The most common pelvic floor disorders include urinary incontinence (leakage of urine), pelvic organ prolapse (when organs like the bladder, uterus, or rectum shift from their normal position), fecal incontinence, and chronic pelvic pain. Many patients also experience pelvic floor muscle dysfunction, where the muscles are either too weak or too tight.
You may have a pelvic floor issue if you experience symptoms such as urine leakage, frequent urgency to urinate, difficulty emptying your bladder or bowels, pelvic pressure or heaviness, pain in the pelvic region, or discomfort during intimacy. These symptoms are common—but not normal—and can often be effectively treated.
No, pelvic health is not only for women. While many women seek care for pelvic floor concerns related to pregnancy, childbirth, or menopause, men can also experience pelvic health issues, including urinary symptoms, pelvic pain, and bowel dysfunction. Pelvic health care is for anyone experiencing symptoms in this area.
You should consider seeing a pelvic health specialist if your symptoms are affecting your daily life, comfort, or confidence. Early evaluation is helpful—even for mild symptoms—because many conditions can be treated more easily when addressed early. You do not need to “wait until it gets worse” to seek care.
Pelvic pain, a complex condition with a myriad of causes, demands a nuanced approach for diagnosis and treatment. It’s a symptom that can arise from various systems within the body, making it a challenge to pinpoint and manage effectively.
Pelvic pain can have many causes, including muscle tension or weakness, nerve irritation, inflammation, past injuries, childbirth, surgery, or underlying medical conditions. In many cases, pelvic pain is related to how the muscles and tissues in the pelvic floor are functioning, and it can often be improved with the right treatment approach.
The pelvic floor muscles play an important role in sexual function. When these muscles are too tight, weak, or not working properly, it can lead to pain during intercourse, decreased sensation, or difficulty with arousal or orgasm. Addressing pelvic floor health can significantly improve comfort and overall sexual well-being.
Endometriosis will respond to the hormone estrogen and can cause pain with menstrual cycles, pain with sexual intercourse, infertility, and unrelenting chronic pelvic, back, hip-and leg pain. Not everyone has every symptom, and some individuals have had pregnancies. Endometriosis is a factor in up to 40% of cases of unexplained infertility.
Endometriosis affects 10-15% of the female population.
Endometriosis is a surgical diagnosis. This means it cannot be definitively diagnosed by taking your history, physical examination, blood or urine tests, x-rays, ultrasounds, MRI, or CT scan. A diagnosis can be presumptive and interventions can be attempted with medication to alter hormones in order to alleviate symptoms.
2 key points to remember about Endometriosis:
1) There is no correlation between the symptoms the person is experiencing and whether endometriosis is present. (You may have severe cyclical pain that seems like it is endometriosis, but it is not).
2) There is no correlation between the severity of the symptoms and the extent of endometriosis present. (You may have extensive endometriosis and have pain that is tolerable or managed by medical interventions. Conversely, you may have only a few endometriosis lesions and experience debilitating pain with periods.)
For these reasons, laparoscopic surgery may be the best way to have definitive diagnosis and/or treatment.
(CAUTION: Hardcore Science-y stuff ahead. But it is very useful to understand.)
Every organ has different tissue types. Each tissue type within an organ can produce tumors, benign and malignant.
The ovary has 3 tissue types:
1) Eggs and follicles (aka cysts) produce germ cell tumors
2) Connective tissue (aka the tissue that holds the ovary together) produce stromal tumors
3) Epithelial tissue (aka covering over the outer surface of the ovary) produce epithelial tumors. Approximately 70% of all ovarian tumors are epithelial. Epithelial tumors can be serous, mucinous, clear cell, or endometrioid.
These subtypes are based on how the tumors look under the microscope.
There is evidence in the medical literature that clear cell and endometrioid ovarian tumors may develop from endometriosis. Literature review shows only a mild association between endometriosis and the development of ovarian cancer. The relationship of endometriosis and ovarian cancer is not confirmed.
A literature review published in early 2014 using the keywords “endometriosis” and “ovarian” found 1 prospective cohort study, 10 retrospective cohorts, and 5 case-control studies. All of these studies, except for one, did not include operative confirmation of endometriosis. Authors found a consistent association between endometriosis and clear cell and endometrioid cancer, but the authors concluded that the association linking endometriosis and ovarian cancer is not sufficient to impact current clinical practice.
Therefore, to summarize what is known at this time, there is an association between epithelial cancers of the ovary and endometriosis, but there is currently not enough evidence to warrant alteration in endometriosis treatment.
Pain is always real. Often, we can find what is causing the pain. In many of these patients, we can alleviate the pain. When the source of the pain is not immediately found, we work to exclude the most deleterious diagnoses at first. A klist of possible diagnoses is generated and then we sequentially rule out diagnoses until we have a more specific idea s to the cause and thus, a clearer picture of what can help.
Endometriosis can present as menstrual pain, pain intermittently throughout the month, or continuous pain. Response, or lack of response, of symptoms to medications, such as hormonal modifiers and contraceptives does not necessarily rule in or rule out the presence of endometriosis. However, they can help to identify when the cause of the pain is hormone dependent.
The most common surgical finding of endometriosis is fibrosis and scarring (“adhesions”) it leaves behind. If adhesions are felt to be due to previous surgery, then the adhesions can be just divided. If adhesions are felt to be related to endometriosis, then it is necessary for the surgeon to come around both sides of adhesions and remove the scarring/adhesions.
If you’re ready to get started, or if you have any questions, please call the office at (207) 200-7671 or send us a message, we’d love to hear from you.
