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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for lower back pain and IBS

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Dr. Timothy Raichle

OBGYN

Practicing since :1999

Answered : 1681 Questions

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Posted on Mon, 20 Mar 2017 in Women's Health
Question: iv recently had. a diagnostic laparoscopy for on going troubles ibs symptoms since I could remember and bladder problems since I had. my daughter via c section constant lower back pain that gets worse with period. not being able to conceive. my question is they found 2 pieces of black endo and lasered it away. (large dense piece of scar tissue from the bowel area to the belly button and my tubes were running XXXXXXX through slow.) iv been doing some research and realised that black endo Is patches that have been there a while and now inactive and that clear and red endo is active the pics iv seen show why it would be difficult to identify all types of endo if your not an endo specialist. please could you tell me if it's probable that there is endo that had been missed by general gynae and that may explain why my symptoms haven't got better?
doctor
Answered by Dr. Timothy Raichle 2 hours later
Brief Answer:
Yes there is probably some endometriosis still present

Detailed Answer:
Hello,

Endometriosis has many different appearances. It can look like powder burn lesions and it can have a tannish or red appearance. Also, the amount of endometriosis that is visible does not always correlate with the patient's level of pain - it can look awful with little pain and vice versa.

It really does not matter in the sense that you have endometriosis and you have pain that is associated with endometriosis. Even though they have treated the obvious lesions, there is almost certainly some left behind.

I tell my patients that 'it is not a curable problem but it is certainly a manageable problem'. You need to followup the diagnosis and treatment with long-term suppression of your cycles. This would include the following options:

1. Birth control pills taken continuously
2. The depo shot
3. Lupron therapy

Does this help?
Dr. Tim


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Timothy Raichle 1 hour later
yes thanks. sorry doctor XXXXXXX would I be right in thinking endo could be hiding under dense scar tissue. and can scar tissue be biopsied to see if it's course is endo? thanks for your answers I'm just trying to gain knowledge for my next appointment.
doctor
Answered by Dr. Timothy Raichle 7 minutes later
Brief Answer:
Yes it can be nonvisible and yes biopsies can be done

Detailed Answer:
Hello again,

It really can be elusive in terms of where it is and how it appears. It can be as subtle as superficial increased vascularity or as obvious as large burn-like lesions.

Usually we just treat what we can see and then put a patient on long-term suppressive therapy to make them pain free for as long as they can or until they are considering pregnancy.

Dr. Tim
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Timothy Raichle 32 minutes later
I'm trying to get pregnant as you already know but the pain I go through I certainty don't think it's going to have gone with the two bits of endo they burnt off. I believe it's got a lot to do with this scar tissue maybe other active endo that wasn't recognized what do you suggest? try deal with pain I try not to take meds as I'm trying to conceive and hope for the best in conceiving or get rid of this scar tissue and then try conceive? my pain is on a 7 8 most of time.
doctor
Answered by Dr. Timothy Raichle 1 hour later
Brief Answer:
I would suggest a visit with a Fertility Specialist

Detailed Answer:
If you have a history of endometriosis and are having trouble getting pregnant (usually defined as up to 12 months of attempts without conception) then it would not be unreasonable to consider a visit with a fertility specialist. While your pain may be related to endometriosis, there are also other causes of abdominal and pelvic pain.

This could be scar tissue and endometriosis, but it could also be your bowels (chronic constipation, IBS, inflammatory bowel disease, etc.)

I think that given your goals of pursuing pregnancy, it makes sense to get a second opinion and this seems best with a Fertility Specialist.

Does this help ?
Dr. Tim
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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