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Suggest the type of specialist to consult for endometriosis

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General & Family Physician
Practicing since : 2012
Answered : 3614 Questions
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Hi. I'm a 39-year old woman of healthy weight with fairly serious degenerative disc disease in my lower back (being monitored by a neurosurgeon, but no surgery as of yet). I also suffer from constipation-prevalent IBS. I've had near-constant pain in my lower back for years, but lately I've had severe, sharp pain in my tailbone. It is noticeably worse when I'm constipated. I have suffered from mild rectal prolapse on and off for a few years, have endometriosis, and have had twins, all of which make bowel movements slow and difficult. I use a stool softener/laxative recommended by my GI doc, and I have a diet rich in fiber. I've also had 4 separate laparoscopic procedures to remove endometriosis, some of which was growing near my rectum. I guess I'm just wondering which of my doctors I should be seeing first, lol! The pain is extremely severe when standing up or bending, and it's gone from occasional bouts to being constant. It's impacting my daily activities. Advice? I feel like a walking train-wreck!
Posted Thu, 14 Aug 2014 in Brain and Spine
 
 
Answered by Dr. Shafi Ullah Khan 4 hours later
Brief Answer:
Needs management

Detailed Answer:
Thank you for asking
You would be surprised to know that endometriosis is most of the time presented with a correlated bowel IBS symptoms due to predispositions still to be researched.
Degenerative disc disease has also a role in your constipation etc as nerves arise from that place and pain there can compromise function down here in rectum etc.
So first seek a gynecologist and get a management for endometriosis.50 % of bowel symptoms will resolve.you are young and might be needing babies so discuss some conservative options apart from pharmacotherapy like pre sacral neurectomies, LUNA laptop comic uterine nerve ablation etc.
Then comes the degenerative disc disease.seek a rheumatologist and a physiotherapist in this regard for the conservative management and exercises to help the pain and if need be one mild interventional procedures and surgery if necessary losing weight and avoiding lifting heavy weights would be advised.
Then comes ibs.that for you are already on diet and lifestyle modifications

Dietary measures may include the following:
Fiber supplementation may improve symptoms of constipation and diarrhea
Polycarbophil compounds (eg, Citrucel, FiberCon) may produce less flatulence than psyllium compounds (eg, Metamucil)
Judicious water intake is recommended in patients who predominantly experience constipation
Caffeine avoidance may limit anxiety and symptom exacerbation
Legume avoidance may decrease abdominal bloating
Lactose and/or fructose should be limited or avoided in patients with these contributing disorders
Although evidence is mixed regarding long-term improvement in GI symptoms with successful treatment of psychiatric comorbidities, the XXXXXXX College of Gastroenterology has concluded the following:
Psychological interventions, cognitive-behavioral therapy, dynamic psychotherapy, and hypnotherapy are more effective than placebo
Relaxation therapy is no more effective than usual care
Pharmacologic agents used for management of symptoms in IBS include the following:
Anticholinergics (eg, dicyclomine, hyoscyamine)
Antidiarrheals (eg, diphenoxylate, loperamide)
Tricyclic antidepressants (eg, imipramine, amitriptyline)
Prokinetics
Bulk-forming laxatives
Serotonin receptor antagonists (eg, alosetron)
Chloride channel activators (eg, lubiprostone)
Guanylate cyclase C (GC-C) agonists (eg, linaclotide)
Antispasmodics (eg, peppermint oil, pinaverium, trimebutine, cimetropium/dicyclomine).
I hope it helps. Take good care of yourself and don't forget to close the discussion please.
May the odds be ever in your favour.
Regards XXXXXXX

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