Pelvic Conditions

Pelvic Prolapse

Pelvic Prolapse is a weakening in the web of muscles at the base of the pelvis. These muscles, called the pelvic floor muscles, hold the organs of the pelvis in place. If these muscles are weakened in one area, the organ they support will shift position and begin to press against the vagina. This is called a prolapse. The organs that can be affected include the bladder, urethra, uterus, vagina, small bowel and rectum.

Weaknesses in the pelvic floor muscles are most often caused by strain during a vaginal birth. This is more likely if the baby was very large, or if the labour was long and difficult.

Pelvic prolapse can also result from a hysterectomy (an operation to remove the uterus). After the uterus is removed, other organs, such as the bladder, may drop.

Although it is possible for a younger woman to have a prolapse, a woman is most likely to experience a prolapse after menopause. Lower levels of the hormone estrogen can make the ligaments and muscles of the pelvis weaker and less elastic, which makes prolapse more common in post-menopausal women.

Pelvic Pain

An estimated one-third of all women will experience some form of pelvic pain in their lifetime. Although it is one of the most common complaints in women, it is also one of the most difficult to diagnose and manage. As many as three out of five women, who experience pelvic pain, never find out the cause of their pelvic pain.

Typically, women seek help from gynecologists, urologists or family practitioners who may not be able to pinpoint the cause. Adding to this difficulty is that many women are often embarrassed about pain in the pelvic area – below your bellybutton and between your hips – and wait until the pain is unbearable before seeking help.

Chronic pelvic pain is defined as any pelvic pain lasting more than six months and as many as one out of five women experience chronic pelvic pain. This differs from acute pain, which may indicate a specific injury. In chronic pelvic pain, the initial injury or problem may have disappeared but the pain continues because of changes in the nervous system, tissues, or muscles.

Among the signs and symptoms of chronic pelvic pain include:

• Severe and steady pain
• Pain that comes and goes (intermittent)
• Sharp pains or cramping
• Dull aching
• Limited physical activity
• Pressure or heaviness deep within your pelvis

Accurate Diagnosis and Treatment

Although there are many tests that can be performed to determine the cause of your pain, including pelvic exam, cultures, pelvic ultrasound or laparoscopy, a Magnetic Resonance Imaging (MRI) of the female pelvis is one of the most accurate methods of pinpointing what is causing your discomfort.

Chronic pelvic pain, like most other chronic pain conditions, affects your physical and psychological well being. Some of the more common causes include:

• Endometriosis, a condition in which tissue from your uterine lining (endometrium) grows outside your uterus. These deposits of tissue respond to your menstrual cycle, just as your uterine lining does – thickening, breaking down and bleeding each month as your hormone levels rise and fall. Because it’s happening outside your uterus, the blood and tissue can’t exit your body through the vagina and become trapped in your abdomen. This can lead to painful cysts and adhesions.
• Adenomyosis, a condition in which tissue from your uterine lining (endometrium) grows inside your uterus and into the muscle, resulting in heavier menstrual bleeding.
• Tension in your pelvic floor muscles causes spasms of the pelvic floor muscles and can lead to recurring pelvic pain.
• Chronic pelvic inflammatory disease is the results of a long-term infection, often sexually transmitted, which causes your fallopian tubes to scar and adhere to your ovaries.
• Pelvic congestion syndrome caused by enlarged, varicose-type veins around the ovaries. These veins cause blood to pool in your ovaries and pelvic area.
• Ovarian remnant, which occurs after a complete hysterectomy when a small piece of ovary is left inside, which can later develop tiny, painful cysts.
• Fibroids, non-cancerous uterine growths, which may cause pressure or a feeling of heaviness in your lower abdomen.
• Irritable bowel syndrome – bloating, constipation or diarrhea – can be a source of uncomfortable pelvic pain and pressure.
• Interstitial cystitis, chronic inflammation of the bladder resulting in a more frequent need to urinate, characterizes interstitial cystitis.

Vaginal Fistula Diagnosis – A vaginal fistula is an abnormal passage that connects the vagina to other organs, such as the bladder or rectum, resulting in leakage of urine or feces into the vagina. A vaginal fistula could also be described as a hole in the vagina that allows stool or urine to pass through the vagina.

Fistulas may result as a complication of pelvic surgery — more than 50 percent occur after hysterectomies. They may also develop after injury to the pelvic area, infection, inflammation or radiation treatment.

