Advanced Endometriosis Center NJ

Advanced Endometriosis Center NJ is one of the leading endometriosis treatment place in NJ areas.

Pelvic Pain is a Warning

The simple truth is that ALL pain is a warning signal. It is part of our evolution and the thing that helped us survive as a species. A simple example is the act of pulling your hand away from the fire. You could imagine the damage to your skin and hand if you waited until you came to a decision to remove it instead of yanking it away as soon as it became painful, which is immediate. Injuries hurt so that you will not do things that injure you. And the pain from an injury is so you’ll leave that injury alone. A muscle strain’s pain will remind you to not use that muscle so it can heal.

Pain is a complicated thing

There are different types of pain:

• Pain from injury: there are things which injure tissue directly, firing off the pain nerves’ signals to your brain. These pain signals start before an injury so that you’ll stop the action before injury actually begins. Penetrating injuries, burns, and even pain from compromise to the blood supply of an area begin with enough of a warning to limit the actual damage.
  The point of a knife will hurt progressively more as it’s pushed into the skin. Remedying the situation before penetration, for example, will prevent an actual injury. There are many pain nerves that respond to this type of stretching (or, if not prevented, tearing or lacerating). One example is distention of your bowel with gas or obstruction, the actual stretch of the overlying tissue causing pain.
• Inflammatory pain: this is the type you might experience with endometriosis. Inflammatory chemicals are released at the site of inflammation (also from infection or injury) and these make the nerves which fire off to transmit the sensation of pain fire off from less provocation than usual. These nerves become oversensitive.
  Think of a sunburn. Normally it doesn’t hurt if someone were to pat you on the back. Add a sunburn, however, and this normally innocent action is very painful. Getting a cut on your finger will hurt (sharp pain), but a day later bumping that same area will hurt much more severely (having added the inflammatory pain to the acute injury).
• Referred pain: pain from a certain place will land at one of your spinal segments before traveling to your brain for appreciating its discomfort, quality, quantity, and location. Other nerves that land at or near that segment can pick up the signal which will confuse your brain that the pain is coming from those otherwise innocent places.
  For example, when someone’s neck or left arm hurts with the pain of a heart attack; the right shoulder blade hurting with gallbladder distension; or the left shoulder blade hurting with enlargement of the spleen. There are many other examples.

Your pelvis is a complicated place.

Your pelvis is the lowermost part of your abdominal cavity, and is that part of the cavity that contains your intestines, colon, rectum, reproductive organs (ovaries, tubes, uterus), bladder, and a complex ring of muscles which make up its floor. Thus, your pelvis is a very busy place.

All of the organs are in contact with an overlying covering called the peritoneum, which is rich in pain nerves that respond to direct injury, inflammation, and distention. Worse than that, because of this covering, pain signals from one organ can spread to other organs in contact with this covering, creating a referred pain which can confuse a diagnosis or—worse—cause a delay in diagnosis.

Why is a delay in diagnosis dangerous?

A delay in diagnosis is dangerous in the same way that not pulling your hand out of a fire is more dangerous the longer you take to do that: more injury can accumulate.

What are types of pelvic pain?

This can be described best as a list:

Bladder pain:

• Intrinsic (internal) pain in your bladder can be due to inflammatory substances that are released as a reaction to infection, and with the inflammation, pain. This can also sensitize your bladder wall to distension such that small amounts of urine can make your bladder think it is over-full, giving you pain or urinary urgency.
• Extrinsic (external) pain is when something outside of your bladder is pushing on it. However, the nerves that respond to distension cannot tell the difference between things making it stretch from the inside (intrinsic pain, above) or from the outside, like a fibroid tumor.

Rectal pain:

• Intrinsic pain can be from inflammation, such as infection (e.g., diverticulitis) or blood (intestinal bleeding). Also, constipation will distend the tissue surrounding your small intestines or colon/rectum, causing colicky pain.
• Extrinsic pain, like in the bladder, can make it seem the stretching or inflammation is coming from the inside when it really is originating from outside, due to fibroids or the kinking from scarring (from infection or endometriosis).

