Back pain? Chest pain? Leg Pain? Chronic Fatigue?
Other painful and unusual symptoms associated with endometriosis
You’ve probably heard about the severe pelvic pain that endometriosis can cause right before or during menstruation. However, did you know that many women with endometriosis also report lower back pain, leg & hip pain, acid reflux, chronic fatigue, and many other symptoms that don’t appear to be related to the pelvic area? In fact, over 300 years ago, the preeminent physician, Thomas Sydenham, described an endometriosis-like disease (referred to as hysteria back then) which had “back pain as the disorder’s most reliable diagnostic feature.” Some even experience chest, shoulder, or upper abdominal pain, though these symptoms are less common. Confusing matters more is the fact that these symptoms are not always cyclic, meaning that they may occur anytime during the month, not just synchronously with menstruation.
Although not all women who have endometriosis will have chronic lower back pain, some studies have shown that as many as 15% do present with this symptom. While it’s not entirely understood why endometriosis can cause lower back pain, most believe it is the result of nerve damage, inflammation, lesions, and/or adhesions that are adjacent to the spinal cord. When endometriosis infiltrates nerves near to the spinal cord, for example, it can cause radiating pain throughout the region. Surgically removing endometriosis from this and other nerves can help reduce these symptoms. However, only the most advanced laparoscopic surgeons can remove endometriosis from nerves minimally invasively without causing complications. Therefore, make sure to ask your surgeon how much experience he or she has with removing endometriosis from nerves using minimally invasive techniques.
Endometriosis of the diaphragm, liver, lungs is very rare, but nonetheless should be ruled out if you are experiencing chest pain (pleuritic pain), shortness of breath (dyspnea), epigastric pain (upper GI), shoulder pain, and right or left upper quadrant (upper abdomen) pain, all of which may or may not be cyclic. The rarer but more serious and potentially life-threatening conditions of catamenial pneumothorax, hemopneumothorax, chest wall lesions, and lung parenchyma can also cause similar symptoms and sometimes occur concomitantly with diaphragmatic endometriosis. And although even rarer still, with fewer than 20 cases reported in the literature, liver endometriosis should also be a part of differential diagnoses, as it too can cause cyclic upper abdominal pain.
These areas of the upper abdomen are sometimes overlooked by gynecologic surgeons, who sometimes only perform diagnostic evaluations of the lower abdomen. However, even though these conditions are rare, Dr. Nezhat always makes sure to rule them out during any diagnostic investigation.
The following video of laparoscopic diaphragmatic stripping for ovarian cancer demonstrates several highly advanced surgical techniques. Even though in this video they’re applied in an oncological setting, nevertheless these techniques can be used for treating diaphragmatic endometriosis as well.
LEG PAIN, HIP PAIN
Endometriosis that affects the obturator nerve, which crosses through the pelvic region and innervates the inner thighs, can cause pain that radiates down the leg or toward the groin area or hips. Another way that endometriosis can cause leg pain is when it affects the pudendal nerve, which innervates the lower vagina and external female genitalia. As with the obturator nerve, any areas connected to the pudendal nerve can become painful due to the endometriotic lesions. Endometriosis has also been found traveling along the obturator nerve to the adductor compartment of the thigh (P Waer, et al, Japan Journal of Radiology, 2012), which can cause pain in the hips and thighs.
The symptoms of bowel endometriosis can overlap with those of other gastrointestinal disorders, such as gastroesophageal reflux disease (GERD), more commonly known as acid reflux. Other times the patient has both endometriosis and GERD. As well, frequent use of certain pain medications, which often goes with the territory for those with endometriosis, can cause acid reflux to develop.
Both bowel endometriosis and acid reflux can cause painful indigestion or stomach discomfort, nausea, vomiting, bloating, abdominal pain, diarrhea, and regurgitation. While usually the symptoms of endometriosis become more acute right before or during menstruation, this is not always the case. That’s why it’s important to obtain a thorough evaluation by both a gastrointestinal and endometriosis specialist if possible.
Many women with endometriosis experience chronic fatigue. Of course, chronic pain itself can cause fatigue, as can the attendant high levels of anxiety and stress that go with the territory of chronic illness. Surgically removing endometriosis may help reduce the pain and therefore reduce symptoms. We can also perform blood test to check for the following disorders that may be contributing to your fatigue:
- pernicious anemia
- hypothyroid, Hashimoto’s disease
- b12 deficiencies
PUDENDAL NERVE PAIN (NEURALGIA)
Endometriosis of the pudendal nerve (PN) can cause severe neuralgia (nerve pain) in those places that are innervated by this nerve, such as the anus, labia, perineum, rectum, vaginal area, and urethra, just to name a few. However, the pain may radiate beyond these areas. Reported symptoms include stabbing pain, numbness, bowel symptoms, and painful intercourse. Endometriosis of the PN is often mistaken for other conditions, such as pelvic floor disorders, interstitial cystitis, and musculoskeletal disorders.
If you suspect that you may have these rare forms of multi-organ endometriosis, make sure to discuss all of your symptoms with your doctor, even if you don’t think they’re important.