Chronic pain sometimes takes a long time to go away. Most of our endo patients have had their pain for many years, so it may not go away in a month or 2. Patients who have robotic excision of endo with or without a presacral neurectomy will usually have pretty significant menstrual cramps the first few months after surgery. In fact, your first period after surgery may be worse than before surgery. Some lucky folks will have immediate pain relief including menstrual cramps, but it is difficult to predict who will react either way.
Once 3-6 months goes by, most of the endometriosis pain should be gone. If it is not, then most likely something else is causing the pain. The most common reasons are pelvic floor pain, bladder pain, and nerve pain. Pelvic floor muscle spasm commonly coexists with endo and some patients don’t realize how much the spasm is contributing to their overall pain. Physical therapy is much more effective after removing the stimulus of endo that usually causes the spasm in the first place, so if you’ve had ineffective PT before surgery, don’t dismiss it afterwards. Bladder pain, also known as Interstitial Cystitis (IC) is also frequently concurrent with endo, and sometimes resolves spontaneously after removing the endo, but sometimes persists. Please read the article on IC for more information.
Persistent “phantom endo pain” in the absence of any identifiable cause is rare, but occurs in about 5% of patients after excision. It is a similar phenomenon to phantom limb pain, and Complex Regional Pain Syndrome (CRPS), which are conditions where even though there’s nothing stimulating the nerve endings, they fire anyway and cause an exaggerated response in the brain. Please see the article “My Philosophy on Treating Pelvic Pain Patients”.
If you do have persistent pain months after excision surgery, please come back to see us and we will help to direct and coordinate your followup care. Dr. Mosbrucker is not “just” a surgeon, she also wants to make sure that every patient feels as good as they possibly can. While our office does not provide primary care, we are happy to see you for any issue related to endometriosis or pelvic pain, whether it is a surgical issue or not.