MIGS PROCEDURES

Chronic pelvic pain is a debilitating condition that affects millions of people worldwide, especially women. It is defined as pain in the pelvic region that lasts for more than six months and is not related to menstruation or pregnancy. The pain can be constant or intermittent, mild or severe, and can affect various areas of the pelvic region, such as the lower abdomen, back, and thighs.

Chronic pelvic pain can have a significant impact on a person’s quality of life. It can cause physical limitations, social isolation, and emotional distress. The pain can interfere with daily activities, such as work, exercise, and sexual intercourse. Many people with chronic pelvic pain also experience anxiety, depression, and other mental health issues.

The causes of chronic pelvic pain are diverse and complex. Some common causes include endometriosis, uterine fibroids, pelvic inflammatory disease, irritable bowel syndrome, and interstitial cystitis. In some cases, the cause of the pain may be unknown. Diagnosis often involves a thorough medical history, physical exam, and imaging tests, such as ultrasounds and MRIs.

Treatment for chronic pelvic pain varies depending on the underlying cause and severity of symptoms. It may include medications, such as pain relievers or hormonal therapies, physical therapy, nerve manipulation, or surgery. Lifestyle changes, such as stress management and dietary modifications, can also be helpful in managing symptoms.

It is important for those experiencing chronic pelvic pain to seek medical attention and receive proper diagnosis and treatment. With the right care, many people with chronic pelvic pain can improve their quality of life and manage their symptoms effectively. Additionally, raising awareness of this condition and reducing stigma can help those affected feel more supported and empowered to seek help.

Endometriosis is a common and often painful condition that affects millions of women worldwide. It is a condition in which the tissue that is similar to the one that lines the inside of the uterus (endometrium) grows outside of it, typically on the ovaries, fallopian tubes, and tissue lining the pelvis. This tissue can cause inflammation, scarring, and adhesions, which can lead to pain and infertility.

Endometriosis is a chronic condition that can cause severe pain during menstruation, intercourse, and bowel movements. It can also cause fatigue, nausea, and other symptoms that can significantly impact a woman’s quality of life. The condition can also cause fertility problems, as the adhesions and scarring can interfere with the passage of eggs through the fallopian tubes or the implantation of a fertilized egg in the uterus.

The exact cause of endometriosis is unknown, but it is believed to be related to a combination of genetic and environmental factors. There is no known cure for endometriosis, but treatment options are available to manage symptoms and improve quality of life. Treatment may involve medications, such as pain relievers and hormonal therapies, or surgery to remove the endometrial tissue.

It is important for women to seek medical attention if they experience symptoms of endometriosis, as early diagnosis and treatment can help prevent complications and fertility problems. Additionally, raising awareness of the condition and reducing stigma can help women feel more supported and empowered to seek help.

Overall, endometriosis is a challenging condition that can significantly impact a woman’s physical and emotional wellbeing. However, with proper management and support, many women with endometriosis can lead fulfilling lives and achieve their reproductive goals.

Cervical incompetence, also known as cervical insufficiency, is a condition in which the cervix (the narrow opening at the bottom of the uterus) is unable to support a pregnancy to full term. The cervix is responsible for keeping the fetus inside the uterus until it is ready to be born. In women with cervical incompetence, the cervix may begin to dilate (open up) too early in pregnancy, leading to premature labor and delivery.

Cervical incompetence is thought to be caused by a weakness in the cervix, often due to previous cervical trauma or surgery, or due to genetic factors. Women who have had multiple miscarriages or premature deliveries are at higher risk of cervical incompetence.

Symptoms of cervical incompetence may include vaginal discharge, pelvic pressure, and spotting or bleeding during the second trimester of pregnancy. In severe cases, the cervix may dilate and the amniotic sac may rupture, leading to premature labor and delivery.

Diagnosis of cervical incompetence typically involves a physical exam, ultrasound, and measurement of the length of the cervix. Treatment options may include cervical cerclage, a surgical procedure in which a stitch is placed around the cervix to keep it closed, and medication to prevent premature labor.

It is important for women who have had previous miscarriages or premature deliveries to discuss their risk of cervical incompetence with their healthcare provider. Early diagnosis and treatment can help reduce the risk of complications and improve the chances of a successful pregnancy.

