The Evil Quadruplets: Painful Conditions Coexisting with Endometriosis

Endometriosis causes pain in many different mechanisms. In addition to direct pain caused by implants, patients often develop additional pain generators. One of them is the spasm of the pelvic floor muscles. Those muscles become spastic in the mechanism known as viscerosomatic convergence. In this mechanism, painful impulses travel from the pelvis to the spinal cord through the afferent fibers. They reconnect in the dorsal horn of the spinal cord, and efferent signals travel back to the muscles of the pelvis triggering them to spasm. Spasming pelvic floor muscles are a source of pain by themselves similarly to muscle spasm elsewhere in the body. They also lead to obstructive voiding, constipation, pain with and after urination, pain with and after bowel movement, and pain with and after intercourse. Constipation from spasming rectal sphincter likely leads to bowel becoming hyperactive to aid with evacuation of the stool. Those are the symptoms of irritable bowel syndrome. Mechanism called viscero-visceral convergence may explain direct involvement of the bladder. Afferent impulse travels from the peritoneal surface and then reconnects in the spinal cord to visceral efferent fiber traveling to the bladder. This explains bladder pain in those patients. It is crucial in patients with endometriosis to identify all the sources of pain since they must be addressed to alleviate. Pelvic floor muscles need to generally be addressed first. Patients should be referred to pelvic floor physical therapy. They may also benefit from muscle relaxants, especially vaginal suppositories. Patients with severe muscle spasm will benefit from injection botulinum toxin A into those muscles. Those injections may need to be repeated but ultimately physical therapy will allow muscles to stay relaxed. Bladder pain also needs to be addressed. Bladder hydrodistentions and installations in addition to pelvic muscle treatment may be effective in patients with bladder pain. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

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