The most common misconceptions about chronic pelvic pain
The causes of chronic pelvic pain in women can only be gynecological diseases
In fact, chronic pelvic pain can cause diseases of the musculoskeletal system (osteochondrosis of the spine, myofascial syndromes, osteoarthritis of the sacrococcygeal joint, primary tumors of the pelvic bones, metastases to the pelvic bones and spine, bony forms of tuberculosis, pathology of the symphysis), retroperitoneal neoplasms, diseases of the peripheral nervous system (plexitis), diseases of the gastrointestinal tract diseases of the urinary tract (chronic colitis, irritable bowel syndrome, ulcerative colitis, proctitis, adhesions), diseases of the urinary system (chronic cystitis, urolithiasis, pelvic location of the kidney, kidney prolapse), vascular diseases (varicose veins of the pelvis). The causes of chronic pain syndrome can also be mental illnesses (abdominal epileptic seizures, depressive syndrome, schizophrenia).
Pain is usually caused by one factor, eliminating which can get rid of the pain
In fact, in most gynecological diseases, the origin of pain is caused by several stimuli at once, and it is often impossible to single out the leading factor. With uterine fibroids, pain can be caused by an increase in this organ, a violation of its blood supply and contractility of the uterine muscle, deformation of the uterine cavity by nodes, compression by the enlarged uterus or individual nodes of neighboring organs - intestines, urinary tract, nerve plexuses, blood vessels.
With tumors and cysts of the ovaries, the tissues and ligaments of the ovaries are stretched (up to twisting), follicle maturation is disrupted, microfractures with inflammation and adhesions are possible, compression of neighboring organs by cysts
Pelvic pain is characteristic of malformations of the genitals (normal or closed functioning uterus with cervical or vaginal aplasia, rudimentary uterine horn, closed cavity of a two-horned or doubled uterus) and other conditions accompanied by impaired outflow of menstrual blood (intrauterine synechia, cervical canal stenosis uterine or vaginal scarring). In these cases, the pain is caused by the stretching of closed cavities by blood and irritation of the peritoneum with almost constant hemoperitoneum, inflammation, and adhesions. Incorrect positions of the internal genitalia (bends of the uterus, abscesses, prolapses) also cause pelvic pain.
As a rule, most patients have a combined gynecological pathology, and each of the diseases can be the cause of pain. External endometriosis often accompanies any other gynecological disease, and uterine fibroids are combined with internal endometriosis of the uterine body. It is not uncommon to have a prolapse of the uterus affected by fibroids or adenomyosis. The presence of combined gynecological and extragenital pathology (hernias, diseases of the gastrointestinal tract, urinary tract, osteochondrosis of the spine) can significantly complicate the determination of the true cause of pain.
Periodic pain in women is normal
This myth has been prevalent since the 19th century. Doctors then explained menstrual pain by the instability and delicacy of women's physiology and believed that pain during menstruation was a norm that was very characteristic of the female body. Another "cause" of pain in women during menstruation is, as some believe, a low pain threshold.
In fact, many women and girls experience pain during menstruation. However, severe pain that disrupts a habitual lifestyle and activity level cannot be the norm, and they are usually based on some kind of disease, such as endometriosis, a hormone-dependent disease in which the uterine mucosa (endometrium) grows in other parts of the body. This is the third most common gynecological disease after uterine fibroids and various inflammatory processes in the genitals.
Therefore, every woman with severe pain during menstruation should be fully examined to identify their cause.
Early detection of the causes of pain determines the success of treatment. To identify possible causes of pelvic pain, we work in a unified team with doctors of other specialties - general surgeons, oncologists,urologists, neurologists, psychologists.
For the treatment of chronic pelvic pain, gynecological surgeons of the EMC use an approach based on reducing the invasiveness of surgery, avoiding excessive radicalism, and waiting tactics for certain diseases of the genital area.
Laparoscopy and hysteroscopy provide us with unique diagnostic and therapeutic opportunities, which allow us to identify and eliminate possible causes of pain that are not diagnosed by other examination methods: endometriosis of the pelvic peritoneum, adhesions, anatomical disorders - hernias, peritoneal defects (Allen-Masters syndrome).
From the patient's point of view, laparoscopic intervention, unlike laparotomy, is not perceived as a "large and severe" operation, and the absence of intense and prolonged postoperative pain associated with the surgical wound of the anterior abdominal wall eliminates the aggravation of the initial pain due to the layering of operating rooms on them. And finally, early activation and return to physical activity, with virtually no cosmetic defects, also contributes to a rapid recovery.
The volume of surgical intervention is selected by EMC gynecologists depending on the patient's age, her plans for childbirth, the severity of the detected pathology, and the severity of pain. Organ-preserving operations are performed in young women, warning patients about the likelihood of recurrence of diseases such as endometriosis and uterine fibroids. Patients of the older age groups with adenomyosis, multiple uterine fibroids, accompanied by severe pain, bleeding and leading to anemia, tumor growth and its significant size, impaired functions of neighboring organs, radical operations are indicated in the volume of removal of the uterus, which we perform by laparoscopy or vaginal access.
For pelvic organ prolapses and prolapses accompanied by pelvic pain, EMC gynecologists use surgical correction technologies that are fundamentally different from each other, depending on the patient's age, to effectively eliminate gynecological pathology and restore impaired pelvic anatomy. With varicose veins of the pelvic vessels, we perform laparoscopic ligation of the ovarian veins, which is highly effective against pelvic pain due to stagnation in the pelvic veins, while not adversely affecting ovarian function.
The effectiveness of surgical interventions performed by specialists of the Department of Gynecology and Oncogynecology of the EMC varies from 60 to 95%, which indicates the effectiveness of the treatment and the high level of training of specialists, whose experience allows them to take on even the most difficult cases.
Work The EMC Gynecology and Oncogynecology Clinics are built in accordance with the protocols of evidence-based medicine practiced in the USA and Western European countries. The EMC clinic is one of the few in Moscow, the level of medical services of which meets international standards.
The Clinic's doctors work under the guidance ofVladimir Nosov is an experienced oncogynecologist and obstetrician-gynecologist, certified by the US National Board Certified in Obstetrics and Gynecology and Oncogynecology, as well as certified in Russia in obstetrics and gynecology and oncology.
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