Vaginal fistulas are classified into four types; treatment varies for each:

• Vesicovaginal fistulas, also called bladder fistulas, occur between the vagina and urinary bladder. This is the most common type of vaginal fistula.
• Uterovaginal fistulas occur between the vagina and distal ureter (ureters are ducts that carry urine from the kidney to the bladder)
• Urethrovaginal fistulas, also called urethral fistulas, occur between the vagina and urethra (tube that carries urine out of the body)
• Rectovaginal fistulas, also called rectal fistulas, occur between the vagina and the rectum

Pelvic Ultrasound

A Pelvic Ultrasound uses sound waves to make a picture of the organs and structures in the lower belly (pelvis).

A pelvic ultrasound looks at:

• The bladder, ovaries, uterus, cervix, and fallopian tubes of a woman. See a picture of female organs seen on pelvic ultrasound.

Organs and structures that are solid and uniform (such as the uterus, ovaries, or prostate gland) or that are fluid-filled (such as the bladder) show up clearly on a pelvic ultrasound. Bones or air-filled organs, such as the intestines, do not show up well on an ultrasound and may keep other organs from being seen clearly.

Pelvic ultrasound can be done in two ways: Transabdominally and transvaginally

• Transabdominal ultrasound. A small handheld device called a transducer is passed back and forth over the lower belly. A transabdominal ultrasound is commonly done in women to look for large uterine fibroids or other problems.
• Transvaginal ultrasound. The transducer is shaped to fit into a woman’s vagina. A woman may have both transabdominal and transvaginal ultrasounds to look at the whole pelvic area. A transvaginal ultrasound is done to look for problems with fertility. In rare cases, a hysterosonogram is done to look at the inside of the uterus by filling the uterus with fluid during a transvaginal ultrasound. Sometimes, a small sample of tissue (biopsy) may be taken with small tools inserted through the vagina during a transvaginal ultrasound.

In all types of pelvic ultrasound, the transducer sends the reflected sound waves to a computer, which makes them into a picture that is shown on a video screen. Ultrasound pictures or videos may be saved as a permanent record.

For men and women, pelvic ultrasound may be done to:

• Find the cause of blood in the urine (hematuria). An ultrasound of the kidneys may also be done.
• Find the cause of urinary problems.
• Look at the size of the bladder before and after urination. This can determine whether the bladder is emptying completely during urination.
• Check for growths in the pelvis.
• Guide the placement of a needle during a biopsy or when draining the fluid from a cyst or abscess.
• Check for colorectal cancer and how it is responding to treatment.

For women specifically, pelvic ultrasound may be done to:

• Find out what is causing pelvic pain.
• Look for the cause of vaginal bleeding.
• Look for pelvic inflammatory disease (PID).
• Find an intrauterine device (IUD).
• Look at the size and shape of the uterus and the thickness of the uterine lining (endometrium).
• Look at the size and shape of the ovaries.
• Check the condition and size of the ovaries during treatment for infertility.
• Confirm a pregnancy and whether it is in the uterus. Pelvic ultrasound may be used early in pregnancy to check the age of the pregnancy or to find a tubal pregnancy (ectopic pregnancy) or multiple pregnancies.
• Check the cervical length in a pregnant woman at risk for preterm labor.
• Check a lump found during a pelvic examination.
• Check uterine fibroids found during a pelvic examination. Pelvic ultrasound may also be done to check the growth of uterine fibroids.
• Guide a procedure to remove an ovarian follicle for in vitro fertilization.

Sonohysterography (SIS)

Sonohysterography, also known as saline infusion sonography, is a special, minimally invasive ultrasound technique. It provides pictures of the inside of a woman’s uterus.

The radiologist or ultrasound technologist places a vaginal speculum, and introduces sterile water into the uterus to distend the cavity and better evaluate the lining, usually when there is unexplained abnormal bleeding.

Pelvic MRI

For many women, Pelvic MRI is a non-invasive test is more comfortable than many of the alternatives and can clearly show pelvic anatomy in 3 dimensions and accurately demonstrate pelvic abnormalities. Using this vital information, your doctor can uncover the exact source of the problem and quickly initiate the appropriate treatment regimen.

This elegant imaging technology is capable of diagnosing and staging malignant pelvic diseases, such as cervical cancer, endometrial cancer, vaginal cancer, vulvar cancer and ovarian cancer.

It can also diagnose benign causes of chronic pelvic pain, such as uterine leiomyomas (fibroids), adenomyosis, endometriosis and pelvic congestion syndrome. MRI of the pelvis can clearly exhibits pelvic floor abnormalities, which can result in urinary incontinence and pelvic pain.