Endometriosis is One Possible Cause of Pelvic Pain

Q:  Lately my daughter has been experiencing pain in her bladder/pelvic area. It seems to get worse right before her period. She is becoming depressed because she likes to play sports and go out with her friends, but is embarrassed because she has to go to the bathroom all the time. I'm very worried about her and the pain she is experiencing. What could be causing this and is there anything that can be done to help her?

A:  You're quite correct to be concerned about her physical and mental well being. Although you didn't suggest her age, I am going to assume she is in her mid to late teens. There are many older women who can also identify with the restrictions imposed by the need to always make sure a bathroom is nearby.

The cause could be something as simple as a bladder infection, but this would not explain her symptoms peaking just before her period. Beyond an infection, the most pressing concern would be something called endometriosis.

Endometriosis occurs when "islands" of endometrium, the natural lining of the uterus, are found in other parts of the abdominal cavity and pelvis. One of the most common locations is the bladder. Pain is due to the growth and then shedding of this tissue, which behaves exactly as the normal tissue in the lining of the uterus. This is why the symptoms often peak just before she begins her period.

The condition is at the least bothersome and at the worst debilitating and extremely painful. It is generally not a cause of serious or life-threatening illness. In your daughter's case, I'd be at least, if not more worried about her emotional health.

She needs to see a gynecologist who will collect a history followed by a pelvic examination and a few basic blood tests. More than likely, a pelvic ultrasound will follow. If suspicion for endometriosis is high, a laparoscopic exam could be a part of the evaluation. Other possibilities include irritable bowel syndrome, complications of pregnancy and sexually transmitted diseases.

Treatment involves medication for pain. She may want to start taking 600 mg of ibuprofen up to three times per day until prescription medications can be made available. Laser techniques may be used during the laparoscopic procedure to burn away the abnormal areas. There are a variety of hormonal medications that can be used to diminish the intensity of each episode.

The most important step is to schedule that appointment now.

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