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Sharp pelvic pain after ablation. Ultrasound, CT scan normal. Took doxycycline. Colonoscopy to be done

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General & Family Physician
Practicing since : 2012
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I asked a question earlier and got a response, but did not ask a follow up quickly enough I guess and now I can't. Here are the basics. I've been having chronic pelvic pain since my ablation in 2012. Constant dull/achy pain in pelvic area and back, debilitating menstrual cramps. Occasional labor intensity pain out-of-the-blue. Ongoing cycle of right sided stabbing pain in the area of the right ovary--lasts a few days, is better for a few weeks, then comes back. An ultrasound and CT scan March 19th, 2013, found nothing. No cysts or fibroids were seen, and was told my uterus looks "as they would expect a uterus to look after an ablation". I do not have an elevated white count but my doctor wants me to take antibiotics (Doxycycline) and call back in 2 weeks to schedule a colonoscopy if I don't feel better after the medication. I have no bowel issues. I do not have, nor have I ever had, any STDs. I've been doing a lot of research online, and I don't see the reason behind a colonoscopy. She mentioned they would be checking for colitis, none of my symptoms fit that. If they would have told me they wanted to look into possible bladder issues, that would have made more sense to me than a colonoscopy. If really don't have any problematic bladder issues either (aside from a bit of leaking when sneezing, which I assume is fairly normal after having children), but at least a bladder issue would make more sense to me than a bowel issue. I really don't want to pay for a very unpleasant operation that seems to have little purpose. Any input would be welcomed. Thank you.
Posted Wed, 17 Apr 2013 in Abdominal Pain
Answered by Dr. Achuo Ascensius 5 hours later

Thanks once more for the query.

I do agree with you that your symptoms do not really point in the direction of a colonic problem apart from the pelvic pain. However, in medicine every possibility is considered unless you have sufficient reasons to consider just one or to rule out the others.

Well, following my last response, there are two main possible diagnoses that have sufficient reasons to be incriminated; a Pelvic inflammatory disease (PID) or a side effect of the ablation.

It is true that whenever one talks of PID the notion of STD comes in. This is so because the number one cause of PID is sexually transmitted infections and chlamydia, Neisseria, Mycoplama and Ureaplasma in most cases. However, PID does not only result from STD; interventions with manipulation of the uterus or introduction of instruments, hands etc into the genital tract and even following normal deliveries could as well result to infections and hence to PID. With a history of a D & C, uterine polypectomy and thermachoice ablation, PID is more likely. More so, the characteristic crampy pain occurring especially during menses (a condition known as secondary dysmenorrhoea) further supports a PID. Also, most PID infections are silent or asymptomatic (without symptoms) until a later stage.

In order to say the pain is a side effect of the ablation, other possible diagnosis has to be ruled out. Colonic issues usually present with blood stained or bloody or mucoid stools, frequent and or painful motions alternating with constipation etc. These are the symptoms that point towards a colonic problem and their absence makes it less likely to assume a colonic problem in the first place.

Apart from the two most likely above stated possibilities, one could also consider a third; endometriosis which is the presence of endometrial (inner layer of uterus) tissue outside the uterus most often the ovaries, ligaments of the uterus and the bowels. It presents with dysmenorrhoea and pains during ovulation and even pains during sexual intercourse in some cases. Unfortunately the diagnosis of this is through laparoscopy which is similar to colonoscopy that you are trying to avoid.

However, mild forms of the disease response well to oral combined contraceptive pills resulting in reduced pains and reduced progression.

Hope this helps you and if you have further queries I will be waiting to help.

Best regards
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