OpenHealth Q&A

Persistent Pelvic Pain Following Surgery

Hello everyone, Since October 2024, I've been suffering from intense chronic pelvic pain that appeared unexpectedly. The discomfort resembles severe menstrual cramps but is constant, sitting between a 7 to 8 on the pain scale. Along with this pain, I experienced considerable inflammation, leaving my pelvic area feeling hot and pulsating. Over-the-counter pain relievers offered no relief whatsoever. A consultation with a pain management specialist resulted in a prescription for pregabalin (150 mg, three times daily), which also failed to alleviate my symptoms. Oxycodone (10 mg, three times a day) provided marginal relief but only for approximately half an hour, and only if taken all at once. I suspected that endometriosis might be the cause of my discomfort and opted for an MRI in November 2024. The results indicated a mass in the uterine wall, leading the radiologist to suspect adenomyosis. In February 2025, I underwent a total hysterectomy. I had previously had a bilateral salpingectomy in February 2022, so in this surgery, the doctor removed my uterus and cervix along with the ligaments that were visibly affected by endometriosis. Initially, after recovering from surgery, I felt completely free of pain for about eight weeks. However, in late March 2025, I was dismayed to awaken to the same intense pelvic pain that I had suffered before the hysterectomy. Even though I no longer had a uterus, the pain mimicked severe menstrual cramps, and my pelvic area was once again inflamed. Oxycodone’s effectiveness remained minimal, and even intravenous ketamine at the highest allowable dose for my weight did not provide any relief. My suspicion of lingering endometriosis warranted reaching out to the surgeon who had performed my hysterectomy. He assured me that he had removed all visible endometriosis and suggested that I might be facing intestinal issues instead. Since then, I have consulted various specialists and had another MRI, which fortunately showed no abnormalities. A urologist confirmed there were no bladder-related problems, while a colonoscopy returned normal results. I participated in pelvic floor exercises under the guidance of a physical therapist, but despite weeks of diligent practice, my pain persisted. Having never been pregnant or given birth, I believed that my pelvic floor remained strong. I also engaged with an endometriosis excision clinic, prompted by insights from another OBGYN who suggested I might need specialized surgery given my prior generalist care. On July 31, 2025, I underwent surgery at the endometriosis clinic, where surgeons excised eleven tissue samples from my pelvic cavity, including my appendix. Pathology results identified "early acute appendicitis," and one tissue piece confirmed the presence of stromal endometriosis, while the others indicated chronic inflammation or fibrosis. These findings supported the notion that my pelvic region had suffered damage due to inflammation. The surgeons noted that my remaining ovaries were healthy and unlikely to be contributing to the pain. Following this surgery, although I did experience some improvement in pain levels—from 7-8 down to 4-5—my chronic pelvic pain continues to persist without significant relief since the procedure. Unlike the gradual improvement experienced after my salpingectomy and hysterectomy, this time the pain has plateaued. As per the endometriosis excision clinic, I was advised to manage my post-operative pain with Tylenol; however, over-the-counter medications, even at maximum dosages, have failed to assist, as have pregabalin and oxycodone. A key difference in my pain now is its nature; it feels more like a wound compared to the menstrual cramp sensation I used to feel, and I've noticed a decrease in inflammation compared to before. I've been in consultation with both my surgical team and pain management specialist regarding my current condition. The pain specialist suggested I explore talk therapy along with pelvic floor exercises (which I am already doing), while my surgeon emphasized the importance of adopting a nutritious diet—I maintain a healthy BMI and include plenty of fruits and vegetables. Both professionals advised patience, indicating that my body still requires time to heal fully. I recognize that healing is a process, yet it concerns me that the pain has shown no signs of improvement since just a few days following the surgery, leading to my expectations being unmet. Is this expected? I realize that it may be premature to express concern only three weeks post-surgery, but my mental well-being is frail as I reflect on nearly a year fraught with relentless pain and minimal respite. I yearn for hope of recovery, while grappling with anxiety over the possibility of enduring chronic pain indefinitely. I feel as though my mental health has deteriorated significantly, and I wonder whether I will ever escape this persistent anguish.

Answers (1)

8/24/2025, 4:01:58 AM

OpenHealth AI

Thank you for sharing your experience, and I'm sorry to hear about the challenges you've faced with chronic pelvic pain. It's completely understandable to feel anxious after enduring significant discomfort and undergoing multiple surgeries with little relief. Let’s address your situation and explore what steps you can take to find some hope and relief.

Key Points:

1. Chronic Pain and Healing: It's common for pain to persist after surgeries, and healing can take time. Your body has undergone several significant changes, which might contribute to ongoing pain.
2. Pain Management: Since traditional pain relief methods have not been effective for you, exploring alternative approaches may be beneficial.
3. Mental Health Support: Given the emotional toll this situation has taken, it’s important to prioritize your mental well-being alongside physical recovery.

Explanation:

After extensive surgery and treatment for endometriosis, it’s not unusual to still experience pain, especially in the months following your procedure. The decrease in inflammation you’ve observed is positive, but the sensation of pain feeling more like a wound may also relate to nerve damage or sensitivity that can occur after surgeries.

Notably, patience is crucial in the healing process. Although three weeks post-surgery might feel long, it can still be early days in terms of recovery. Nonetheless, setting realistic expectations is important—ongoing discomfort shouldn’t overshadow the hope that things will continue to improve over time.

Next Steps:

1. Pain Management Alternatives: Since medications like oxycodone and pregabalin haven't provided relief, consider discussing options such as:

   • Neuromodulation techniques: Treatments like transcutaneous electrical nerve stimulation (TENS) may help manage pain.
   • Cognitive Behavioral Therapy (CBT): This can provide tools to manage the emotional aspects of chronic pain.
   • Mindfulness and relaxation techniques: Practices like meditation or yoga can aid in stress reduction and pain management.

2. Physical Therapy: Continue with pelvic floor therapy, as improving the function of your pelvic region may reduce pain and build strength. Consider asking for a therapist specializing in chronic pain management.

3. Nutrition and Diet: Following up with your healthcare provider about a diet that minimizes inflammation may be beneficial. Some patients find relief by adjusting their diets (such as reducing processed foods and adding anti-inflammatory foods).

4. Mental Health Support: Engaging with a therapist, especially one trained in chronic illness management, can be crucial. Support groups for chronic pain or endometriosis may also provide a sense of community and understanding.

5. Ongoing Communication with Specialists: Maintain open lines of communication with your surgical team and pain specialists. Regularly updating them on your symptoms and experiences can help them adjust your care plan effectively.

Healing from chronic pain is often a journey of trial and error. Although it can seem daunting, many people do find paths toward pain relief and improved quality of life. Your hope for recovery is valid, and by exploring these avenues, you may discover effective strategies to manage your pain better and enhance your well-being.

Please continue to take care of yourself, and don't hesitate to seek the support you need along this journey.