Diagnosis
Endometriosis is a very difficult condition to diagnose and thus occasionally it can take a long time for patients to be referred to hospital specialists. Many patients will suffer with pelvic pain for over 6 years before the required tests are carried out.
Mr Amer Raza has a carefully planned series of investigations and assessments available to diagnose the extent of endometriosis and these can be carried out in a timely fashion without delay.
Some of these tests are summarized below. The order of these tests may vary with every patient, and you may not require every test performing.
History taking and examination A full and thorough history will be taken to understand the extent and type of disease process. This is the most important part of the assessment. This will be followed by a gentle examination, including a pelvic assessment and possibly speculum to palpate any endometriotic nodules, bowel adhesions or masses.
Pelvic ultrasound scan
Mr Raza carries out all the ultrasounds himself. This is an additional tool along with the examination to get the accurate diagnosis. The ultrasound scan is a very good tool to help with the ovarian endometriosis, tenderness and adhesions. The patients gets the instantaneous explanation of any finding and linking these the symptoms such as painful periods, painful intercourse, chronic pain and irregular bleeding pattern.
The ultrasound scan also helps to check the follicular count from a fertility perspective.
If there is an evidence of severe endometriosis with involvement of bowel, then a pelvic MRI scan is arranged within days to map out the disease and plan a surgical treatment. The pelvic MRI gives a very detailed information about the extent of the disease and involvement of other organs. His is also the best investigation to look in to adenomyosis. Dr Iola Papanikolaou is the consultant radiologist with a special interest in endometriosis. She reports all the MRI scans.
Expanded investigations
Colonoscopy and flexible Sigmoidoscopy
Performed by Mr. Oliver Warren, this may become necessary in severe cases of endometriosis where the colon and rectum can become involved in the disease.
This may become necessary in severe cases of endometriosis involving the large and small bowel, particularly where the rectum becomes stuck to the back of uterus. Mr Oliver Warren, a laparoscopic colorectal surgeon with an interest in endometriosis surgery will carry out the procedure. These investigations help us to understand the extent of bowel involvement and perform pre-operative planning and where necessary a detailed consent process. Mr Raza and Mr Warren work very closely in these complex cases of rectovaginal endometriosis to achieve the best results for their patients, and are happy to perform joint consultations with patients and their families prior to surgery.