaon.
