How to Cure Chronic Pelvic Pain

51 Tips for Dealing with Endometriosis

51 Tips for Dealing with Endometriosis

Do you have Endometriosis? Do you think you do, but aren’t sure? Are you having a hard time learning to cope? 51 Tips for Dealing with Endometriosis can help.

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Endometriosis Bible & Violet Protocol

The Endometriosis Bible & Violet Protocol is a comprehensive guide to understanding and treating Endometriosis and Endometriosis and Pregnancy. The author, Zoe Brown, has. suffered from Endometriosis and has also been cured of it's devestating consequences. She is dedicated to helping other women trying to cope with endometriosis and pregnancy. symptoms. The e-guide contains 303 pages which cover all fundamental information about endometriosis that can helps you pinpoint the root causes of your endometriosis condition and abolish typical symptoms of this problem. By learning this e-book, you can access to the road of quick natural healing without the side effects of over-the-counter drugs, or dangerous surgery at all. In 5 simple-to-apply steps within this e-guide, you will be taken through a process of learning what you should do to entirely defeat endometriosis within 2 to 4 months in such all natural ways.

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Endometriosis and Infertility Solution

Treating Your Endometriosis is written by Shelley Ross. It is an ebook explaining a safe, simple method to treat endometriosis naturally. Endometriosis is a condition where the uterus lining actually develops on the outside of the uterus. This abnormal growth is not just a nuisance it can be potentially dangerous if not treated properly. In this eBook Shelly does a wonderful job in showing you how to get your body to function as nature intended, a very important aspect if you are trying to get pregnant and suffer from endometriosis. Learn how a few simple changes in your diet can dramatically reduce your endometrial implants from spreading. You will also find more information on nutritional supplements, stress reduction techniques, best exercises to reduce endometriosis symptoms, and much, much more!

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Section Iii Therapy For Visceral Pain Scientific Basis And Practice Aspects

Psychological Interventions for Patients with Chronic Abdominal and Pelvic Pain 323 Luis F. Buenaver, Robert Edwards, and Jennifer A. Haythornthwaite Introduction 323 Biofeedback 324 Hypnosis 324 Cognitive Behavior Therapy . . . . 325 Multidisciplinary Treatment 326 Future Directions 326 References 327

Stages Of Diverticulitis

Patients usually present with visceral pain that localizes later to the left lower quadrant and that is associated with fever, nausea, vomiting, or constipation. A right lower quadrant presentation would not exclude this diagnosis because ascending colon or cecal diverticulitis can occur. If a colovesical fistula is present, the patient may present with pneumaturia or fecaluria (a virtually pathognomic finding). On examination, the patient may have localized left lower quadrant tenderness or more diffuse abdominal tenderness with peritoneal irritation signs, such as guarding or rebound tenderness. The differential diagnosis includes painful diverticular disease without diverticulitis, acute appendicitis, Crohn disease, colon carcinoma, ischemic colitis, irritable bowel syndrome, and gynecologic disorders such as ruptured ovarian cyst, endometriosis, ectopic pregnancy, and pelvic inflammatory disease.

Referred Pain Hyperalgesia and Viscero Viscerar Interactions

In the clinical context, it is common to observe that algogenic conditions may affect simultaneously more than one internal organ in the same patient. Especially when two viscera are involved, which share at least part of their central sensory projection, this circumstance gives rise to the so-called phenomenon of ''viscero-visceral hyperalgesia,'' due to which the patient experiences an enhancement of both spontaneous referred pain and referred hyperal-gesia (22). The concomitant presence of coronary heart disease and gallbladder calculosis, for instance, tends to produce more numerous anginal attacks and biliary colics in the patients than does one condition only (common sensory projection between heart and gallbladder T5) (24). The association of dysmenorrhea with IBS (common projection between uterus and colon T10-L1) (25) frequently produces more menstrual pain, intestinal pain, and somatic abdominal pelvic hyperalgesia (in the areas of referral from the uterus and from the...

Viscerovisceral Convergence

Convergence Spinal

Because the dorsal horn neuron cannot distinguish the source of the afferent input, there is confusion as to the site of the initial stimulus contributing to poor localization. The consequences of these viscerovisceral interactions are more profound than that of the referred somatic pain. Viscerovisceral interactions can produce inflammation in normal visceral tissue (via the dorsal root reflex) and can increase pain originating in other viscera (e.g., endometriosis increases pain from ureteral stones) (57).

