Topic of Chronic Pelvic Pain
I am committed to pursuing continuing medical education. In an ongoing effort to communicate this to my patients, I will periodically update my website with brief summaries of recent peer-reviewed publications and information learned through reading, clinical experience and discussions with expert colleagues.
This installment will focus on the care of women with chronic pelvic pain. A large number of women suffer from pelvic pain that lasts for many months or years. It is very important for women suffering from pain to seek care, irrespective of their age or surgical history. Proper examination and radiologic testing are essential parts of the evaluation of women with pain that has lasted for a long time.
Recent studies are supporting the role of robotic surgery in properly selected cases, to make minimally invasive procedures much easier for women who otherwise would require a large incision. As a specialist providing robotic and minimally invasive surgeries such as hysterectomy and removal of endometriosis, I have seen the benefits of careful application of surgery in the care of women with pelvic pain. On rare occasions, surgery is needed even in women who have had hysterectomy and ovarian removal in the past.
It is important to keep in mind, however, that pelvic pain is very often not due to conditions that can be treated with surgery, even robotic hysterectomy. The intestines, bladder, or pelvic muscles can be the sources of chronic pain. In women with such findings, referral to a gastroenterologist or urologist should be considered. Also, nonsurgical treatment, most prominently pelvic muscle rehabilitation and re-strengthening, are essential. For women with these findings, surgery of the female organs may not be helpful at all.
A multidisciplinary approach is advocated more and more by specialists treating chronic female pelvic pain. With targeted and careful evaluations, the cause of the symptoms can be more easily found and treatments initiated. It is critical that both surgery and nonsurgical treatment options for pelvic pain be considered as part of the comprehensive care of women.
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