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Dr. C.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience:  30 years of experience and an award-winning educator.
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I have had an ovarian endometioma while ... at least

Customer Question

I have had an ovarian endometrioma for a while ... at least 2 years. Never been told I had endometriosis. I've had urinary urgency for a while. And in the last 2 months, I've had lots of bloating. I'm usually very thin and now my stomach is a bit distended, like it's not my stomach. I'm uncomfortable when I eat. My CA-125 was normal. I also have cramping on left side. Not extreme pain, but extreme discomfort. Two gyns don't think the bloating and urgency is related to the cyst. That I should try birth control to possibly ease symptoms or go for laporoscopic surgery. (I've never been on birth control) I guess I'm confused if I should get surgery if they say these symptoms aren't from cyst or look into GI or urinary route? I've also asked about aspirating cyst vaginally (instead of an operations/cuts), but my doctor has said that's not something docs do (but I read about it on Columbia University). Thanks.

Submitted: 1 year ago.
Category: OB GYN
Expert:  Dr. C. replied 1 year ago.
Hi , It's Dr. C. Board certified Ob-gyne. I can help you today. I'm sorry that you're having so much trouble. But a good investigation should be able to tease apart what is going on. Whether bloating and urgency is related to the cyst depends on how big the cyst is. If the cyst is large, it can put pressure on the pelvic structures enough to cause bladder urgency. Also if it actually is an endometrioma, there may be small endometriosis implants on the bladder that are irritating the bladder. But also it may be unrelated. Draining the cyst vaginally can be done but the problem is that unless the cyst itself is removed, it will often just refill with blood. It's preferable to remove the cyst to prevent this. The other comment I have is that the diagnosis of ovarian endometrioma cannot be made from an ultrasound. It requires a pathology report. So they can say that it's consistent with an endometrioma or suspicious for endometrioma but until there is tissue for a pathologist to examine, there is no diagnosis of endometrioma. It's also possible that you have a separate GI issue like a low grade irritable bowel syndrome. So overall, it sounds like I mostly agree with what you're being told. That separate GI or bladder issues may be a factor. In situations where things are confusing, having laparoscopy can be helpful because it gives the gyncologist a look at the inside. A urologist can help with a cystoscopy, a camera look inside the bladder. Please reply if I can clarify anything or provide more details. I want to be sure you have the most helpful information possible.
Customer: replied 1 year ago.

Thanks for replying. I've been told the cyst is about 2.5 inches. Is that large enough to cause bladder urgency? I originally learned about it last year when I went to the urologist for urinary urgency. However, I discovered it's been there since 2012 (which I learned from requesting a lab report from another test -- an x-ray for pain on left side). My first gyn said she couldn't biopsy it because cutting it might cause bleeding - since it was a hemorraging cyst. So I have no idea what's inside of me. My 2nd gyn said he didn't see scarring, a sign of endo.

I guess the reason I'm concerned is because new symptoms are happening, like the runners-cramp feeling on the left side. And the bloating is never going away. And I don't want to get an operation, possibly lose an ovary, if these symptoms aren't related to the cyst.

One other thing I forgot to mention is that I have had a history of hematuria for a couple years. It's never a UTI. Is that from cyst? Or bladder problem?

How can you know for sure what is causing the bloating before going through an operation?

And could aspiration provide some relief?

And is there any value in taking b/c pills? Could it really help with this intense discomfort? Or is it better to just go for surgery?

Also wondering if leaving the cyst untreated has caused damage, if it's dangerous to leave it in there (except for torsion risk).

Thanks.

