Advanced, multidisciplinary treatment available at new pelvic pain specialty center

When it comes to pelvic pain, patients often find more uncertainty than clarity around their diagnoses and treatment options.

A physician at UChicago Medicine is working to make treatment more comprehensive, accessible and convenient for patients seeking relief from pelvic pain’s debilitating effects.

Insiyyah Patanwala, MD, Assistant Professor of Obstetrics and Gynecology, is a fellowship-trained minimally invasive gynecologic surgeon and a pelvic pain specialist.

Chronic pelvic pain affects 15 to 20% of U.S. women at some point in their lifetime.

Pelvic pain is often associated with menstrual cycle-related conditions such as endometriosis and uterine fibroids. However, there are many other sources of pelvic pain. It may also be caused by pelvic floor and musculoskeletal disorders, sports and work-related injuries, accidents, genetics and post-traumatic stress disorder (PTSD). The ways in which patients experience pelvic pain may also vary significantly: it may be felt as a constant, debilitating discomfort on one side of the body, a chronic pelvic floor tightness, or as episodic sharp sensations — during intercourse, going to the bathroom, or while lifting heavy objects, for example.

According to Patanwala, this range of sources and symptoms — along with a shortage of trained specialists — can lead to a lack of awareness and understanding around pelvic pain, how it is diagnosed and how it is treated. For example, ultrasound can sometimes help physicians find the source of a patient’s pelvic pain, but not always.

“A lot of patients will come see me after they have seen a lot of other doctors and unfortunately have tried multiple therapies or their pain hasn't really been addressed,” Patanwala said. “Because their ultrasound findings are negative, they'll be told, ‘It's not this, but we don't know what it is.’”

Patanwala’s specialization and training has given her the opportunity to evaluate and effectively treat a wide variety of pelvic pain. Her treatment approach is multidisciplinary and often incorporates pelvic floor physical therapy along with anesthetic pain management.

This treatment approach is the foundation of UChicago Medicine’s new Pelvic Pain Center, for which Patanwala has been leading the planning and development. With multidisciplinary clinics now open on the Hyde Park campus (Duchossois Center for Advanced Medicine) and at UChicago Medicine River East, the Pelvic Pain Center offers a central location where patients can receive a comprehensive pelvic pain evaluation. If indicated, they can then see an anesthesia pain specialist and/or a pelvic floor physical therapist, all during the same visit.

Both Patanwala and Magdalena Anitescu, MD, PhD, a chronic pain-focused anesthesiologist, can provide trigger point injections and nerve blocks to help with pain. Since Patanwala also specializes in gynecologic surgery (including robotic surgery), she can offer surgery planning as well, if appropriate.

“We’re very excited,” Patanwala said. “It is our hope that through the Pelvic Pain Center, we can provide a lot of relief for patients in the community and greatly improve their quality of life.”

Below, Patanwala shares some helpful information for patients seeking answers about — and relief for — pelvic pain.

What is causing my pelvic pain?

Pelvic pain is different for each patient and occurs for different reasons. Generally, sources of pelvic pain fall into two categories: pain related to the menstrual cycle and pain related to other sources. One example of a menstrual-related source of pelvic pain is endometriosis, a condition where endometrial, or uterine-like, tissue grows outside of the uterus and can cause scar tissue, irritation and cysts. Another example would be uterine fibroids, non-cancerous growths in the muscle walls of the uterus that can cause pain and excessive bleeding.

The pelvic pain that is noncyclical and more constant is often a form of myalgia, or muscle pain, that can result from trauma, accidents, falls and sports injuries. Doing labor-intensive work can put a lot of pressure on the pelvic floor muscles and cause pelvic pain. We also see that the physical effects of childbearing can lead to pelvic pain.

In addition, some patients have PTSD from various traumatic experiences in their lives, which can cause the pelvic floor muscles to become hypertonic, or unable to relax. And patients who have a history of endometriosis or pelvic scarring due to adhesions or prior surgeries can have pelvic floor muscle spasms as well. Therefore, there is often more than just one cause for the pelvic pain.

How can I manage my pelvic pain?

Every patient has different needs and will have a unique treatment course. It’s important to find a pelvic pain specialist to help you understand the source of the pelvic pain and the best available treatments. Two key treatment approaches are pelvic floor physical therapy and pain management. In my practice, 70 to 75% of patients benefit from having pelvic floor physical therapy. Further treatment may include medicated vaginal suppositories, muscle relaxants, and nerve medications, as well as pelvic floor trigger point injections and nerve blocks.

What about kegels? Will they help with my pelvic pain?

Kegels are an exercise to tighten the pelvic floor. Whether or not they are appropriate for a patient depends on their specific condition and cause of the pelvic pain. For example, some patients suffer from pelvic organ prolapse, where organs like the bladder, rectum and uterus collapse into the vagina. Kegels may be useful for strengthening the pelvic area for this condition. Also, a patient who has incontinence — where they have difficulty controlling urine leakage — may benefit from kegels to provide support for the bladder.

I do not recommend kegels for patients experiencing significant pelvic pain, particularly if the pain is resulting from an already too-tight, or hypertonic, pelvic floor. In this case, kegels would aggravate, rather than relieve, the pain.

How will the new Pelvic Pain Center help patients?

The Pelvic Pain Center will help patients by bringing members of the care team — the gynecologist, the physical therapist and the anesthesiologist — all together in one office. This makes multidisciplinary care more accessible and convenient. Instead of waiting several weeks after the physician appointment for physical therapy, for example, the patient can see the physical therapist during the same visit. If needed, the patient could also access the anesthesia pain clinic on the same day. This way, there’s no delay in care and a faster path to pain relief.