Chronic Pelvic Pain

Chronic Pelvic Pain (CPP) is generally defined as pain in the pelvic areat that is persistent for three to six months or longer, is severe enough to cause functional disability or require treatment, and it unrelated to pregnancy.

1. Endometriosis: is a condition where a woman has endometrial tissue outside the uterus. This by far the most common cause of CPP. Women will often associated symptoms of nausea, urinary frequency, and/or loose stools during their periods. They may have dysparunea (painful sex on deep penetration), dyschezia (deep pelvic pain with bowel movements), mid-cycle spotting (pink spotting with ovulation) and/or post-coital spotting (spotting after intercourse). The research is somewhat variable, but Napro surgeons will find endometriosis about 80% of the time in women who experience CPP. To learn more about  NaPro surgery click here.

2. Intra-abdominal Adhesions: the term "adhesions" refers to scar-like formation within in the pelvic or abdominal cavity, which forms when the body perceives something foreign or infectious is present and /or after an injury is perceived. Adhesions have been reported to develop following more than 90 % of abdominopelvic surgeries. Adhesions can attach to the organs and/or pelvic side walls and completely distort the anatomy. My Intro to NaProlecture will briefly discuss both endometriosis and adhesions. 

3. Adenomyosis: is a condition in which endometrial tissue is found within the smooth muscle layer of the uterus. The ectopic implants can induce abnormal changes in the myometrium, and cause abnormal uterine bleeding and dysmenorrhea (painful periods). Women who have adenomyosis often also have endometriosis. 

4. Pelvic Inflammatory Disease (PID): results from an acute, subacute, or chronic infection in the genital track that ascended through the vagina, into the upper reproductive organs. PID can involve uterus, fallopian tubes, and/or the  ovaries. The CPP associated with PID is believed to be caused by a prior infection that perhaps went untreated for a period of time. About as 30 % of women with PID will  develop CPP. 

5. Pelvic Congestion Syndrome (PCS): is a vascular disorder where the veins of the pelvic region become engorged due to improper drainage of blood out of the region. PVC often presents very similarly to endometriosis with some or all of the following symptoms: dysparunea, dyschezia, urinary frequency, nocturia, or chronic pelvic pressure, and/or lower leg swelling, that is worse after standing for a while. PVC is more common in women who have had multiple pregnancies. 

6.  Uterine Fibroids: area benign growths in the muscle layer of the uterus that can cause abnormal uterine bleeding, dysmenorrhea (painful periods), "bulk" symptoms, such as urinary frequency, leakage of urine with cough or sneeze, and nocturia (having to urinate in the middle of the night). Fibroids can also cause pelvic pressure. In the study linked to the button below, chronic pelvic pain was reported to be nearly 15 % in women with fibroid as compared to only 3% of women without fibroids. 

Your appointments at MyCatholicDoctor with me will be one FULL HOUR in length. Generally speaking, NaPro appts will follow a typical protocol as outlined below. However, every individual is different and your situation may warrant a more expeditious process. Please know, the Creighton Model System (CrMS) is very important. Your CrMS chart will help direct me to what diagnostic tests and imaging tests should be done and what treatment plan would be most appropriate. 

First Appt: I will take a comprehensive medical history and provide you with education about normal healthy reproduction and oftentimes about a condition I suspect you may have after we have talked a while. 

I will order a pelvic ultrasound which I will ask you to schedule on day 5 of your next menstrual cycle. I will order a series of laboratory tests. Click the "laboratory tests" button below to learn more. 

You will be asked to begin charting your menstrual cycles using the Creighton Model System (CrMS). Please choose a Fertility Care Practitioner (FCP)  by clicking the "Fertility Care Practitioners webpage" button below to learn more about scheduling an Introductory Session to get started. 

Please consider joining me as I pray for you here.

Second Appt:  You will be asked to return to the office in 2 mos for a follow-up appointment to review the results of your imaging and laboratory tests. Together we will also review your Creighton Model System (CrMS ) chart to look for specific biomarkers which will help me make a diagnosis. 

Please upload an image of your CrMS chart two days prior to all follow up visits and send to me via the portal. 

Please add the length of your post-peak phase and your mucus cycle score (MCS) to the R-hand margin of the chart. Your Fertility Care Practitioner (FCP) will calculate your MCS for you. 

During this appointment, you may be asked to begin some supplements and/or medications. We will also discuss drawing a full set of hormone panels. We will make a decision if you should have a peri-ovulatory estradiol panel, a post-Peak estradiol & progesterone panel, or both panels. 

 Hormone Panels: 

• Peri ovulatory estradiol panel: start on CD8, go to the lab EOD for an estradiol draw, until you have one draw post-peak. 
• post-Peak estradiol and progesterone panel: P+3, 5, 7, 9, and 11. See Handout #3 on the the Patient Handout webpage 
• Hormone panels require 2 mos of CrMS charting AND the patient must be able to confidently identify her Peak day.

Many patients will be asked to consider working with a dietitian or a nutritionist to help optimize your reproductive health. Oftentimes I may also recommend a mental health appointment to help with anxiety, depression and/or disordered eating habits. 

Third Appt: You will return to the office in 2 mos to review the results of your hormone panels as well as the biomarkers on your CrMS chart. Most often at this time I will have made one or more more diagnoses to identify the root cause of your symptoms. Together we will discuss a treatment plan, which will be implemented. 

Follow Up Appts:  You will return to the office every 2 months. During this time, I will conduct a comprehensive medical interview to ensure your symptoms have resolved, and to ensure you are responding well and not having any negative responses to the management plan. Depending on the individual patient and your individual diagnosis, I may need to monitor your progress with serial laboratory tests and/or serial imaging. 

After 6 -9 months: If medical management has not been successful, it is likely you will need a diagnostic laparoscopy. Therefore, I will refer you to a NaPro surgeon.  On occasion, I may come to know a surgical evaluation will be of benefit to you earlier on in this process, and an expedited surgical referral will have been recommended. NaPro surgeons typically book out 5 mos to one full year. At any time, if you feel you would like an expedited surgical referral, please feel free to discuss this with me. 

Please review my laparoscopy page. You will notice NaPro surgeries are done very differently as compared to laparoscopies done by mainstream medicine surgeons. We use a near contact approach and a near adhesion-free technique", which has been described as pelvic surgery of the pelvis.  

At any point in time, if a diagnosis has been made, treatment initiated, and/or you are satisfied with the medical management we have implemented, you can schedule annual or biannual visits, per your choice.