Q: My 28 years old wife had a C-section delivery two years back. She has been experiencing severe pain in the right side of her lower abdomen even before that. It stays for 3-4 days and moves around from right to left. It is also accompanied with the lower back pain. The frequency of this pain is around once a month and it does not have any connection with her periods. After an ultrasound, it was found that she has 3-4 small size cysts in the right ovary. She had been given a course of antibiotic medicines. This gave her minor relief for a couple of months but then the pain started again. She also experiences severe pain during the first two days of the menstrual cycle. It is so bad that she cannot even go to work. How can my wife get rid of this pain?

A:The pain, which your wife gets for the first two days of her periods, is more likely to be because of a condition called 'endometriosis'. Briefly, in this condition, the lining of the womb is deposited outside the womb (uterus). Therefore, during periods, women who have this condition tend to bleed in this tissue as well. This bleeding within the (endometriotic) tissue causes pain, which can be severe. The 'gold standard' method of diagnosing this condition is by performing 'laparoscopy' in which a telescopic check of the abdomen and pelvis is performed. Ultrasound scan can only pick up if this condition involves ovaries or in the area behind the uterus.

The other condition, which can give severe pain, is 'adenomyosis' in which the lining of the womb invades the body of womb. A very good sonographer / ultrasonologist can diagnose this condition with reasonable confidence but definitive diagnosis is only possible after hysterectomy. If the pain is because of tight cervix (neck of womb), the pain tends to get better after (normal) childbirth.

Unfortunately, it is difficult to comment upon the origin of the other pain, which 'moves' without actually performing a clinical examination. However, it does not look like it is related to caesarean section nor do antibiotics have any role in its treatment. If at some stage your wife undergoes laparoscopy for the reason I explained above, the ovaries can also be looked at to see for any obvious cause such as cysts. Not all cysts found on ovaries need treating. If she has had any previous pelvic infections or scarring from previous operations over her abdomen, she may get pain because of adhesions.