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Gastroenterology (Expert Forum)
Pelvic floor pain
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Pelvic floor pain
by redrobin, Apr 18, 2003 12:00AM
I am 61 and have been extremely healthy until about 5 years ago.
I have been diagnosed with Interstitial Cystitis and though they have me on many medications my pain has worsened. I've found that some of my worst pain happens when I need to have a bowel movement. I have to really push and then my movement is a few hard balls. I usually feel better after this for a little while. I hurt from just below my navel down and inside. Sometimes I have spasm like pains that double me over. I take about 5 aspirin and lay down till they take effect. But even laying down causes pain. I wake up as many as 10 times a night to urinate. Sometimes I'll releve myself and go back to bed to have to get up again in about 5 to 10 minutes. It's not a matter of waiting it out. The pain just keeps getting worse till you get up. Oddly when I'm up I don't usually have this problem. I have been cystoscoped twice and my bladder has shrunk and is red and inflamed. I take Elmiron (to coat inside of bladder) Effexor XR (to help with pain) Neurontin (pain) Urised (bladder spasms) Ditropan (urgency) Hydroxine (help me sleep). All any of these do is make me stay sleepy all the time. I have had a hysterctomy and then a year later had a rectocele and cytocele repair surgery. All this has happened within the last five years.
Do you think this pain I feel and constipation is coming from the damage to my pelvic muscles ,my medications or is it something I should ask a different doctor about?
I can't plan a trip because it hurts to hit bumps or go for long rides. I have to sit down real easy and sometimes over on the side of one hip. Sometimes I have to stand. I've gained weight because I can't pick up any weight without it hurting in my pelvic area, up inside. The same goes for bending down to pick something up, it feels like everythings going to fall out.
I know this is long but I'm at the end of my rope. I have a Son, two Grandchildren and my Mother living with me and if I didn't have a loving husband who is trying to do his work and mine I couldn't make it.
Any suggestions welcomed,
I have been diagnosed with Interstitial Cystitis and though they have me on many medications my pain has worsened. I've found that some of my worst pain happens when I need to have a bowel movement. I have to really push and then my movement is a few hard balls. I usually feel better after this for a little while. I hurt from just below my navel down and inside. Sometimes I have spasm like pains that double me over. I take about 5 aspirin and lay down till they take effect. But even laying down causes pain. I wake up as many as 10 times a night to urinate. Sometimes I'll releve myself and go back to bed to have to get up again in about 5 to 10 minutes. It's not a matter of waiting it out. The pain just keeps getting worse till you get up. Oddly when I'm up I don't usually have this problem. I have been cystoscoped twice and my bladder has shrunk and is red and inflamed. I take Elmiron (to coat inside of bladder) Effexor XR (to help with pain) Neurontin (pain) Urised (bladder spasms) Ditropan (urgency) Hydroxine (help me sleep). All any of these do is make me stay sleepy all the time. I have had a hysterctomy and then a year later had a rectocele and cytocele repair surgery. All this has happened within the last five years.
Do you think this pain I feel and constipation is coming from the damage to my pelvic muscles ,my medications or is it something I should ask a different doctor about?
I can't plan a trip because it hurts to hit bumps or go for long rides. I have to sit down real easy and sometimes over on the side of one hip. Sometimes I have to stand. I've gained weight because I can't pick up any weight without it hurting in my pelvic area, up inside. The same goes for bending down to pick something up, it feels like everythings going to fall out.
I know this is long but I'm at the end of my rope. I have a Son, two Grandchildren and my Mother living with me and if I didn't have a loving husband who is trying to do his work and mine I couldn't make it.
Any suggestions welcomed,
Doctor's Answer
by Kevin Pho, MD, Apr 18, 2003 12:00AM
, Apr 18, 2003 12:00AM
Hello - thanks for asking your question.
You note pelvic flood dysfunction. You have had a hysterectomy, rectocele and cystocele repair.
It is certainly possible that your symptoms may be due to your pelvic muscles. Instrumental testing may be considered to diagnose pelvic musculature. Electromyography with needle electrodes permits visualization of individual motor unit action potentials; surface electrodes detect activity of groups of motor units. Pressure recording from the urethra, vagina, and anus can be used to assess pelvic floor muscle strength.
You stated you have had surgery for a cystocele. Ancillary procedures include reinforcement of the vaginal wall with a synthetic patch underneath the bladder and anchor it to the existing fascia.
Regarding the rectocele, several approaches to rectocele repair have been described that depend upon the nature of the defect(s) identified. They include:
Traditional posterior colporrhaphy
Repair of a specific defect
Graft placement
Rectal wall imbrication
Repair of rectal prolapse.
If a recurring rectocele is the cause of your symptoms, you may want to discuss one of these approaches with your surgeon.
Of course, if you are having changes in your bowel habits, you may want to consider endoscopy (either a colonoscopy or flexible sigmoidoscopy) to ensure that a colorectal mass is not causing your symptoms.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
You note pelvic flood dysfunction. You have had a hysterectomy, rectocele and cystocele repair.
It is certainly possible that your symptoms may be due to your pelvic muscles. Instrumental testing may be considered to diagnose pelvic musculature. Electromyography with needle electrodes permits visualization of individual motor unit action potentials; surface electrodes detect activity of groups of motor units. Pressure recording from the urethra, vagina, and anus can be used to assess pelvic floor muscle strength.
You stated you have had surgery for a cystocele. Ancillary procedures include reinforcement of the vaginal wall with a synthetic patch underneath the bladder and anchor it to the existing fascia.
Regarding the rectocele, several approaches to rectocele repair have been described that depend upon the nature of the defect(s) identified. They include:
Traditional posterior colporrhaphy
Repair of a specific defect
Graft placement
Rectal wall imbrication
Repair of rectal prolapse.
If a recurring rectocele is the cause of your symptoms, you may want to discuss one of these approaches with your surgeon.
Of course, if you are having changes in your bowel habits, you may want to consider endoscopy (either a colonoscopy or flexible sigmoidoscopy) to ensure that a colorectal mass is not causing your symptoms.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
