Suggest treatment for pain in lumbar region after hysteroscopy
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Hello, 51 y/o female RN, 4 days s/p hysteroscopy under general anesthesia for what was supposed to be endometrial biopsy and ablation for menorrhagia but instead had unexpectedly large polyp mostly removed. Unable to do endometrial ablation. Having significant post procedure pain in sacral/lumbar region. Symphysis pubis is partially numb. Having significant saddle pain and some posterior thigh pain/numbness. Surgeon won't call me back. I think this pain is from positioning on the table for the procedure as well as manipulation and attempts to get to a high and abnormally twisted uterus (s/p 3 c-sections). Norco makes me sleepy but doesn't do anything really for the pain. Sitting definitely worse (especially on toilet), prolonged standing makes it worse. Lying on back for the most part after 45 minutes or so relieves the pain until I stand up again. No prior back history. No issues with post-op vaginal bleeding that I can tell. Thoughts?
Posted Mon, 3 Mar 2014 in Women's Health
Answered by Dr. Madhuri N Bagde 31 minutes later
Brief Answer: Other causes need to be ruled out Detailed Answer: Hi, Thanks for the query. I am sorry for all the pain that you are undergoing. I do agree that this pain may be due to positioning but other causes need to be ruled out. You have had three sections so the procedure may have been a difficult one, but even then if it was possible to remove the polyp it does indicate that the doctor was able to get inside the uterine cavity. It would help to know the duration of the procedure as well as your weight to say if the pain is due to positioning. Other causes of pain are the hysteroscopy fluid entering the abdominal cavity that happens as the tubes are open. Potentially this occurs in every procedure but it may cause pain in some women. Peritonitis may also cause severe abdominal pain. If bits of polyp remain behind they too can cause pain at times but usually it is associated with bleeding. Uterine perforation and damage to peritoneal structures is a rare but possible cause. Other common causes are urine infection especially if catheters have been used. Please check to see if you have any fever. If no, then chances of injury and perforation are very low. Also note if you have any burning while passing urine or excessive urination as these may indicate urine infection. I suggest that you take a simple analgesic like ketorolac sr to control pain. Local application of analgesic ointment like diclofenac will help decreasing the pain if it is due to positioning. If the pain does not decrease, you will need to see your doctor, get a urine test and an abdominal examination to look for any other signs like rebound tenderness and so on. If the pain is severe an ultrasound of the abdomen and pelvis will also be needed to localize the cause. I am sorry that you are undergoing such severe pain but am sure you will get over this. Hope I was able to help you. Thanks for using Health Care Magic. I would be happy to answer any further queries. Have a nice day. Dr. Madhuri Bagde Consultant Obstetrician and Gynecologist
Follow-up: Suggest treatment for pain in lumbar region after hysteroscopy 29 minutes later
Thank you for your quick response. It's not my abdomen (unless it's retroperitoneal?) Its my back. I weigh 175 and I'm 5'5". I'm big boned and dense but if you saw me you wouldn't guess my weight. Would something retro peritoneal present itself as back pain right over the lumbrosacral area? If I touch this area, it hurts. I was given Cipro x 3 days starting day of procedure. No UTI. No fever. My best guess for procedure length is about an hour plus recovery time. They started at 12:50 in OR and I dc'd home at 5pm. I had Versed, Sevo, Fentanyl and Percocet. I don't have access to Toradol and Motrin gives me nose bleeds. Thank you for your help.
Answered by Dr. Madhuri N Bagde 11 hours later
Brief Answer: It looks like pressure sores Detailed Answer: Hi, I understand your response. It is possible that a retroperitoneal mass will present like this. But your current symptoms make it more clear that it is associated with pressure. Please ask someone to check if the area is red or inflamed or any blisters in that area. Try not to put any pressure on it by lying down on your sides as much as possible. Massage it daily for three or four times using any soothing body lotion and use hot compresses [do this only if there are no blisters]. Use local diclofenac ointment. This will not cause any gastrointestinal upset or nose bleed. Best treatment is massage regularly the area as well as the surrounding area and change your position, do not allow any pressure on it. If at all you have to lie on your back, put really soft pillows under your lumbosacral region and lie only for very short periods. It will heal but take time for healing. Do let me know if there are any pressure signs like redness and swelling in the area. wish you an early recovery. Take care. Dr Madhuri Bagde