What is causing my pelvic pain?
January 28, 2012 8:35 PM   Subscribe

I'm having pelvic pain. You are not my doctor. I have an appointment next week, but would like to go prepared. Can you help?

Starting in October 2011, I started noticing a great deal of lower abdominal pain during my period. This pain occurs:
- While straining during a bowel movement
- While emptying a full bladder
- While moving around or being jostled (like driving on bumpy roads)
- While pressing on my lower abdomen
- During certain deeply penetrative sex positions

I saw my OB/Gyn about this, and she ordered a transvaginal ultrasound and blood tests and nothing unusual was noted. She diagnosed me with endometritis (PID), as I had switched from a Mirena IUD to a Paragard IUD in August and had a yeast infection not long after, which she said might have climbed the strings.

Over Thanksgiving, the pain was just as bad, if not worse. The doctor on call prescribed another round of antibiotics for me. The next week I went back to see my regular OB/Gyn, who told me there was no reason for my pain and asked me what I wanted her to do about it (as a sidenote, this left me stunned!). According to her, something like endometriosis would have shown up years earlier, and she ridiculed me when I asked about cancer. She removed my Paragard at this time to rule out all possible causes (RIP, little friend).

The pain remains. When I do not have my period, pressing on my lower abdomen causes mild pain (1-2 on a scale of 10) and is generally uncomfortable on the left side. When I have my period, my entire lower abdomen is tender and painful to pressure (5-7 on a scale of 10). The pain has decreased somewhat, perhaps 1-2 notches on the scale since removing the Paragard, but is still quite significant. I generally don't get pain with elimination when I'm not having my period unless I have a very full bladder.

I have an appointment with a new doctor next week, but would like opinions and knowledge to bring to the table. Any ideas on what's going on with me?

43 year old woman, 2 pregnancies/2 kids, both over 10 years old.
posted by anonymous to Health & Fitness (14 answers total) 1 user marked this as a favorite
It sounds exactly like endometriosis to me (same symptoms, diagnosed 1992) But if the ultrasound showed nothing, hmmm? Who did the ultrasound?

Just came in to tell you that that sounds EXACTLY like when I was first diagnosed. Down to the pain during bm's. A little laser surgery cleared that right up for me, though.
posted by jbenben at 8:50 PM on January 28, 2012

My first thought was Interstitial cystitis, which might still be something to ask about, but after re-reading your post and jbenben's response, it sounds like the bladder involvement is sort of minimal.

Good luck with the new doctor. It sounds like your previous one was perhaps not quite paying attention to you the way she ought, so hopefully it will turn out that this can be treated, and soon.
posted by Made of Star Stuff at 8:58 PM on January 28, 2012

Have you been to your GP? Sometimes starting with a specialist is a BAD idea, speaking from experience. (I've learned the hard way twice.)
posted by wintersweet at 9:07 PM on January 28, 2012

It sounds very much like endometriosis to me, also. Your Dr./ultrasound tech may not see much on ultrasound. The standard for definitive diagnosis is visualizing the lesions during laparoscopic surgery (at which point they usually will try to remove it). Maybe see a gynecologist who sees lots of endo patients.
posted by quince at 9:36 PM on January 28, 2012 [2 favorites]

Get checked for fibroids as well. They could be giving you that feeling of fullness.
posted by Anima Mundi at 9:50 PM on January 28, 2012

Seconding to go to your GP. There's a lot of organs squished into your lower abdomen.
posted by desuetude at 10:44 PM on January 28, 2012

Do you live near a teaching hospital? Try to see a gyn who specializes in endo or fibroids or some other niche. At the very least you need a doctor who is curious and experienced and not as dismissive as the last one.

Side note: although I had similar pain, my symptoms didn't exactly match yours. I had to go through multiple doctors and imaging processes before getting my diagnosis of adenomyosis. It's like endomyosis but in a different location. Same type of pain.
posted by ImproviseOrDie at 10:45 PM on January 28, 2012

Sounds like cysts on your ovaries to me. Or a possibility.
posted by Ms. Moonlight at 1:33 AM on January 29, 2012

So sorry you are having this pain. Seconding everyone who suggests seeing a GYN who specializes in endo, cysts, and fibroids rather than a general-practice OB/GYN, if the next GYN doesn't have anything else in her bag of tricks either.

Did the pain go away when you took the antibiotics? That might be indicative of whether it's endometritis. Not to be Captain Buzzkillerina, but I have been having some similar pain as part of my perimenopause, er, thing, and severe pain can be c to that. Of course you are super young to be in that situation, so.
posted by Sidhedevil at 1:51 AM on January 29, 2012

You may also want to consider a colonoscopy. All kinds of colon problems could cause the pain you're describing. Good luck.
posted by Philemon at 5:25 AM on January 29, 2012

Endometriosis - all classic symptoms of colonic and ureteric involvement (which I've endured). An ultrasound is limited - an MRI will pick up much more detail, but a laparoscopy is the only way to make a definitive diagnosis. Especially since it sounds like your pain is in the Pouch of Douglas area which is often difficult to see in scans.

Your doctor's behavior is, sadly, frustratingly, very common - endo and many other painful pelvic disorders often take years between complaint and diagnosis. I've had doctors respond to my pelvic pain complaints in the way you have experienced.

Pelvic pain is debilitating and insidious - be wary of acclimating to the difficulties you're having with elimination. Maybe keep a pain diary detailing your day to day symptons to show your doctor. I realized that during the years I was trying to get a diagnosis, I kept acclimating to increasingly intrusive, terrible pain. Your symptoms sound terrible. Get it sorted, urgently and good on you for getting a new doctor!
posted by honey-barbara at 5:52 AM on January 29, 2012

There are GYNs who specialize in pelvic pain.

The fact that the symptoms increase during your period specifically makes it more suspicious for endometriosis and less suspicious for a GI/rectal issue.
posted by treehorn+bunny at 10:18 PM on January 29, 2012

Endo does not show in an ultrasound, as noted above. In my case, I didn't have any current endometrial lesions, but I did have lots of adhesions from the past, which tangle and attach bits of my insides where they should not (i.e. ovary yanked toward rectum, and it hurts especially at period time.) Seconding a laparoscopy to find out more.
posted by Riverine at 1:19 PM on January 30, 2012

From the OP:
"I met with the new gynecologist (she's gyn-only) today and had a very positive experience with her. She sat and spoke with me for quite some time and took all my concerns seriously. Her top suspicion is endometriosis, and she was confused as to why my previous doctor dismissed the possibility. However, given that my pain is manifesting on the left side, I'm also going in for a colonoscopy. My initial GI consultation is later this week.

If the colonoscopy is clear, given the fact that I don't get along with hormonal treatments very well, I might also have a laparoscopy in my future to deal with the endometriosis. I guess I'll burn that bridge when I come to it.

Thanks to all of you for your suggestions and support!"
posted by jessamyn at 6:13 PM on January 31, 2012 [1 favorite]

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