QC: Beyond Endometriosis: Understanding Nerve Pain in the Pelvis

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Professor Marc Possover transforms our understanding of chronic pelvic pain by targeting the pelvic nerves directly when traditional treatments fail. His pioneering work in neuropelviology bridges gynecology, neurology, and minimally invasive surgery to bring relief to patients who've been told to simply live with their pain.

• Pain or disorder of pelvic organs always involves nerve issues, with endometriosis being one potential cause
• Gynecological examination, sonography, and MRI help determine if endometriosis is present
• Many doctors aren't familiar with neuropelviology - if they don't recognize the term, they likely have limited knowledge of pelvic nerves
• Nerve-sparing techniques are crucial for all patients undergoing pelvic surgery to avoid postoperative organ dysfunction
• In patients with Ehlers-Danlos Syndrome (EDS), atypical blood vessels can compress nerves causing pain
• Treatment often involves releasing the nerve by removing the problematic vein rather than treating the nerve itself
• Sickle cell disease can also cause compression of pelvic nerves through small areas of ischemia throughout the body

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Episode Transcript

Speaker 1 (00:00):
Could it be endometriosis?
Or could it just be nerveirritation that's giving you all
this reoccurring pain?
And how would you even try todescribe neuropelviology to one
of your clinicians?
This and so much more withProfessor Possover.
Stick around.
Life moves fast and so shouldthe answers to your biggest
questions.
Welcome to EndoBattery's QuickConnect, your direct line to

(00:21):
expert insights.
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You send in the questions, Ibring in the experts and in just
five minutes you get theknowledge you need.
No long episodes, no extra timeneeded, and just remember
expert opinions shared here arefor general information and not
for personalized medical advice.
Always consult your providerfor your case-specific guidance.

(00:43):
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect.
Today's guest has built hiscareer on a bold but vital
belief that suffering painshould not be a life sentence.

(01:05):
And for Professor Mark Possover, that belief isn't just a
philosophy, it's a mission as aworld-renowned pioneer in
neuropelviology.
Yes, you heard that right.
He has transformed how weunderstand and treat chronic
pelvic pain, especially when thesource is elusive or deemed
untreatable.
His work bridges the worlds ofgynecology, neurology and

(01:27):
minimally invasive surgery totarget the pelvic nerve directly
, often bringing relief topatients who've been told to
simply live with it.
His methods have given hope tocountless people who have felt
like they've run out of options.
So if you've ever wonderedwhat's really going on when no
one seems to have answers, thisepisode is for you.
How do we know that it's ournerves firing, or the pain from

(01:54):
our nerves, and notendometriosis, if we've already
had excision, or even prior toexcision, deciphering if it's
nerves or endometriosis?

Speaker 2 (02:01):
So is the patient feels pain or disorder of the
pelvic organ.
It's always an issue with thenerve, and endometriosis is a
cause that induces a dysfunctionof the nerves and not the
contrary.
And now to know it isendometrial or something else,
you have the gynecologicalexamination and sonography and
maybe MRI.

Speaker 1 (02:23):
How do we talk to our providers about neuropelviology
?
This could be tricky.

Speaker 2 (02:30):
That is a little bit tricky because I've seen a lot
of colleagues.
Even they will not know thename neuropelviology.
Simply use the wordneuropelviology.
If the colleagues don't knowwhat it means neuropelviology,
they will have no knowledge ofthe pelvic nerves.

Speaker 1 (02:46):
Yeah, how important is nerve sparing for talking to
your doctors.

Speaker 2 (02:52):
Nerve sparing is only one aspect in the
neuropalveology.
It's a simple part inneuropalveology but for all
patients not just women, men aswell who are undergoing pelvic
surgery it's the key to avoidpostoperative dysfunction with a
pelvic organ.
You will have to preserve evenmore because mostly the nerve

(03:13):
has nothing to do with thepathology.
The pathology is theendometriosis, not the nerve.
There is nothing wrong with thenerve.
The nerves are affected by theendometriosis.
So you have to treat theendometriosis and not to reset
the nerve.

Speaker 1 (03:27):
Right.
How, with the nerves and thingslike Ehlers-Danlos syndrome or
EDS, is there a more heightenedstate of sensitivity on the
nerves when you have conditionslike EDS?

Speaker 2 (03:40):
When patients are affected by hypermorbidity
syndrome or Ehlers-Danlossyndrome they have likely
atypical vessels in the pelvisnot only enlarged.
Sometimes the vessels arerunning in the wrong position
and will induce an irritation bytying, by compressing the nerve
and that will induce secondarypain.
Then the treatment is not to dosomething with the nerve but to

(04:03):
release the nerve by removingthe vein.
In our country we haveEhlers-Danlos Syndrome.
I had yesterday a patientcoming from South Africa and he
told me that in America there isanother disease, very, very
often, which may induce as wellcompression of the pelvic nerves
.
It's skillet cell disease.

(04:24):
Compression of the pelvicnerves is skillet cell disease.
It's an autonomic nerve diseasewhere the body develops
everywhere small ischemia in thebody.
And this patient seemed to be apathology with a very, very
high incidence in South Africabut also in America.
So I will for sure make aneducation video on that in the

(04:48):
future.

Speaker 1 (04:49):
Yeah, that would be an interesting topic to cover,
for sure.

Speaker 2 (04:53):
I will.

Speaker 1 (04:54):
That's a wrap for this Quick Connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming, send them inand I'll bring you the expert
answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at endobatterycom or visitingthe endobatterycom contact page.

(05:19):
Until next time, keep feelingempowered through knowledge.