WOMENS-HEALTH Messages for July, 1997: Re: Post Endometrial Ablation Pain

Re: Post Endometrial Ablation Pain

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Thu, 31 Jul 1997 22:54:08 -0500 (CDT)

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In reply to: Karen: "Post Endometrial Ablation Pain"

At Thu, 31 Jul 1997, Karen wrote: >
>Well, I had my ablation done 7/28. When I awoke in the recovery room, I was experiencing
>severe, stabbing pain throughout my entire abdomen. It became so
>intense that I began vomiting. I required Demerol/Vistaril IM to
>relieve the discomfort. I still am experiencing tenderness in my
>abdomen along with right shoulder pain.

Karen-

One of the hardest questions to answer on this forum involves pain, since it is so subjective, and since assessment often requires a physical examination (wouldn't *that* be a technological breakthrough for the Internet?!). In general, endometrial ablations or resections are painless or only minimally uncomfortable. However, we each have a different sensitivity to pain. The uterus and endometrium release prostaglandins, which can cause severe uterine pain. These chemicals can be blocked by nonsteroidal medications like higher doses of ibuprofen (600-800 mg every 8 hours).

Other causes of this type of pain include intestinal injury, such as a "bowel burn" or perforation of the intestine. A uterine perforation might account for pain, and would certainly be suspected in cases of shoulder pain (often caused by air or gas under the diaphragm). In many cases an intestinal injury will cause severe vomiting, fevers, and abdominal distention. I have never had one of these occur (knock on wood), but counsel my patients to come to the ER immediately, day or night, if they experience these symptoms after a laparoscopy or hysteroscopy. Just like bad things happen to good people, bad things can happen to good surgeons. The trick is to diagnose them and fix them in a timely fashion. Most uterine perforations heal by themselves, although they may lead to an infection of the uterus or abdominal cavity, another possible source of abdominal pain.

As you can see, diagnosing post-op pain is a complicated process. Much of the training that doctors in surgical specialties undertake is learning how to work-up surgical problems preoperatively, and how to care for postoperative problems and complications. Doing surgery is only part of the big picture. So, please check out your concerns with you doctor. If you develop severe pain, fevers, abdominal distention, etc., it would always be prudent to contact your doctor or go the the nearest ER for evaluation.

Best wishes,

--
Ashley Hill
D. Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, FL
dahmd@gate.net

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In reply to: Karen: "Post Endometrial Ablation Pain"

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