Conditions We Treat
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Chronic Pelvic Pain
Chronic pelvic pain develops in the area below your belly button and between your hips — and lasts for six months or longer. Symptoms may include consistent or intermittent pain; a dull aching; sharp pains or cramping; deep, heavy pressure in the pelvis; or pain during intercourse, bowel movements, urination or after sitting for long periods of time.
Common causes include endometriosis, tension or spasms in the pelvic floor muscles, chronic pelvic inflammatory disease, Irritable Bowel Syndrome, fibroids, painful bladder syndrome or psychological factors like depression, stress or history of sexual or physical abuse.
Diagnosis can include pelvic exams, cultures, or a variety of imaging tests. Generally, treatment can include medications, therapies and/or surgery.
Endometriosis is a disorder in which tissue that normally lines the inside of the uterus grows outside of it. Displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle but, because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions.
The primary symptom of endometriosis is pelvic pain, often associated with the menstrual period. Although many women experience cramping during this time, women with endometriosis typically describe menstrual pain that's far worse than usual. Other symptoms may include excessive bleeding; pain with intercourse, bowel movements or urination; and infertility. Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID), ovarian cysts and Irritable Bowel Syndrome (IBS). Risk factors include family history, uterine abnormalities, history of pelvic infection and no history of childbirth.
Diagnosis can include pelvic exam and a variety of imaging tests. Treatment can include medications, therapies and/or surgery. Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.
Abnormal Uterine / Vaginal Bleeding
Abnormal Uterine Bleeding (AUB) is irregular bleeding from the uterus that is longer or heavier than usual or does not occur at your regular time. Causes can range from changes in hormone levels to growths or clotting problems. Diagnosis involves a pelvic exam, urine test, blood tests, ultrasound or biopsy. Treatments include hormones, such as birth control pills, use of an IUD, and the removal polyps or fibroids. In extreme cases, surgery is recommended.
Vaginal bleeding is considered to be abnormal if it occurs when you are not expecting your period or when menstrual flow is lighter or heavier than normal. By itself, abnormal vaginal bleeding does not necessarily indicate a serious condition. However, bleeding during pregnancy is a different problem that should be immediately evaluated by a physician.
Ovulation, hormonal imbalance, infection, inflammation, growths such as fibroids and STDs are just a few of the common causes. Other, more serious causes include cancer, diabetes, hyperthyroidism or structural problems like prolapse. Abnormal bleeding may also occur following delivery or abortion, or as a precursor to perimenopause. Treatment depends on the cause of the bleeding.
Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer. Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). The growth patterns of uterine fibroids vary — they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage. Uterine fibroids are extremely common, but most are unaware of them because they often cause no symptoms.
Common symptoms include heavy or prolonged menstrual bleeding, pelvic pressure or pain, frequent urination, difficulty emptying your bladder, constipation, backache or leg pains. It is important to note that signs and symptoms are influenced by the location, size and number of fibroids.Their cause is unknown, but research points to genetics, hormones, or other growth factors. Risk factors include heredity, race, age and diet. Diagnosis generally happens during a routine pelvic exam and may result in further lab and imaging tests. Treatment options range from watchful waiting and medication to surgery.
Adenomyosis occurs when endometrial tissue, which normally lines the uterus, grows into the muscular wall of the uterus. While displaced endometrial tissue continues to act as it normally would — thickening, breaking down and bleeding — during each menstrual cycle, an enlarged uterus and painful, heavy periods can result.
The cause of adenomyosis remains unknown, but the disease typically disappears after menopause. For women who experience severe discomfort from adenomyosis, certain treatments can help, but hysterectomy is the only cure.
Risk factors include prior uterine surgery, such as a C-section or fibroid removal, childbirth and age. Most cases are found in women in their 40s and 50s. Adenomyosis in middle-aged women could relate to longer exposure to estrogen compared with that of younger women. Until recently, adenomyosis was most often diagnosed only when a woman had a hysterectomy. Current research suggests that the condition may also be common, but often undetected, in younger women.