Overall, cervical incompetence is a challenging condition that can lead to premature labor and delivery. However, with appropriate management and support, many women with cervical incompetence are able to carry a pregnancy to full term and deliver a healthy baby.

Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths that develop in the uterus. They are common, affecting up to 80% of women by the age of 50. While some women with uterine fibroids may not experience any symptoms, others may experience heavy menstrual bleeding, pelvic pain, and pressure on the bladder or rectum. This can use frequent urination and constipation.

The exact cause of uterine fibroids is unknown, but they are thought to be related to hormonal changes and genetics. Risk factors for uterine fibroids include age, family history, obesity, and African-American race.

Diagnosis of uterine fibroids typically involves a pelvic exam, ultrasound, or MRI. Treatment options depend on the severity of symptoms and may include medication to control bleeding or pain, hormone therapy to shrink the fibroids, or surgery to remove them.

In some cases, uterine fibroids may cause complications such as infertility, miscarriage, or preterm labor. Women with uterine fibroids who are trying to conceive or experiencing complications may need specialized care from a reproductive endocrinologist.

In summary, uterine fibroids are common non-cancerous growths that can cause a range of symptoms. While they may not always require treatment, women who experience symptoms or complications may benefit from medication or surgery. With proper management and care, many women with uterine fibroids are able to maintain their reproductive health and quality of life.

Surgical management of uterine fibroids may be necessary for women who experience severe symptoms, such as pressure symptoms or heavy uterine bleeding or complications such as infertility, miscarriage, or preterm labor. There are several surgical options available, each with its own benefits and risks.

Myomectomy is a surgical procedure that involves removing the fibroids while leaving the uterus intact. This is an option for women who wish to preserve their fertility or who want to avoid a hysterectomy. Myomectomy can be performed through an abdominal incision or minimally invasive laparoscopic or robotic surgery. The minimally invasive approach is preferred due to faster recovery times and less risk of complications. The downsides of a myomectomy are the risk of recurrence of fibroids (approximately 50%) and about 20% of women who have a myomectomy end up needing another surgical intervention due to fibroids later in life.

Hysterectomy is the surgical removal of the uterus and is the only definitive cure for uterine fibroids. It may be recommended for women who have completed childbearing or who have severe symptoms that have not responded to other treatments. Hysterectomy can be performed through an abdominal incision or minimally invasive laparoscopic or robotic surgery. Here again, the minimally invasive approach is preferred.

Endometrial ablation is a minimally invasive procedure that destroys the lining of the uterus, which can reduce heavy menstrual bleeding caused by uterine fibroids. This option is only recommended for women who do not wish to have children in the future.

Uterine artery embolization (UAE) is a non-surgical procedure that blocks the blood supply to the fibroids, causing them to shrink. This option is not recommended for women who wish to preserve their fertility or who have fibroids that are too large or numerous.

Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a non-invasive procedure that uses focused ultrasound waves to destroy the fibroids. This option is only available at select medical centers and is not recommended for women who wish to preserve their fertility.

The choice of surgical management for uterine fibroids depends on several factors, including the size and location of the fibroids, severity of symptoms, and desire for future fertility.

Neuropelveology is a relatively new medical specialty that focuses on the diagnosis and treatment of chronic pelvic pain (CPP) and other pelvic floor disorders (PFDs) caused by nerve dysfunction. This field combines the knowledge and expertise of multiple disciplines, including urology, gynecology, neurology, and pain management.

Neuropelveologists use a multidisciplinary approach to evaluate and treat patients with CPP and PFDs, with a particular focus on the relationship between the nervous system and the pelvic floor muscles. They may use a variety of diagnostic tools, including imaging studies, nerve conduction studies, and pelvic floor electromyography (EMG), to identify the underlying cause of a patient’s symptoms.

Treatment options for CPP and PFDs may include medications, nerve blocks, physical therapy, and surgical interventions, such as neuromodulation or nerve decompression surgery. Neuropelveologists work closely with other specialists, including pain management physicians, physical therapists, and psychologists, to provide comprehensive, individualized care to patients.

Overall, neuropelveology represents an important advance in the diagnosis and treatment of chronic pelvic pain and other pelvic floor disorders, offering new hope and improved outcomes for patients with these challenging conditions.