Physical Health Consequences

Gastrointestinal problems in battered women are not uncommon. In fact, studies suggest that battered women have significantly more self-reported gastrointestinal symptoms than the average woman. Drossman (1994) tested the relationship of physical or sexual abuse history with the health status of female gastroenterology outpatients at a university medical center. Such a history was reported in 44 of the sample. After controlling for medical diagnosis and demographic variables, Drossman found that patients with an abuse history reported significantly more severe abdominal pain, a higher frequency of pelvic pain, more symptoms of headache and fatigue, and more lifetime surgeries than those not abused. Rapkin and associates (1990) conducted a controlled investigation of 31 women with chronic pelvic pain, 142 women with pain in other locations, and 32 control subjects without any pain complaints to determine if there is association between pain and abuse in one's childhood or adulthood....

Pathways in the Dorsal Funiculus

More direct clinical evidence comes from successful neurosurgical procedures aimed at treating intractable visceral pain. These procedures have often accidentally severed dorsal column axons in and around the midline. Commissural myelotomy was introduced as a technique to produce bilateral analgesia by interrupting the decussating axons of the spino-thalamic and spinoreticular tracts by means of a longitudinal midline incision extending over several segments (59). The rostrocaudal extent of commissural myelotomy was later reduced to a localized lesion made stereotaxically by inserting a metal electrode into the midline at the C1 level with the patient awake (69-72). The clinical result was an unexpectedly widespread distribution of pain relief, similar to that found with open commissural myelotomy, despite the small extent of the lesion and its location well rostral to the decussation of most of the STT. Similar successes were reported later using limited midline myelotomy to treat...

Approach To Ureteral Injuries Definitions

Hydroureter Ivu

Up to 1 of abdominal hysterectomies can be complicated by ureteral injury. Cancer, extensive adhesions, endometriosis, tubo-ovarian abscess, residual ovaries, and interligamentous leiomyomata are risk factors. Any gynecologic procedure, including laparoscopy or vaginal hysterectomy, may result in ureteral injury however, the majority of injuries are associated with abdominal hysterectomy. The most common location for ureteral injury is the cardinal ligament, where the ureter is only 2 to 3 cm lateral to the cervix. The ureter is just under the uterine artery, water under the bridge (Figure 12-1). Other

Etiology of Adhesion Formation

Surgically induced adhesions are a complication of invasive surgical procedures (48). Adhesions induced by either trauma, surgical or otherwise, and pathology (i.e., endometriosis) can lead to a variety of complications including infertility, bowel obstruction, pain, impaired joint mobility, and unintended complications during reoperation (49-53). The etiology of surgically induced adhesions is thought to be a result of incidental trauma caused by tissue manipulation (54), desiccation (54), tissue ischemia, and a foreign body reaction to particulates (55-57). This damage leads to a wound healing response that results in the production of a serous exudate that leads to fibrin clot production (58-60). If the fibrin clot is relatively short lived then it is resorbed with concomitant normal wound repair. If, however, the fibrin clot resides for a longer time period then cells of fibroblastic phenotype are recruited to the site. These cells begin to generate collagen leading to a scar-like...

Other progesterone derivatives

Danazol (Danol) is a derivative of the progestogen, ethisterone. It has partial agonist androgen activity and is described as an 'impeded' androgen it has little progestogen activity. It is a relatively selective inhibitor of pituitary gonadotrophin secretion (LH, FSH) affecting the surge in the mid-menstrual cycle more than basal secretion. This reduces ovarian function, which leads to atrophic changes in endometrium, both uterine and elsewhere (ectopic), i.e. endometriosis. In males it reduces spermatogenesis. Androgenic unwanted effects occur in women (acne, hirsutism and, rarely, enlargement of the clitoris). It is chiefly used for endometriosis, fibrocystic mastitis, gynaecomastia, precocious puberty, men-orrhagia and hereditary angioedema (p. 715).

CAM Approaches for Pediatric Pain 21 Acupuncture

Kemper and colleagues (23), however, found that 67 of children referred to an acupuncturist for chronic pain problems (most commonly migraine headaches, endometriosis, and reflex sympathetic dystrophy) and 60 of their parents thought that acupuncture was a positive experience 70 of the children and 59 of the parents reported definite pain relief from the intervention. These findings support the feasibility and acceptability of acupuncture for pain relief in children. However, most of the patients in this study were adolescents (median age, 16 years), and only those patients who were referred and actually visited the acupuncturist were interviewed. No information was available regarding the percentage of referred patients who refused acupuncture or the reasons for their doing so. Thus, this study may have overestimated the acceptability of treatment. These researchers recommended further prospective investigations, particularly in younger samples.