Expert:  Dr. C. replied 1 year ago.
I'm wondering how your 2nd gyne could say there was no scarring. Scarring isn't visible without doing a laparoscopy. It can't be seen on imaging. None of this can be known for sure. Bloating is what we call a "non-specific" symptom. That means that it can be caused by a lot of different things that are hard to tell apart. Do you really mean 2.5 inches? Usually ultrasound reports are given in centimeters. If really 2.5 inches, that is certainly big enough to cause a feeling of bloating and urgency. But if 2.5 centimeters, not so much. We don't just generally biopsy ovarian cysts. The reason is that there isn't a lot of point to it. If we are going to biopsy it, we may as well just remove the whole thing. Biopsy doesn't solve anything. If it's blood filled, like endometriomas are, it will just continue to bleed. Runners cramp on the left side can often be bowel related if not gynecological. Or perhaps the psoas muscle on that side. Sometimes, it can be helpful to try "abdominal self-massage". The way to do this is to drink some warm chamomile tea, then lay on the floor with a pillow under the knees. This relaxes the belly muscles. They while taking big deep belly breathes, massage the tender area. Make sure that the entire rest of the body is relaxed. When there are tender abdominal areas, there is a tendency to tighten the legs and shoulders. So taking big deep belly breathes, keep checking in with the legs and shoulders to keep them relaxed and continue to massage the tender area. This technique can help with alot of things, various chronic pain conditions, bowel issues, scar tissue, etc. Birth control pills can help decrease the formation of cysts and stop bleeding inside active cysts. It may be worth a 3 month trial of birth control pills and daily abdominal self-massage for 5 minutes before bedtime. But if that doesn't work, full imaging with laparoscopy, cystoscopy and GI evaluation could be worth it. I hope this was helpful.
Customer: replied 1 year ago.

Hi, thanks for the reply.

Yes, the cyst is 2.5 inches. I believe it was around 7.2 cm?

I have never been on b/c pills before. But I just requested them from my doctor. He's booked for surgery in July and August, so I requested another doctor he recommends in case I can't take pain anymore. He has said the could help the cyst shrink, but everywhere else I read, they say b/c pills won't shrink an existing cyst, just stop new ones from forming.

At this point, my main concern is the bloating. I know doctor calls this a non-specific symptom, but it really is very abnormal for me. And I'm not sure what could cause my flat stomach to be this big every day -- even when eating extremely clean and drinking tons of water.

I guess I was concerned this bloating was ascites or disease of some kind. It's not normal period bloating. It's distended. But because i'm not a huge person, it's not a huge stomach. So doctors aren't looking at it as something serious.

So what, a cytoscopy and colonoscopy, I should try? Then if none of them, I can attribute the bloating to the cyst?

Expert:  Dr. C. replied 1 year ago.
That is a large cyst and is certainly large enough to be causing urinary urgency. That that size the recommendation is to have it removed. One of the risks is torsion, where the ovary twists on it's stalk, cutting off the blood supply to the ovary. This causes severe pain and potentially loss of the ovary. At 7.2 cm, the cyst should be removed. I also don't believe that bcps will help this current cyst but may prevent it from enlarging further. Yes you can attribute everything that is going on to the cyst for now. It is large enough to be causing bloating, pain, urgency, etc. Once it's removed, you'll be able to see what symptoms are left and deal with them then, if any are left after cyst removal. Anything else?
Customer: replied 1 year ago.

That is one thing I forgot to mention. The cyst has been the same size on each of the vaginal ultrasounds I've had. I had one in October 2014. And another in February 2014. It didn't get any bigger. But it didn't get any smaller, either.

I think surgery is my best option. I'm assuming doctor will put me on b/c after anyway. So might as well take b/c pills now, too.

This should be my last question!

Could the left-side runners-cramp and the new bloating indicate it's gotten bigger? Or that the ovary is being twisted already? This is definitely the worst I've felt the entire time I've had it.

Expert:  Dr. C. replied 1 year ago.
Yes I agree that surgery and may as well go on BCPs if you were thinking about it anyway to prevent future cysts. Yes the new left sided cramp could be from it getting bigger, or it starting to twist or just that it's aggravating the bowel on that side. With twisting, it's usually sudden stabs of pain especially with moving, like rolling over or exercise. It can be quite severe. But it can start with a low grade aching or cramping with sudden stabs on top of it. Anything else?
Expert:  Dr. C. replied 1 year ago.
If no further questions, please leave a rating for my service. I aim for excellent and appreciate your feedback. Thanks and good luck!