Why Do I Have Pain After Excision?
Dr. John Dulemba is an obstetrician-gynecologist practicing in Denton, TX. Dr. Dulemba specializes in women's health, particularly endometriosis, adhesions, and pelvic pain. As an obstetrician-gynecologist, or OB-GYN, Dr. Dulemba can treat endometriosis and adhesions related to the vagina, uterus, ovaries, fallopian... more
Many of my endometriosis patients wonder why they have pain after their procedure. They also wonder why they are not always "cured" after excision (cutting out endometriosis) surgery from an endometriosis expert. There are a multitude of reasons why, and it is not always just endometriosis. The average time from when symptoms begin until a medical professional mentions endometriosis is 9 years and 5 different doctors. Some patients have had the disease for decades. Any disease process that has been present for years is bound to have a devastating effect on other organs, and make a cure more difficult.
What are the other problems that could cause pelvic pain, and this is not all inclusive. The pain can be from bone, ligament, muscle, tendons, intestines, bladder, nerves, and adhesions/fibrosis/scarring (all 3 are the same process). The bone ligament, muscle, and tendons may be part of the PFD (Pelvic Floor Dysfunction) issue. There are treatments for those problems, and I refer those patients to experts in those fields.
The bladder may have endometriosis, but can also be affected by Interstitial Cystitis (IC). This can contribute to the pelvic pain.
Intestines can be a source pf pelvic pain for a variety of reasons. Not only can endometriosis be on the bowel, but it can erode into the lumen (inside) of the bowel. There can be other problems associated with the intestines that can contribute to the pain: Ulcerative colitis; Crohn's disease; Celiac disease; and Diverticulitis. This can be evaluated with a colonoscopy, and I urge my patients to have this done.
Nerves can be a difficult problem to deal with. Many may have heard of "phantom pain". This is not fake pain, but pain when an organ or area is no longer present. An example of this is when someone has a limb amputated. They still can have pain in their limb (such as a foot) without having that limb there. How can that be? The nerves that send the signal to the brain that something is causing pain, can still send a signal, no matter where the nerve has been cut. This can even happen in areas where endometriosis has been excised. It will give the feeling of pain, similar to the pain from the endometriosis, even if no endometriosis is present.
The last problem is adhesions/scarring/fibrosis. This is the natural healing process of the body. Any injury to the body can result in the adhesions/fibrosis/scarring. Trying to prevent this process can be a daunting experience. There are ways to try and minimize the process, and these can be barriers, suspending the ovaries, and second look surgery. Nothing is 100% successful.
All of these issues can be present, or any combination. This can cause frustration, pain, and anger because patients want/expect a great outcome when having surgery with an expert, but as you have read, many factors play a role that can decrease pain relief. I hope this helps many of you to have a better understanding of why it can be so difficult to be pain free. Never give up, and endometriosis needs to be excised as early as possible, in my opinion.
