Pelvic organ prolapse occurs when the tissues and muscles that support the pelvic organs weaken over time. As a result, organs such as the bladder, uterus, or rectum may shift or descend due to gravity.
This condition can develop gradually and may vary in severity. Treatment options depend on the extent of prolapse, symptoms, and individual goals, and may include both surgical and non-surgical approaches.
Not everyone experiences every symptom. The type and severity of symptoms depend on which organs are involved and the degree of prolapse.
Pelvic organ prolapse can progress gradually over time, and symptoms may change depending on activity level and daily habits. Some patients may find relief with non-surgical options, while others may benefit from surgical intervention.
Early evaluation can help prevent worsening symptoms and improve quality of life. Discussing your goals, lifestyle, and comfort level with your physician is key to determining the most appropriate approach for your care.
Diagnosing pelvic organ prolapse involves a thorough medical history and physical examination to assess the extent of organ descent and symptom impact.
The first step is a comprehensive evaluation to determine which pelvic organs are affected and how the condition is impacting daily life. This helps guide appropriate treatment options.
Pelvic organ prolapse can interfere with daily activities and quality of life. As the condition progresses, symptoms may worsen, making treatment important for symptom relief and functional improvement.
Treatment options may include both non-surgical and surgical approaches, depending on the individual case.
Dr. Lucas takes a personalized approach to treating pelvic organ prolapse, carefully considering each patient’s symptoms, goals, and lifestyle.
Both surgical and non-surgical options are discussed to determine the most appropriate plan. Treatment is tailored on a case-by-case basis to ensure optimal outcomes and improved quality of life.
Dr. Lucas works closely with patients throughout their care, providing guidance, follow-up, and adjustments as needed for long-term management across Maine and the New England region.
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.
See Dr. Lucas!! There are hundreds of options to alleviate symptoms until definitive surgical intervention. This is a very specific question because only YOU know your endometriosis pain experience. Dr. Lucas will work with you to develop a plan of care to address your pain until surgical intervention is needed, available and/or desired.
These options can range from oral medicine to compounded medicine to manual medicine to acupuncture, the list goes on. The same pain care regimen will not work for everyone so we have a wide spectrum of treatment options available.
(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.
Abdominal, pelvic, back pain can have many sources, including but not limited to musculoskeletal dysfunction/spasm, vascular insufficiency, endometriosis, pelvic inflammatory disease (PID), interstitial cystitis (IC; now known as Painful Bladder Syndrome), inflammatory bowel diseases (IBD), irritable bowel syndrome (IBS; now known as Disorder of the Gut-brain Interface/Axis), and neurologic dysfunction.
Pelvic floor muscles respond to chronic pain conditions. Even if endometriosis is thoroughly removed, some patients need physical therapy/biofeedback. Manual therapy (Osteopathy, physical therapy, acupuncture, massage, etc) has a better chance of being successful after the underlying cause for the pain is removed. To have the best chance for pain relief, we need to treat the whole person and eliminate as many sources of pain that we can identify.
Sometimes after laparoscopic excision, some, most, or all the specimens are positive for endometriosis on pathology, but the patient still has pain. In that individual, there may be another factor at work that is causing her pain. We now know and understand that pain responses change over time. Literally, the nerves change to become easily excitable and more likely to send pain signals to the brain, even when there is no actual damage being done to tissue. This is called Central Sensitization. This is a complex disease entity but there are options to treat it. This is a major reason why, if you continue to have pelvic pain after having had surgery:
