Lifewatch: Chronic pelvic pain

Reported by Claire Hosmann - bio|email
Posted by Debra Worley - email

(WECT) - 15 percent of women in the United States live with chronic pelvic pain.  For some, it's so bad they can't move or function normally, yet as many as 70 percent of sufferers never get a definite diagnosis.

Shannon Henderson considered herself a happy mom until she had surgery to remove an ovary.  It left her with chronic pain so severe, she considered the unthinkable.

"It was like a stabbing, burning pain," said Shannon.  "At some point, I just knew that if I didn't have a family, I didn't want to live."

Prescription drugs didn't help the pain, and some doctors told her she was crazy.

"Chronic pain of any kind will cause symptoms like depression, suicidal thoughts, but it's never ever all in their head - there's always a reason for pain," said Gynecologic Surgeon Dr. Michael Hibner.

Hibner is pioneering new treatments for pelvic pain.  In surgery, he cuts away scarring or ligaments that can press on nerves, causing pain.  Then he puts a protective sheath around the nerve to keep the scar tissue and pain from coming back.

"Approximately 70 percent of patients do better after surgery," said Hibner.

Dr. Hibner also uses lidocaine or botox injections to ease muscle spasms and nerve pain, particularly for women who have chronic pain after having a baby or surgery.

"A lot of women with chronic pain develop muscle spasms in the pelvic floor," said Hibner. "Botox is very good at relaxing those muscles."

Shannon had lidocaine injections, and within a few days the pain started to subside.

Dr. Hibner is one of the fewer than ten surgeons in the world who perform the pelvic pain surgery.  He first recommends physical therapy and injections before an operation.

For more information, please contact:
Carmelle Malkovich
Public Relations
St. Joseph's Hospital and Medical Center
Phoenix, AZ
(602) 406-3319

BACKGROUND: Chronic pelvic pain is one of the most common medical problems women experience. According to the International Pelvic Pain Society, 25 percent of women with the condition spend two to three days out of each month stuck in bed, and more than half of them must cut back on certain daily activities. For pelvic pain to be considered chronic, it must last for more than six months.

SYMPTOMS: Chronic pelvic pain is characterized by strong, constant pain that is physically and mentally exhausting. Symptoms besides pain include difficulty sleeping, decreased appetite, "slow motion" body movements and depression. Some women become suicidal because of the overwhelming pain. Despite such life-altering symptoms, experts say many causes of chronic pelvic pain are overlooked and underdiagnosed. "I have seen hundreds and hundreds of women with chronic pelvic pain, and I don't think I have seen a single one in whom I could not find a reason for pain," Michael Hibner, M.D., a gynecologic surgeon at St. Joseph's Hospital and Medical Center in Phoenix, Ariz., told Ivanhoe.

Some of those underdiagnosed conditions are endometriosis, adenomyosis, pelvic congestion and genetic abnormalities. A 2005 study found a majority of women suffering chronic pelvic pain had pelvic congestion, a condition marked by the presence of varicose veins in the ovaries and elvis. The study also found overall, women who underwent a procedure called nonsurgical embolization experienced a 62 percent reduction in pain, and 85 to 95 percent of women reported improvement after the procedure.

TREATMENTS: Before considering surgery, most doctors encourage nonsurgical treatments for chronic pelvic pain including medications like anti-inflammatories, anticonvulsants, opiods and antidepressants; local nerve blocks; physical therapy; and psychotherapy. Botox injections provide relief in some cases. "A lot of women with chronic pelvic pain develop a muscle spasm in their pelvic floor, and Botox is very, very good at relaxing those muscles," Dr. Hibner said.

Surgeries are recommended in certain cases of pelvic pain, including to treat endometriosis or scar tissue, or to treat a condition called pudendal neuralgia. In a surgery called pudendal nerve compression, surgeons cut away ligaments that may be pressing on the pelvic nerve and put a protective sheath around to prevent pain from recurring. Some women seek hysterectomies to alleviate perstistent pain.

In fact, according to the National Pain Foundation, about 12 percent of hysterectomies are performed to treat chronic pelvic pain. Success rates range from 60 percent to 95 percent, but some experts believe those rates may be exaggerated.

Copyright © 2009 Ivanhoe Broadcast News, Inc.