Endometriosis

What is endometriosis?

Endometriosis is an abnormal growth of endometrial cells outside the uterine cavity. This condition is an estrogen-dependent, benign, chronic inflammation that affects women during all stages of life. 

After presenting with symptoms, it takes an average of 10 years to make a diagnosis of endometriosis. Part of the problem is that patients present with many different complaints: painful periods, UTI symptoms, pain with sex, irritable bowel syndrome (IBS), chronic pelvic pain. Patients are incorrectly treated for UTIs with antibiotics and a variety of medications for IBS when the true cause of their symptoms is endometriosis.

Why do patients with endometriosis and pelvic pain also have urinary and bowel dysfunction?

Patients frequently present to our office after years of treatment of recurrent UTIs when they did not have evidence of infection in the urine. Some patients report bloating, painful bowel movements, and diarrhea that did not improve after being seen by a gastroenterologist. In these cases, the underlying problem is often endometriosis and inflammation of the hypogastric nerve plexus.

The hypogastric nerve plexus is a collection of nerves (electrical wires) that carries information going between the brain and the bladder, uterus, and bowel. When inflammation from endometriosis affects this nerve system it causes dysfunction of these pelvic organs. Just like faulty wiring can cause a light bulb to malfunction, damage to the nerves can affect the corresponding organs. This delicate system of nerve fibers runs along the pelvic sidewall, an area highly susceptible to injury from endometriosis inflammation (Picture 1).

Picture 1: Bilateral hypogastric nerves are shown. The left hypogastric nerve is entrapped by inflammation and an endometriotic implant. The right pelvic sidewall and hypogastric nerve are normal.

What is different in our approach and surgical management of endometriosis?

We believed when patients understand their condition and the reasons underlying their symptoms, they are empowered to take back control of their lives and heal their bodies. Therefore, our first step is to make sure the patient understands the true nature of endometriosis and how it damages the pelvic nerves. We help explain why a patient not only has severe pelvic pain, but often has urinary and bowel function related symptoms.

If presence of endometriosis and its related inflammatory changes are suspected, then surgical intervention should be considered. At Women’s Pelvic Surgery of NJ, surgery is performed with a minimally invasive approach using robotic assisted technology. The magnified and stable view provided by state of the art robotic technology, along with the priceless experience and skill of Dr. Shakiba, will significantly optimize the outcome of the surgery. Our approach is an aggressive but safe resection of all inflammatory insults regardless of their proximity to vital organs like the ureter and bowel. More importantly, the unique knowledge of Dr. Shakiba about neuropelveology and his extensive experience on operating on pelvic nerves will significantly improve the outcome of surgery on patients suffering from urinary, bowel, and sexual dysfunction related to endometriosis.

Patients should understand that after pelvic nerve surgery, they should not expect immediate complete resolution of symptoms. The surgery is the first step to eliminate the cause of nerve inflammation and damage so subsequent healing can occur. After elimination of the insult on the nerve, a patient immediately feels significant relief. However, there will be additional medical management and pelvic physical therapy needed after surgery to reverse the damage incurred and normalize the functionality of the nerves. This may take 4 to 6 months to reach the best result after the surgery, depending on the severity of the previous nerve insult.