Saturday, December 27, 2014

Location of endo and pain felt

I am trying to decipher old notes about the location of endo or associated affected sites (i.e. muscles like the obturator and piriformis) and where the pain can be felt. Please correct and add! (And don't get me started on if it's the lesion itself or its effect on nerve growth, angiogenesis, prostaglandins, cytokines, etc etc!!)
So far I have:    
Obturator internus- hip pain

Levator ani- rectal pain

Uterosacral ligaments- low back and SI joint (hard to differentiate from US endo vs adeno), down legs, painful sex

Round ligament- groin or lateral lower quadrant

Side wall of pelvis- pain or cramps radiating down the leg

Posterior cul de sac- low back, pain with/after sex, GI symptoms, pain with defecation (esp. during menstruation),  sits on the piriformis muscle and can cause spasms and sciatic type pain

Recto-vaginal septum- low back

Bladder- functional urinary tract symptoms

Hip issues and pelvic obliquities (like pelvis torsion where the hips are not level) can cause piriformis spasm

"The most common physical finding is discomfort during the pelvic examination, particularly with stretching of the uterosacral ligaments and palpation of the posterior cul-de-sac. There may be some induration or nodularity of the uterosacral ligaments and in severe cases there may be a very firm palpable mass in the posterior vaginal fornix."

“What is most interesting is that right-left orientation of the pelvis does not exist in some patients. That is to say, palpation of a lesion of endometriosis on the left side of the pelvis may produce pain that the patient perceives as being on the right side of the abdomen, and the opposite is also true.”