The past few weeks I’ve been having lots of problems, turns out they are not likely caused by the Endometriosis itself, but rather complications caused by the Endometriosis and surgery. Last week I had my first appointment with my new gynecologist. It was a real eye opener, and I am so thankful that I switched doctors. The reasons why will be very clear as I tell the story
The appointment was fairly standard until my exam. She told me it would likely be different than any exam I had before. During the bi-manual examination she pressed on all the muscle groups in my pelvis. Almost every pressure point caused pain. A few actually caused radiating pain across my entire pelvis, and pain I have not felt since starting Lupron.
After the exam we had a lot to talk about. I now have a diagnosis of Pelvic Floor Dysfunction caused by the long term pain and inflammation from when my Endometriosis was active. The primary treatment is Pelvic Physical Therapy, and on average it takes about 10 sessions to resolve the muscle issues. She also prescribed Valium Vaginal Suppositories to help relieve my near constant muscle spasms.
Initially she thought I needed to see a Gastroenterologist for my constipation issues. After talking through the spasms and tightness of my pelvic muscles she said it was very possible that my pelvic muscles were unable to properly relax to allow me to have bowel movements. This is likely why the Bentyl I was prescribed for intestinal spasms has not been working. This theory also explains why I have severe pain and spasms after bowel movements.
She also expressed concern that some of my Endometriosis may have been missed during surgery. Based on my surgery report she noted that there were several areas of deep lesions that my old doctor likely had not anticipated. She referred me for an MRI as dense lesions of Endometriosis often show on MRI scans. She said no medical therapy will work effectively until all deep lesions of Endometriosis are removed.
The last and most surprising discovery was that during my physical exam she felt that my uterus was still enlarged and inflamed. She stated that at this point after surgery my uterus should be normal and this is a sign of potential infection. So I was also prescribed a two week course of antibiotics and at my follow-up if it is still enlarged, or my MRI shows it is something else she will need to keep investigating and trying treatments.
She was blown away that my last doctor had not done a physical since surgery, did not have any theory or plan for my ongoing pain, that I did not have a plan for post Lupron, and had been resistant to prescribe Provera in place of Northinedrone.
I am surprised that a potential uterine infection had been missed, Pelvic Floor Dysfunction had not been diagnosed, that my last doctor does not use MRI, and am just beside myself with relief that I made the switch.
The past week has been extremely difficult. My constipation has been a lot worse often requiring enema and several other laxatives to use the bathroom. Likely this was a combination of running to hard last week, antibiotics, and muscle trauma from the physical exam. As the constipation started to improve my pelvic pain became severe. Leading to a fruitless ER visit on Thursday. Yesterday and today I have slowly been improving. I have been able to use the bathroom the past few days and am close to completely voiding my bowels. Also my pelvic pain is slowly improving. My guess is that I had further trauma to my muscles from needed to forcefully cause my body to void.
I’m also guessing that will the introduction of the muscle relaxers my pelvic muscles are starting to relax more, but not completely and that is likely also causing some of the pain.
Every new turn on my Endometriosis journey blows my mind, and is completely new and unexpected. Hopefully in the next few weeks I will have some positive updates as I start PT, and have my follow up appointments.