As an OB/GYN, I have examined and treated thousands of women who complain of pelvic pain. Sometimes the diagnosis is easy — it’s pelvic inflammatory disease, a ruptured ovarian cyst, a twisted ovary, or an ectopic pregnancy. But more often than not, the cause doesn’t jump out and whack you on the white coat.
How We Evaluate Pelvic Pain
In most cases, we start with a pelvic exam, which may not reveal any helpful information. So we dig deeper, ordering a pelvic ultrasound, which will usually rule out ovarian cysts or fibroids, or we get a pregnancy test, meant to rule out ectopic pregnancy. These tests won’t pinpoint a diagnosis of endometriosis or scar tissue or interstitial cystitis (inflammation of the bladder wall).
So if we find nothing, we wind up scratching our heads, prescribing pain pills, and scheduling surgery so we can go hunting with various scopes and try to determine the cause.
Once we put a laparoscopic camera inside a woman’s abdomen, we can get up close and personal with her ovaries, the outside of her uterus, the lining of her abdomen, the outside of her bowel. We can look for little lesions that resemble burn-marks or red blebs or clear blisters, which can signal endometriosis. Or we can track down and cut up scar tissue.
What If You Find . . . Nothing?
But way too often, we do all that, we invade a woman’s body, we look inside and we find….nothing. Which should be good news, right? Congratulations! You don’t have cancer or any bad disease we can see with a laparoscope! But our patients don’t usually celebrate. They cry, because many have suffered for years and we have failed to diagnose or fix the cause of their pain.
So what do we do? We ship them off to chronic pain clinics, shrinks, and pelvic physical therapists, who drug them up with painkillers and antidepressants and teach them exercises intended to help them change the experience of their pain. But so many of these women lose their mojo. They become despondent. They wind up cutting back on activities until many are stuck in bed, hooked on narcotics. As a doctor, it’s frustrating and defeating — and as a patient, it must be a million times worse.
A Diagnosis That May Cause Hidden Agony
But a new article in The New York Times shines a light on a curable diagnosis many doctors may miss, which may result in years of hidden agony for women suffering from this condition.
The article reports:
“Unlike hernias in men, which are far more common, those that afflict women are usually small and internal and rarely cause an obvious bulge. Symptoms can be suggestive of other problems — ovarian cysts, fibroids, endometriosis or adhesions from a previous operation — but surgically correcting these conditions does not relieve the devastating pain.
On average, women go through four prior surgeries, and some a lot more than that, before the real cause of their pain is identified,” said Dr. Deborah A. Metzger, a gynecologist in Los Altos, Calif., who specializes in chronic pelvic pain.
“When a woman lies flat on the examining table, the signs and symptoms of a hernia disappear. And the usual exam, an ultrasound, rarely reveals the real problem. Lacking an accurate diagnosis, doctors often send patients to be drugged up by pain specialists and psychiatrists.
For many women with these occult, or hidden, hernias, it can take years, if ever, to get the right diagnosis and correct the problem. Women account for only 8 percent of the hernias diagnosed, and doctors simply ‘don’t think hernia’ when women complain of pelvic pain,” Dr. Metzger said in an interview.
How Many Have I Missed?
Honestly, hidden abdominal hernias have just never been in my differential diagnosis when I’m examining a woman with pelvic pain, but clearly they should be. In twelve years of training to become an OB/GYN, nobody ever taught me to be on the lookout for internal abdominal hernias that might mimic all these other conditions. I can’t help wondering how many I might have missed.
So I wanted to make sure to pass this info along to any of you who might be suffering from chronic pelvic pain. And if you were my patient and I missed this because nobody taught me it existed, I’m so sorry. Please forgive my ignorance and go get help now!
Do You Have a Hidden Hernia?
So how do you know if you might have a hidden abdominal hernia? Unlike other hernias, which might present with an obvious bulge in the groin or belly button area, most of these hernias cannot be seen or felt on exam. But the symptoms are not the same as most other gynecologic conditions. You may feel burning, pinching pain shooting down into the groin, leg and back. It is usually worse with exercise, prolonged standing, lifting, bending, coughing, laughing, going up and down stairs, straining at stool, and during the menstrual period. Basically, anything that increases abdominal pressure — even prolonged sitting — can push the abdominal contents through the hernia, provoking the pain, which may occur sporadically throughout the day.
How Can You Diagnose It? An MRI can clinch the diagnosis, although even MRI may miss it, if the abdominal contents are not protruding through what is usually only a tiny hole in the muscle or fascia (the thick layer that holds your organs inside). When these small holes exist, pieces of abdominal fat can protrude, pressing on nerves and causing pain.
Can It Be Fixed? Yes, usually via laparoscopic surgery performed by a general surgeon. But someone has to suspect it first!
Be Your Own Doctor
If you suffer from chronic pelvic pain and you’ve run the gamut of tests, surgeries, pills, etc, take a look at the list of symptoms. Does this sound like you? Check in with your body and ask your intuition. Talk to your Inner MD and ask, “Could this be my diagnosis?”
If your Inner MD says yes, be an empowered patient, print out this article, take it to your doctor, and ask for an MRI. This is your body, your life, your pain — you deserve to be vital. You deserve to get your mojo back. You deserve to have relief so you can get on with what you’re here on this earth to do — live, love, serve, be happy, and make your dreams come true.
Do you suffer from pelvic pain or know someone who does? Share your story and pass this on to anyone it might help…
Lissa Rankin, MD: Founder of OwningPink.com, Pink Medicine Woman coach, motivational speaker, and author of What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend and Encaustic Art: The Complete Guide To Creating Fine Art With Wax.
Learn more about Lissa Rankin here.