QC: How Often Does Endometriosis Contribute to Nerve and Vascular Compression?

Dr. Nick Fogelson, an expert excision specialist with formal neuropelviology training, explains how endometriosis affects nerve pathways and creates specific pain patterns. He shares valuable insights on identifying and treating nerve compression and endometriosis lesions that directly invade nerves.

• All endometriosis pain involves nerve irritation in some way
• Endometriosis can irritate nerves without directly invading them
• Lesions near the hypogastric nerve plexus can cause back pain, bladder and bowel dysfunction
• "Skip lesions" are isolated endometriosis deposits directly on nerves with minimal disease elsewhere
• Finding nerve-involved endometriosis requires specialized neuropelviology training
• Patient history and symptoms often provide clues to nerve involvement
• Some cases involve vascular compression alongside endometriosis

Have questions about endometriosis? Send them in using the link in the episode description, email contact@endobattery.com, or visit the EndobBattery.com contact page.

Website endobattery.com

Chapters

• 0:00 Quick Connect Introduction
• 0:41 Dr. Bobelson's Expertise
• 1:14 Nerve Compression and Endometriosis
• 1:55 How Endo Irritates Nerves
• 3:08 Skip Lesions and Neuropelviology
• 5:10 Episode Closing and Contact Info

Transcript

Speaker 1: 0:00

Life moves fast and so should the answers to your biggest questions. Welcome to EndoBattery's Quick Connect, your direct line to expert insights. Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need. No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers. I'm your host, alana, and it's time to connect.

Speaker 1: 0:41

Today we're joined by expert excision specialist, dr Nick Fogelson, who is a leading surgeon specializing in advanced endometriosis care, managing complex cases involving the bowel, urinary tract and thoracic disease. One of the few in the US with formal training in neuropelviology, he brings a deep neurological understanding of pain and innovative approaches to treatment. He helps us navigate some of the complex questions. Let's get started. How often do you see nerve and vascular compression associated with endometriosis, and is it always associated with endometriosis, or is the endometriosis on the nerve? Specifically, how many of your cases do you see of that, where the endometriosis is on the actual nerve?

Speaker 2: 1:29

Well, I mean to start out with. There's going to be a tremendous selection bias in that answer because those patients come to me.

Speaker 1: 1:35

Right, so how often do I?

Speaker 2: 1:37

see, it is not necessarily a representative of how common it is in the universe.

Speaker 2: 1:41

It is not that common. I would say that it is frequent that there is endometriosis in locations that I think anatomically is probably irritating nerves. I mean all endometriosis pain is nerve irritation in one way or another. I mean all pain is nerve irritation in one way or another, whether it's endometriosis pain or any kind of pain like you've got to be irritating a nerve to cause pain. There's plenty of people that have endometriosis in common locations where people have endo, where anatomically it makes sense what their symptoms are. For someone that has a dull, aching pain radiating to their back, that is cyclic, and then they have endometriosis in their uterus sacral ligaments. It's not necessarily directly invading nerves but it makes all the sense in the world because the hypogastric nerve plexus is like half a centimeter underneath those lesions and so it's going to cause enough inflammation that those nerves are going to be irritated. And if you irritate the hypogastric nerve plexus you're going to get dull, aching pain radiating into your back. You're going to get potentially voiding dysfunction. You can get failure to empty your bladder, you can get urgency to urinate, you can get a variety, and then you can have bowel dysfunction too, or you can have intermittent constipation and diarrhea and dyskinesia, which is painful bowel movements. All of that can come from a lesion that isn't necessarily invading a nerve but it's close enough to be inflaming the nerves.

Speaker 2: 2:58

And then there are some cases that literally are invading nerves and they're not that common. There's a subset of them where there is endometriosis in the pelvis. That's just really bad and it's extending out wide enough that it has gotten kind of onto the nerves. And then there's another subset where they literally have what I would call skip lesions, where the pelvis doesn't look too bad but if you dissect all the way down to the nerve you'll find a lesion right on the nerve that was not contiguous with lesions in the pelvis. And those are the ones that are going to be really hard to ever find without neuropelviology thoughtfulness, because it is the history of the patient that tells you that the lesion is there, by the patient giving you a history and maybe a physical exam that leads you to suspect a lesion on a particular nerve. And then you operate and you don't see anything in the pelvis that would be extending into that area. But you go down and dissect out that nerve anyway and you find the lesion on the nerve. That is something that without neuropelvulology training you're probably never going to solve, because nobody's going and making a cadaver dissection out of pelvic nerve roots for no reason, and so you better have a really good reason to be doing it, because you could injure the patient if you're not technically good at what you're doing.

Speaker 2: 4:11

And also those areas are very vascular.

Speaker 2: 4:13

There's big vessels down there and if you're not very careful you can get into a concerning amount of bleeding, and so those kinds of things are rare, but they do come up and to some extent they're more often when you're really paying attention to them. I see them a fair bit, partially because they come to me, but also I think I make diagnoses that sometimes other people wouldn't make, because I think I'm thinking about it a little bit differently, and it leads one to sometimes pick up on things. Sometimes the patient tells you a story that really leads to think of a very specific lesion in a very specific location, and sometimes you'll operate and don't see anything in the pelvis that you think is going to extend into that area, and yet so then you just dissect into that area specifically and indeed find something, and a lot of times those cases are vascular. You know where there's going to be like a little tight band of vein around there where she never wasn't endometriosis, so there was no reason for it to be extending from anything.

Speaker 2: 5:04

But, she never was endometriosis, so there was no reason for it to be extending from anything. But indeed there is a lesion somewhere that is anatomical.

Speaker 1: 5:10

That's a wrap for this Quick Connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming, Send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.