Disclaimer: The information provided in this post was directly taken from the educational video series created by The University of Toronto, Mount Sinai Hospital, and Federal University of Sao Paulo.
Edwards, D., Zhao, Z., Solnik, J., & Lemos, N. (2020, September 24). Parametrial Endometriosis Part 1: A Correlation of Parametrial Anatomy and Disease Presentation [Video file]. Retrieved March 03, 2021, from https://cansagevideos.com/Video/2230
Parametrial endometriosis (PE) is a unique presentation of deep infiltrating endometriosis that involves the lateral parametrium, which is a band of fibrous tissue that separates the supravaginal (above the vagina) portion of the cervix from the bladder. This type of endometriosis can affect autonomic nerves crossing the parametrium that innervate the bladder.
After I had excision with a top specialist in 2018, with no symptom relief and being in pelvic floor PT for 3 years with not as much progress as you would expect, plus doing a sh*t ton of meditation and mindfulness, I finally have made my way into the hands of a pelvic nerve specialist who has identified parametrial endometriosis in a recent MRI. I am currently waiting for the date for my second endometriosis surgery with this specialist in hopes this is a big piece of my chronic pain puzzle.
Today I wanted to share with you what I have learned about this type of endometriosis, in hopes more awareness can be spread and to yet again emphasizes that endometriosis is a WHOLE BODY condition NOT just a reproductive disease.
The University of Toronto, Mount Sinai Hospital, and Federal University of Sao Paulo have teamed up on a current study conducting the LaNSURe surgical technique and are finding a specific pattern characterized by parametrial infiltration of the pelvic sidewall and lumbosacral plexus that generate a constellation of symptoms.
This pattern in parametrial endometriosis can include symptoms not classically taught as gynaecological problems such as neuropathic and radicular pain in the hip, groin, buttocks and sciatica as well as direct affect to bladder function. Irritation of the nerve bundles by endometriosis can cause urinary pain, urgency, frequency which are commonly associated with parametrial endometriosis infiltration.
As endometriosis infiltrates the parametrium, laterally toward the pelvic side wall and ischial spine, it can affect the levator ani muscles, oberator internus muscle, the sacral nerve roots, the pudendal nerve, and sciatic nerve. This then creates the presentation of deeply infiltrating endometriosis with the unique presentation of clinical symptoms that can be more location specific than those traditionally observed with classical Deep Infiltrating Endometriosis (DIE).
The symptom presentation of parametrial endometriosis is not usually associated with gynaecological conditions.
Cyclic symptoms can include:
- Lateral hip pain (45% of patients)
- Sacral pain (55% of patients)
- Groin and Buttock pain (60% of patients)
- Sciatic pain (60% of patients)
- Pudendal Neuralgia (41% of patients)
- Urethral Pain
- Urinary frequency
- Dysuria (pain burning when urinating)
- Voiding Dysfunction
If a doctor or yourself suspects Parametrial Endometriosis, a neuropelveology exam should be done by a pelvic nerve specialist. MRI is the imaging of choice for visualization of pelvic side wall infiltration and is a mandatory part of the PE surgical assessment and planning.
With this study taking place, it is very clear by observation and/or surgical experience rather than theory, the actual correlation between endometriosis with such somatic symptoms has never been thoroughly investigated.
Even though parametrial endometriosis has yet to be thoroughly investigated, the results from this study are promising in pain and quality of life improvement.
If you would like to know more about Parametrial Endometriosis, check out this amazing video resource by clicking the video image or this link.
Edwards, D., Zhao, Z., Solnik, J., & Lemos, N. (2020, September 24). Parametrial Endometriosis Part 1: A Correlation of Parametrial Anatomy and Disease Presentation [Video file]. Retrieved March 03, 2021, from https://cansagevideos.com/Video/2230