Examining All Causes of Pelvic Pain

Dr Allyson Shrikhande is a pioneer in the field of Pelvic Physiatry. She is Internationally known for her amazing work and compassion for people with pelvic pain. She owns Pelvic Pain Rehabilitation which has offices in New York and at Care Point Health in New Jersey. Dr. Shrikhande is a crucial team member to anyone with endometriosis. She writes:
As a physiatrist specializing in pelvic pain, I focus on the muscles, nerves and joints of the pelvis. I have a special place in my heart for my endometriosis patients, and raising awareness and helping to improve the quality of life of these patients is my life’s passion. A large percentage of my patients have known or suspected Endometriosis. Unfortunately, at this point in time the only way to diagnose and definitively treat endometriosis is through surgery. Most patients have suffered for a long time and seen several physicians before understanding why they are having severe bloating, abdominal and pelvic cramping, constipation, pain with tampon insertion or intercourse just to name a few. 
When treating patients with Endometriosis, I am looking to identify and help treat potential pain generators other than the Endometriosis itself. I break these “other” potential pain generators in to three categories; the central nervous system, peripheral nervous system and musculoskeletal system. It is important to treat all three for a patient’s body to reach a state of internal balance. 
Over time, the presence of Endometriosis causes an inflammatory soup which can irritate and eventually upregulate the peripheral nerves of the pelvis. The upregulation of the peripheral nerves sends signals to the spinal cord and brain, which then upregulates the central nervous system. This is what we call peripheral and central sensitization. In helping patients, we focus on treating these with a combination of peripherally targeted therapies such as pelvic floor physical therapy with nerve gliding techniques, nerve blocks and centrally targeted therapies such as meditation, diaphragmatic breathing, acupuncture and in certain cases mindfulness based cognitive behavioral therapy and central nervous system neuromodulating medications. 
When looking at the musculoskeletal system, it is important to rule out other potential pain generators such as an inguinal hernia, umbilical hernia, obturator hernia, sports hernia, hip or lumbar spine pathology, sacro-iliac joint or pubic symphysis pathology. These can all contribute to pelvic pain and can occur concomitantly with Endometriosis. (Dr. Marc Zoland will present on hernias at The Endometriosis Summit and Dr Amy Stein, PT DPT will present on musculoskeletal causes.) 
Lastly, a large percentage of patients with pelvic pain have short, contracted, weak and tender pelvic floor muscles. I help identify and treat these hypertonic pelvic floor muscles, which if persist can cause pelvic pain even after the endometriosis is surgically removed. 
I truly enjoy treating and getting to know endometriosis patients and helping them regain the quality of life that they deserve.
Come here Dr. Allyson Shrikhande and Pelvic Pain Rehabilitation's Medical Partner Tayyaba Ahmed at The Endometriosis Summit. Tickets on sale www.theendometriosissummit.com

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