Will surgery be enough to treat my pain?Prepared by Dr Susan EvansGynaecologist and pelvic pain specialistEndometriosis is one cause of pelvic pain, but there are many others. If endometriosis is the only cause for your pain, then an operation to remove it may be all you need. However, if you, like most women with endometriosis, have more than one cause for your pain, then an operation alone will not be enough.No one knows why other causes of pain are so common in women with endometriosis, but they are. You may have pain from an irritable bladder, constipation, bloating, adhesions, an irritable bowel, painful nerve pathways, migraines or a painful uterus. Removing your endometriosis is still important, but it will only treat the part of your pain that is due to endometriosis. The other pains remain.Four common causes of pelvic pain and how to recognise themAlthough there are many causes of pain, the four described here are common. You may recognise your pain. Bladder PainThe bladder may look normal, but it is painful and easily irritated. Bladder pain usually causes: -Passing urine often (called frequency)-Getting up at night to pass urine (called nocturia)-Pain if you try to ‘hold on’-Spasms of pain in the lower abdomen or vaginaPain from nerves (called Neurogenic pain)Pain over a long time has taught the nerves from the pelvis to send pain impulses to the brain. These nerves will send pain signals even when all the endometriosis has been removed. Neurogenic pain often causes:-Pain on most days of the month-Pain that wakes you at night-Unusual sensations – your pain may be burning, stabbing, sharp, swollen or numb.-Pain that spreads to a wider area when it is bad.-Pain that narcotic medications like codeine and morphine don’t help much.Pain from the uterus. Not all period pain is endometriosis. Pain from the uterus can cause:-Pain during the first 1-2 days of a period, especially teenagers-Period pain in women later in life whose periods were pain free when they were younger-Period pain in women whose endometriosis has been completely removedPain from the bowelsBowel pain usually causes:-Pain followed by diarrhoea, constipation, bloating or passing wind-Pain that does not seem to come at a particular time of your monthly cycle. This is mostly true, but it can be worse before periods-Spasms of pain that last a minute or so and then go awayMany women with endometriosis have been told that they have Irritable bowel syndrome. Sometime this is true. However, there are many other conditions, including endometriosis, that can cause bowel problems. Other conditions that can cause bowel symptoms include:-Coeliac Disease – a blood test can check for this-Dietary intolerances including fructose intolerance, lactose intolerance and others-Constipation-Bowel disorders such as Crohns Disease-No doctor has the training to care for all these conditions, so unfortunately you may need to see different people for different problems. It can be a long, frustrating and expensive process finding the help you need. To make this easier, our book ‘Endometriosis and Other Pelvic Pain’ includes easy-to-read information on all these types of pain. It explains how you can recognise the causes of your pain, what the treatment options are, how you can help yourself and which type of health professional can help you most. Endometriosis and Other Pelvic Pain is published by Lothian Books and sells for $29.95. The special number that makes it easy for your bookshop to order is ISBN 0 7344 0825 0. You can order the book by fax or mail order from www.drsusanevans.com