Ovarian pain: your ovaries, like your other pelvic organs, respond to stretch of their overlying covering (peritoneum) with a painfully sharp sensation.

• Intrinsic pain can be from a cyst in your ovary distending it and stretching its pain nerve fibers.
• Extrinsic pain can be from anything putting a stretch on the stalk from which your ovary is suspended in your pelvis on either side. This stalk is very rich in stretch-pain fibers, such that a heavier ovary from a cyst or the pulling on it from scarring (again, from infection or endometriosis), can provoke those nerves to fire off.

Tubal pain: your tubes have the same pain nerve endings, which can be fired off from internal distension (as happens with an ectopic pregnancy) or external distension (from the scarring that occurs with endometriosis).

Uterine pain:

• Intrinsic pain is due to your uterus being designed to expel anything that becomes lodged within it, be it menstrual blood (causing cramping) or a baby (causing labor). Infection of the innermost lining (“endometritis”) can cause an irritation which initiates those cramps. So can uterine fibroids, especially if they hang on a stalk into your uterine cavity causing pressure.
• Extrinsic pain happens when the ligaments that normally support the position of your uterus in your pelvis get pulled or stretched, e.g., fibroids making your uterus heavier or adenomyosis making your uterus bigger. When the mechanical act of intercourse causes movement of your uterus against these ligaments, this can cause referred pain to your lower back or inguinal/vaginal/vulva regions.

All menstrual discomfort is of uterine origin. Every woman has her own threshold of when uterine contractions become painful for her, a spectrum which ranges from no pain at all to that of becoming bedridden. However, period pain at the painful extreme is highly indicative of endometriosis.

When pelvic pain becomes even more complicated

The above list oversimplifies what’s really happening. Since these organs all share the same space and since they’re all covered with the same lining, saying that they all “talk” to each other is a quaint way of saying that one painful organ can provoke the sensation of pain from the other organs nearby.

But these are just symptoms: even more alarming is that an actual disease process in one may contribute to disease in another. Studies have shown that a problem in one area raises the probability that you will have problems in another area. These conditions are, therefore, related in some way that have, as yet, been unexplained:

• Painful bladder syndrome (“interstitial cystitis”)
• Pelvic pain (of the reproductive organs—uterus, tubes, ovaries), usually from endometriosis, fibroids, or infection/scarring
• Inflammatory bowel disease or irritable bowel syndrome

While these three make sense because of the “communicative” nature of the organs of your pelvis, there are additional co-conditions associated with pelvic pain:

• Migraine headaches
• TMJ (temporomandibular joint) dysfunction and associated dental conditions
• History of childhood sexual abuse (or other childhood trauma)

The first three seem logical, but the second three point to contributions to the mix from the brain and psyche.

And this is why pelvic pain is so very complicated: it indicates pathology in the pelvic anatomy, the spinal column, the brain, and even the deeper psychological workings of the mind.

How can such a complicated process be fixed?

This takes a specialist in pelvic pain, like Dr. Ulas Bozdogan of NJ Endometriosis—someone who can see the big picture. His vast experience and his ability to think outside the box can corral many seemingly unrelated conditions into a common problem to address. Otherwise, a woman with pelvic pain may bounce from gynecologist to Gastroenterology to urologist to neurologist to—finally—a psychiatrist when she is told “it’s all in your head,” which Dr. Bozdogan considers an unacceptable tragedy. 

Next, armed with the information of all of the “cross-talk” of these organs, endometriosis (for example) can be removed with robotic same-day surgery while incorporating strategies for how it might be causing your bladder pain or your rectal pain. Or even your emotional pain from childhood abuse.

NJ Endometriosis understands the complexity of pelvic pain

If you see someone who doesn’t see the complexity of inter-related disease, you likely will continue to suffer, get bounced around to separate specialists needlessly, and will get no closer to fixing this complicated problem. Making an appointment with NJ Endometriosis is your first step toward untangling the complexity of your problem.