Pelvic pain is a pain that occurs in the lower abdominal area. Your discomfort may intensify after standing for long periods and can become so severe that you are unable to carry on with routine activities.
The pain can be due to many different medical conditions such as endometriosis, an infection, prolapse, fibroids, tumours, cysts on ovaries, pelvic inflammatory disease, irritable bowel syndrome, other problems with bowel, bladder, nerves and diseases of the urinary tract as well as hernias, slipped discs, drug abuse, fibromyalgia. The most common causes of pelvic pain are endometriosis and irritable bowel syndrome.
Symptoms of pelvic pain can occur along with other symptoms, depending on the exact cause. Associated symptoms can include lower back pain, vaginal or urethral bleeding or discharge, fever, and pain during sex.
Finding the cause of pelvic pain involves a process of elimination, the ease of which depends on what the cause is. Some causes of pelvic pain are quite evident and easy to diagnose. For example, if a woman has an ovarian cyst, or ovarian tumour, or an ectopic pregnancy, or fibroid or endometriosis, we can usually make the diagnosis quite easily. However, if a clinical examination and/or a pelvic ultrasound does not elicit any abnormalities that cause pelvic pain then it could be quite difficult to find.
Pelvic pain can be acute or chronic. It is acute when the pain is occurring for the first time which could be due to an injury, illness, or infection. Chronic pelvic pain means that the pain has been a problem for a long time and is often associated with a chronic disorder or underlying condition, it lasts longer than a few months and is more intense than ordinary period pain. It affects around one in six women.
The most common causes of acute pain are an ovarian cyst, appendicitis, peritonitis, acute pelvic inflammatory disease, a urinary tract infection and constipation.
The most common causes of chronic pain are endometriosis, chronic pelvic inflammatory disease and irritable bowel syndrome.
Depending on the diagnosis, your gynaecologist may prescribe medication, therapy or surgery. Dr Novikova is highly experienced in treating all conditions associated with pelvic pain and is specialised in minimally invasive laparoscopic or key-hole surgery.
This surgery investigates pelvic pain to possibly diagnose or exclude endometriosis, or to look for any other causes. Laparoscopic surgery is a keyhole surgery as the cut is made in the belly button which is one centimetre long and half a centimetre in the lower abdomen. We insert a telescope inside of the tummy and blow out the tummy with CO2 gas which helps us visualize the pelvis and abdomen and all the organs quite clearly. The telescope enlarges things so we can see even the smallest lesions quite well.
Other types of surgery that can treat pelvic pain is a laparotomy which involves a bigger cut on the tummy is usually done for big pelvic tumours that cannot be removed through the laparoscopic surgery.
Over time, especially after childbirth, vaginal tissue can overstretch, creating a feeling of looseness (laxity) and lowered sensation. Decreased satisfaction during sexual intercourse can impact the quality of life. The vaginal laser rejuvenation tones the vaginal walls, enhances sensitivity and contracts tissue, increasing tightness and improving sexual satisfaction.
Pre-existing conditions that would exclude someone from having laparoscopic surgery would be severe lung disease which makes administering anaesthesia quite difficult. Having had multiple operations in the past will also exclude you from laparoscopic surgery because previous surgeries could possibly prevent the entry of the telescope into the abdominal area.
Other exclusionary conditions are big tumours and tumours suspected to be cancerous that cannot be treated with laparoscopy.
Pre-surgery preparation would include not eating or drinking for six hours before the operation. In some cases, we would recommend bowel preparation as well but that would be discussed on a case by case basis.
The surgery itself is performed under general anaesthesia. The patient is usually admitted to the hospital in the morning and assessed by an anaesthetist before the procedure then taken into the operating room.
In 99% of cases, we use general anaesthesia for the laparoscopy. It is not painful because the patient is asleep and doesn’t feel anything. The patient will also have very little memory of the procedure afterwards.
The surgery length is dependent on the pathology and usually, the length of the surgery can be predicted using my clinical assessment and imaging before the operation.