Diagnosis is often a result of a pelvic exam that reveals an enlarged, tender uterus; ultrasound or MRI. It should be noted that the only way to be certain of adenomyosis is to examine the uterus after surgery to remove it (hysterectomy). Adenomyosis usually goes away after menopause, so treatment may depend on how close you are to that stage of life. Treatment options often include medication or surgery.
Pelvic Floor Disorder / Pelvic Organ Prolapse
Pelvic Floor Disorder involves the group of muscles that intersect at your pelvic opening. Under normal circumstances, these muscles and the tissues surrounding them keep the pelvic organs, including your bladder, small bowel, rectum, uterus and vagina, in place. When pelvic floor disorders develop, one or more of the pelvic organs may stop working properly. Conditions associated with pelvic floor disorders include pelvic organ prolapse and urinary incontinence.
Pelvic organ prolapse refers to the prolapse or drooping of any of the pelvic floor organs. The condition involves one or more of these organs descending into or outside of the vaginal canal or anus. The categories associated with prolapse include:
- Cystocele: A prolapse of the bladder into the vagina;
- Urethrocele: A prolapse of the urethra;
- Uterine prolapse: A prolapse of the uterus;
- Vaginal vault prolapse: prolapse of the vagina;
- Enterocele: Small bowel prolapse;
- Rectocele: Rectal prolapse.
Anything that puts increased pressure in the abdomen can lead to pelvic organ prolapse. The most common causes include:
- Pregnancy, labor, and childbirth;
- Respiratory problems with a chronic, long-term cough;
- Pelvic organ cancers;
Symptoms depend somewhat on which organ is drooping. If the bladder prolapses, urine leakage may occur. If the rectum is involved, constipation and uncomfortable intercourse often occur. A backache as well as uncomfortable intercourse often accompanies small intestine prolapse. Uterine prolapse is also accompanied by backache and uncomfortable intercourse. Some women notice nothing at all.
Pelvic organ prolapse may be discovered during a routine pelvic exam. Following this discovery, a physician may order a variety of imaging tests of the pelvic region to further diagnosis and determine treatment. Treatment depends on the severity of the symptoms and can include a variety of therapies. In some cases, lifestyle changes like maintaining a healthy weight or incorporating Kegel exercises (designed to strengthen the pelvic floor muscles) into your daily routine is all that is needed. In more severe cases, patients are required to have a small plastic device, called a pessary, inserted into the vagina to provide support for the drooping organs. Surgery may be required to either repair the affected tissue or organ or to remove the organ completely.
Urinary incontinence is the accidental release of urine. Incontinence can be a short-term problem caused by a urinary tract infection, a medicine, or constipation. Or, it can be an ongoing issue that indicates weak muscles in the lower urinary tract or problems or damage either in the urinary tract or in the nerves that control urination.
The most common type is called stress incontinence, which occurs any time there is stress put on the bladder. This includes during a sneeze, cough, exercise, laugh or any other strenuous activity. Stress incontinence can be caused by childbirth, weight gain, or other conditions that stretch the pelvic floor muscles. When these muscles can't support your bladder properly, the bladder drops down and pushes against the vagina, not allowing the muscles that close off the urethra to tighten properly.
Urge incontinence is caused by an overactive bladder muscle that pushes urine out of the bladder. It may be caused by irritation of the bladder, emotional stress, or brain conditions such as Parkinson's disease or stroke. Many times doctors don't know what causes it but the most common symptoms are not being able to reach the bathroom in time and ruining of clothing. Overactive bladder is a kind of urge incontinence. This occurs when the bladder muscle squeezes too often or squeezes without warning. This can cause symptoms such as the need to urinate too often (eight or more times a day, or two or more times a night); the need to urinate immediately; or accidental leakage of urine. Not everyone with overactive bladder leaks urine. Treatments for overactive bladder include oral medications, skin patches or gel, and bladder injections.
It should be noted that it is also common for a woman to have symptoms of both types of incontinence. This is called mixed incontinence.
An examination may include some simple tests to look for the cause of the bladder control problem. Treatments depend on the type of incontinence you have and how much it affects your life. This can range from simple exercises, bladder training, medicines, a pessary, some combination of these to surgery. In many cases, these lifestyle changes can be enough to control incontinence.