Clinical Approach Partner Abuse

Some signs and symptoms may be less obvious and may require numerous encounters until the finding of family violence is made. Victims of abuse may present to doctors frequently for health complaints or have physical symptoms that cannot otherwise be explained. Chronic pain, frequently abdominal or pelvic pain, is commonly a sign of a history of abuse. The development of substance abuse or eating disorders may prompt inquiry into family violence as well.

Clinical Approach

PID, or salpingitis, usually involves Chlamydia, gonorrhea, and other vaginal organisms, such as anaerobic bacteria. The mechanism usually is ascending infection. A common presentation is a young, nulliparous female complaining of lower abdominal or pelvic pain and vaginal discharge. The patient may also have fever and nausea and vomiting if the upper abdomen is involved. The cervix is inflamed therefore, the patient often complains of dyspareunia. Long-term complications of salpingitis include chronic pelvic pain, involuntary infertility, and ectopic pregnancy. The risk of infertility due to tubal damage is directly related to the number of PID episodes. The intrauterine contraceptive device (IUD) places the patient at greater risk for PID. whereas oral contraceptive agents (progestin thickens the cervical mucus) decrease the risk of PID.

Functional Gut Disorders

More than half of the patients in a gastroenterological clinic complain of abdominal symptoms, without demonstrable cause by conventional diagnostic tests. In the absence of positive findings, unexplained abdominal symptoms have been categorized as functional gastrointestinal disorders, and several syndromes, such as noncardiac chest pain, functional dyspepsia, and the irritable bowel syndrome (IBS), have been defined. Non-cardiac chest pain refers to patients with thoracic symptoms without cardiac, pulmonary, or esophageal disorders. Functional dyspepsia applies to symptoms such as epigastric pain, pressure, fullness, and bloating that presumably originate from the upper gastrointestinal tract, and that are frequently precipitated by meals. The IBS is attributable to the distal gut, and is characterized by abdominal pain or discomfort associated to disordered bowel habit. The diagnosis of those syndromes is solely based on clinical criteria, because their underlying pathophysiology...

Physical Examination

Abdominal Examination Pregnant Lady

Rectal examination A rectal examination will reveal masses in the posterior pelvis and may identify occult blood in the stool. Nodularity and tenderness in the uterosacral ligament can be signs of endometriosis. The posterior uterus and palpable masses in the cul-de-sac can be identified by rectal examination.


A 45-year-old woman underwent a total abdominal hysterectomy for symptomatic endometriosis 2 days earlier. She complains of right flank tenderness. On examination, her blood pressure is 130 90, heart rate 100 bpm, and temperature 102 F. Heart and lung examinations are normal. The abdomen is slightly tender diffusely with normal bowel sounds. The incision appears within normal limits. Exquisite right costovertebral angle tenderness is noted.

The Uterus

Animal models for the study of uterine pain have focused on either distension or inflammatory protocols, although there appear to be significantly fewer studies in the current literature compared to, for example, the colon or bladder. Uterine inflammation in the anesthetized rat can be achieved by the introduction of 10 mustard oil into one uterine horn through an implanted catheter (97). A modification of this model enabled its behavioral characterization, and involved the tight ligation of one uterine horn followed by the injection of mustard oil into the lumen, with the rats subsequently allowed to recover (98). Observation of the rats over the following seven days revealed abnormal behavior similar to that reported for the ureteral calculosis model (among others) described above, in the majority (11 of 14) of rats. No sham-operated controls showed these behaviors. Muscle hypersensitivity of the lower back and flanks (a referred pain perhaps comparable to pelvic pain seen in...

Animal Studies

The combination of an artificial ureteric stone with experimental endometriosis in female rats produces particularly pronounced algogenic effects. In this model, mimicking the viscero-visceral hyperalgesia'' observed in women with urinary calculosis and endome-triosis, an enhancement is, in fact, observed not only of the spontaneous pain behavior (both ureteral and uterine) but also of the referred lumbar muscle hyperalgesia, with a poststone decrease in vocalization thresholds to electrical muscle stimulation significantly more pronounced than in rats with a stone only or rats with sham-endometriosis plus stone. Similarly to what is observed in humans, treatment of only one condition in this model relieves symptoms from the other, i.e., treatment of endometriosis before stone formation (with NSAIDs or tramadol) prevents the enhancement of pain symptoms from the ureter (uret-eral crises and referred lumbar muscle hyperalgesia) (43). Injection of mustard oil into the right horn of the...

