Evaluating degree of pelvic pain and comparing it with the type and degree of adhesions in patients of Endometriosis

Tarini Sonwani, Ratna Biswas
In: Indian Journal of Obstetrics and Gynecology Research · 2019 · vol. 6(2) , pp. 169–172 · doi:10.18231/j.ijogr.2019.039 · W2971018161
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This study found significant associations between endometriosis pain severity and both the type and degree of tubal and ovarian adhesions.

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This study evaluated pelvic pain intensity and compared pain type and severity with the type and degree of pelvic adhesions in 30 women diagnosed with endometriosis, using visual analogue scale (VAS) ratings before and after laparoscopy/laparotomy with ASRM staging and simultaneous corrective procedures. Half the participants reported moderate pain, with high frequencies of forniceal thickening and ovarian/cyst findings, and most had unilateral tubal adhesions and predominantly flimsy adhesions. The authors found significant associations between severity of pain and features of ovarian and tubal adhesions (including degree and type), with forniceal thickening particularly associated with moderate pain. The paper’s main caveat is its small sample size and the short 6-week follow-up period, limiting generalizability and durability of the findings. This paper is centrally about endometriosis — it links VAS-measured pelvic pain severity to the type and degree of pelvic adhesions in women with endometriosis.

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Abstract

Introduction: Intra-abdominal adhesions are common features of endometriosis. Adhesions lead to several chronic symptoms including abdominal distension, pain, nausea, and abnormal bowel movement pattern. Adhesive disease may be life-altering in many patients. Aims and Objectives: To study types of pain and compare it with type and degree of adhesion. Materials and Methods: Thirty women diagnosed with endometriosis were studied. Pain intensity was assessed by visual analogue scale (VAS) and categorized as mild, moderate or severe accordingly. This was followed by laparoscopy/ laparotomy and staging of endometriosis which was done as per the American Society for Reproductive Medicine (ASRM) classification system. Corrective procedures were done simultaneously. Women were followed-up after 6 weeks to re-assess the pain intensity by using the same visual analogue scale (VAS). Results: Mean age of study cohort was 30 ±5.75 years. As per VAS, half of the patients had moderate pain (50%). Forniceal thickening was present in 73.33% and cyst was felt in 66.66% women.76.66% had unilateral cysts. Unilateral tubal adhesions were present in 76.66% women and bilateral adhesions were present in 23.33% women. Among the types of adhesions, flimsy adhesions were most common, being present in 76.66% women and deep adhesions were present in 20% women. Majority had 1/3rd-2/3rd tubal adhesions (46.7%). All the ovarian adhesions were flimsy. Obliteration was present in 30% women. Forniceal thickening was reported in majority of the women with moderate pain (93.3%) (p=0.001). Cyst was felt on per-vaginum examination in 80% women with severe pain. The correlation of degree of ovarian adhesions (p=0.003) and type and degree of tubal adhesions (p=0.004) with degree of pain by VAS in endometriosis was significant. Conclusion: We found significant association between severity of pain and type of adhesions and between degree of tubal and ovarian adhesions and severity of pain. Operative pro
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Introduction

Intra-abdominal adhesions are common features of endometriosis. Adhesions lead to several chronic symptoms including abdominal distension, pain, nausea, and abnormal bowel movement pattern. Adhesive disease may be life-altering in many patients. Aims and Objectives: To study types of pain and compare it with type and degree of adhesion.

Materials and methods

Thirty women diagnosed with endometriosis were studied. Pain intensity was assessed by visual analogue scale (VAS) and categorized as mild, moderate or severe accordingly. This was followed by laparoscopy/ laparotomy and staging of endometriosis which was done as per the American Society for Reproductive Medicine (ASRM) classification system. Corrective procedures were done simultaneously. Women were followed-up after 6 weeks to re-assess the pain intensity by using the same visual analogue scale (VAS).

Results

Mean age of study cohort was 30 ±5.75 years. As per VAS, half of the patients had moderate pain (50%). Forniceal thickening was present in 73.33% and cyst was felt in 66.66% women.76.66% had unilateral cysts. Unilateral tubal adhesions were present in 76.66% women and bilateral adhesions were present in 23.33% women. Among the types of adhesions, flimsy adhesions were most common, being present in 76.66% women and deep adhesions were present in 20% women. Majority had 1/3rd-2/3rd tubal adhesions (46.7%). All the ovarian adhesions were flimsy. Obliteration was present in 30% women. Forniceal thickening was reported in majority of the women with moderate pain (93.3%) (p=0.001). Cyst was felt on per-vaginum examination in 80% women with severe pain. The correlation of degree of ovarian adhesions (p=0.003) and type and degree of tubal adhesions (p=0.004) with degree of pain by VAS in endometriosis was significant.

Conclusion

We found significant association between severity of pain and type of adhesions and between degree of tubal and ovarian adhesions and severity of pain. Operative procedures decrease the severity of pain.

Keywords

Tubal adhesions, Forniceal thickening, pain, visual analogue scale. How to Cite This Article Vancouver Sonwani T, Biswas R. Evaluating degree of pelvic pain and comparing it with the type and degree of adhesions in patients of Endometriosis [Internet]. Indian J Obstet Gynecol Res. 2019 [cited 2026 Jun 13];6(2):169-172. Available from: https://doi.org/10.18231/j.ijogr.2019.039 APA Sonwani, T., Biswas, R. (2019). Evaluating degree of pelvic pain and comparing it with the type and degree of adhesions in patients of Endometriosis. Indian Journal of Obstetrics and Gynecology Research, 6(2), 169-172. https://doi.org/10.18231/j.ijogr.2019.039 MLA Sonwani, Tarini, Biswas, Ratna. "Evaluating degree of pelvic pain and comparing it with the type and degree of adhesions in patients of Endometriosis." Indian J Obstet Gynecol Res, vol. 6, no. 2, 2019, pp. 169-172. https://doi.org/10.18231/j.ijogr.2019.039 Chicago Sonwani, T., Biswas, R.. "Evaluating degree of pelvic pain and comparing it with the type and degree of adhesions in patients of Endometriosis." Indian J Obstet Gynecol Res 6, no. 2 (2019): 169-172. https://doi.org/10.18231/j.ijogr.2019.039

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Outcome instruments

VAS-pain

Condition tags

endometriosis

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