Uterine fibroids are non-cancerous (benign) growths that develop in or around the uterus. They are very common, especially during reproductive years, and can vary in size—from very small to large enough to change the shape of the uterus.
Some people have no symptoms at all. When symptoms do occur, they may include heavy or prolonged menstrual bleeding, pelvic pressure or pain, frequent urination, constipation, bloating, or pain during intercourse.
Fibroids are almost always benign and not life-threatening. However, they can significantly impact quality of life if symptoms are severe, such as causing heavy bleeding or chronic discomfort.
There is no cause-and-effect relationship between endometriosis and uterine fibroids. Endometriosis and uterine fibroids tend to occur together only because they both do well in the same environment of estrogen and blood flow.
Fibroids are typically diagnosed through a pelvic exam and imaging studies such as ultrasound or MRI. These tests help determine the size, number, and location of the fibroids.
Treatment options for uterine fibroids:
You should schedule an appointment with us if you experience heavy bleeding, pelvic pain, pressure symptoms, or concerns about fertility. Early evaluation can help you understand your options and choose the best treatment plan.
There are four options for treating endometriosis with laparoscopic surgery which include:
1) laser vaporization
2) electrical cautery/fulguration
3) ultrasonic coagulation, or the most effective
4) laparoscopically excising the endometriosis by means of going around, underneath, and completely removing the endometriosis and fibrosis entirely.
This last option, laparoscopic excision of endometriosis, is Dr. Lucas’ approach. As head surgeon of the New England Center for Endometriosis, Dr. Lucas is dedicated to the safe and thorough removal of endometriosis lesions throughout the abdomen.
Endometriosis starts out superficial in the lining of the body cavity. Over time, with menstrual cycling of estrogen, it will invade progressively deeper into the tissues. When endometriosis invades deeper than superficial application of laser or electrical energy penetrate, these modalities may not be sufficient to treat these deep lesions. There is also some concerns that the burning may leave more tissue damage that now just overlies the endometriosis that was unable to be treated. These may cause recurring pain for the patient, resulting in surgery after surgery. Almost all centers that specialize in endometriosis, in and out of the USA, perform laparoscopic excisional surgery for endometriosis.
As endometriosis invades progressively deeper into the tissues, the endometriotic lesions will bleed into themselves, creating a blood-filled cyst, or endometrioma (“endometri” refers to endometriosis, and “oma” means new growth). Ovarian endometriomas do not occur as isolated findings, and there is usually endometriosis involving the pelvic sidewalls and ligaments that needs to be excised. It is necessary for the surgeon to excise the cyst wall from the ovary, and repair the ovary, to have the best chance of saving the ovary and avoiding recurrence of the endometrioma.
The most common surgical finding of endometriosis is fibrosis and scarring (“adhesions”) it leaves behind. If adhesions are felt to be due to previous surgery, then the adhesions can be just divided. If adhesions are felt to be related to endometriosis, then it is necessary for the surgeon to come around both sides of adhesions and remove the scarring/adhesions.
If you’re ready to get started, or if you have any questions, please call the office at (207) 200-7671 or send us a message, we’d love to hear from you.
Our Endometriosis center focuses on thorough excision of Endometriosis and associated fibrosis, with the restoration of normal anatomy. We do everything possible to help each patient get long-term pain relief and minimize repeat surgeries. While our focus is on the excision of endometriosis for pain relief, many go on to have successful pregnancies.
The uterus is a thick muscular organ that consists of 3 parts: cervix, uterine body, and uterine fundus. The fundus is the upper portion of the uterus above where the fallopian tubes attach. The uterine body is the major portion of the uterus between the uterine fundus and cervix. The cervix is the lower part of the uterus that communicates with the vaginal canal. Hysterectomy (“hyster” means uterus, “ectomy” means to remove) is removal of the uterus.
A hysterectomy is a surgical procedure to remove the part or all of the uterus. Depending on your condition, it may also involve removal of the cervix, ovaries, or fallopian tubes. It is performed to treat a variety of gynecologic and pelvic health conditions.
Removal of the entire uterus, including the cervix, is called total hysterectomy. Removal of the upper uterus (uterine body and fundus), conserving the cervix, is called partial hysterectomy. Since partial hysterectomy is above a portion of the cervix, this is also known as supracervical hysterectomy. These procedures can be done by laparotomy (open) or by laparoscopy (endoscopic).
Many years ago, before blood banks, antibiotics, and modern anesthesia, surgery was dangerous with high mortality. Surgical procedures were kept as short as possible, and all hysterectomies were partial hysterectomies. With the advent of blood banks, modern anesthesia, and antibiotics, total hysterectomies were performed. Total hysterectomy and supracervical hysterectomy are both good procedures being performed today.
Yes, many conditions can be treated with non-surgical or less invasive options, including medications, pelvic floor therapy, or minimally invasive procedures. A hysterectomy is typically considered when other treatments have not been effective or are not appropriate.
Recovery time varies depending on the type of surgery. Minimally invasive procedures often allow for a faster recovery (typically 2–4 weeks), while abdominal surgery may require 6–8 weeks. Most patients gradually return to normal activities with guidance from their care team.
If your ovaries are removed during the procedure, you will enter menopause. If your ovaries are preserved, you will not go into menopause immediately, although some patients may experience hormonal changes over time.
The decision is highly personal and based on your symptoms, medical history, and treatment goals. At New England Center for Pelvic Health, we take a comprehensive approach—reviewing both surgical and non-surgical options—to help you make an informed decision.
The decision is highly personal and based on your symptoms, medical history, and treatment goals. At New England Center for Pelvic Health, we take a comprehensive approach—reviewing both surgical and non-surgical options—to help you make an informed decision.