SCC Antigen

Elevated serum SCC antigen has been detected in tumors containing squamous cell, which include cervical cancer, lung cancer, head and neck cancer, and esophageal carcinoma. SCC antigen, a subfraction of TA-4 purified from squamous cell carcinoma tissue of the uterine cervix, is also a glycoprotein with a molecular weight of approx 48 kDa. Although elevated serum SCC can also be found in benign disease including pulmonary benign diseases, ovarian cystoma, uterine myoma, endometriosis, hepatitis, and cirrhosis, the frequency and the serum levels of SCC in these benign diseases, however, were low (4). Few of these benign diseases containing SCC exceeded 5 ng mL. SCC appears to increase with the advance of clinical stage. SCC antigen is highest in patients with recurrent malignant diseases. Decline of serum SCC was observed in patients who respond to chemotherapy.

Scc Tumor Marker

Squamous cell has been found in tumors such as cervical cancer, lung cancer, head and neck cancer, and esophageal carcinoma. The tumor marker specifically associated with squamous cell is squamous carcinoma antigen (SCC antigen), which is a subfraction of TA-4. TA-4 was purified from squamous cell carcinoma tissue of the uterine cervix, which is also a glycoprotein with a molecular weight of approx 48 kDa. Elevated serum SCC has been detected in patients with cervical, lung, head and neck, and esophageal cancer. However, elevated serum SCC can also be detected in benign diseases, including pulmonary benign diseases, ovarian cystoma, uterine myoma, endometriosis, hepatitis, and cirrhosis. The frequency and the serum levels of SCC in these benign diseases were low (24,25), with few cases exceeding 5 ng mL. In cervical squamous cell carcinoma (CSCC) SCC appears to increase with the advance of clinical stages of the cancer. SCC was highest in patients with recurrence malignant diseases. A...

GnRH Agonists

Twenty-eight women with endometriosis who ranged in age from 22 to 44 years were treated with 3.6 mg of goserelin acetate depot every 28 days for 6 months (137). BMD measurements of the PA lumbar spine were obtained with DXA (Hologic) at baseline, 6, 12, and 30 months. Results were compared to those in 25 healthy women who served as age-matched controls. There was a significant decrease of 4 in lumbar spine BMD in the treated group after 6 months that persisted for the second 6 months during which no goserelin was administered. Values in the control group did not change during this period. At 30 months, however, BMD values in the treated group had returned to baseline levels. Eleven women with endometriosis were treated with goserelin 3.6 mg every 28 days for 6 months, whereas 12 women with endometriosis were treated with oral danazol 600 mg for 6 months (138). BMD measurements of the lumbar spine and proximal femur were performed in both groups using DPA (Lunar DP3) at the beginning...

Menstrual disorders

Medical treatments for endometriosis have focused on the hormonal alteration of the menstrual cycle in an attempt to produce a pseudo-pregnancy, pseudo-menopause, or chronic anovulation. Each of these situations is believed to cause a suboptimal milieu for the growth and maintenance of endometrium and, by extension, of implants of endometriosis. Danazol 600 to 800 mg per day causes anovulation by attenuating the midcycle surge of luteinising hormone secretion, inhibiting multiple enzymes in the steroidogenic pathway, and increasing serum free testosterone concentrations. Although most treatments for endometriosis are directed at the implant themselves, the symptoms can be also treated directly. Nonsteroidal antiinflammatory drugs (NSAID) such as diclofenac, ibuprofen, mefenamic acid, are often given to relieve the pain associated with endometriosis. These drugs are frequently the first-line treatment in women with pelvic pain whose cause has not yet been proved to be...

Cervical Cancer

About 190,000 new cases and 114,000 deaths from ovarian cancer occur annually in the world.24 The highest case loads are in Scandinavia, Eastern Europe, the United States, and Canada. Low incidence rates occur in Africa and Asia. As with most cancers, the risk increases with age. Risk factors include obesity, a history of pelvic inflammatory disease, polycystic ovary syndrome, and endometriosis. Hormone replacement therapy increases risk, whereas oral contraceptives and tubal ligation decrease risk. A family history of breast or ovarian cancer also increases risk and involves mutations in brca1 and brca2 genes. Hereditary non-polyposis colon cancer has also been associated with ovarian cancer.

Clinical Pearl

The groin region should be carefully palpated for bulging (hernias) upon rest and provocation (coughing, standing), c. Rectal examination A rectal examination will reveal masses in the posterior pelvis and may identify gross or occult blood in the stool. In females, nodularity and tenderness in the uterosacral ligament may be signs of endometriosis. The posterior uterus and palpable masses in the cul-de-sac may be identified by rectal examination. In the male, the prostate gland should be palpated for tenderness, nodularity, and enlargement.