What is Frozen Pelvis?

Frozen pelvis is the most extensive form of deep infiltrative endometriosis.

Endometriosis is a condition in which tissue similar to the lining of the uterus (called the endometrium) implants and grows outside of the uterus. The tissue can grow on ovaries, the fallopian tubes, or the outer surface of the uterus. Because the tissue doesn’t belong anywhere outside of the uterus, this can cause health issues, complications, and pain.¹

Deeply infiltrating endometriosis (DIE) occurs when this tissue invades the organs that are near the uterus, including the bowel and bladder. Over time, increased scarring, also known as adhesions, occurs.²

Frozen pelvis happens when these adhesions “glue” pelvic organs together or wrap around organs. The adhesions can also:²

• Attach to the lining of the abdomen or pelvic walls
• Create web-like structures between organs
• Extend to deeper tissues and affect the nerves, lymph nodes, and muscle layers of organs

As the adhesions grow deeper, they cause soft tissues and organs in the pelvis to harden and become rock-like. Other terms for frozen pelvis include “end-stage endometriosis” or “terminal endometriosis.”²

What causes frozen pelvis?

Frozen pelvis can be caused by many things. Causes include:^2,3

• Infections that cause adhesions
• Pelvic inflammatory disease
• Past surgeries, especially removal of an ovary (myomectomy)
• Benign (noncancerous) or malignant (cancerous) growths, including endometriosis
• Radiation therapy to the pelvic area

What are the symptoms of frozen pelvis?

The symptoms of frozen pelvis can vary. The most common symptoms include:²

• Severe and significant changes in bowel habits, including constipation with episodes of diarrhea, painful bowel movements, and bloating. These symptoms might be caused by bowel obstruction.
• Frequent urination, even at night
• Trouble holding urine
• Flank pain (pain between upper belly and back, only on one side) caused by an obstructed ureter
• Severe leg pain around the time of menstruation
• Radiating pain on the sciatic and pudendal (the main nerve of the perineum) nerves

Some people with frozen pelvis cannot cross their legs because of extensive adhesions deep within pelvis. People who have adhesions around the tailbone may also find it hard to sit.²

Diagnosis

A pelvic exam is the first step. During this step, the doctor feels for a firmly fixed uterus.²

The next step is a transvaginal ultrasound. This may also be called an endovaginal ultrasound. During this procedure, an ultrasound wand (covered by a thin plastic sheath) is inserted into the vagina. The probe is then guided to see the uterus and ovaries. This kind of ultrasound provides a better picture of the pelvic organs.^2,4

Pelvic examinations can be very painful for a person with frozen pelvis, so the pelvic exam and ultrasound are done very carefully. After these exams, the doctor performs a rectovaginal exam. This allows the doctor to check for nodules, or growth of abnormal tissue, in the rectum and upper vagina.²

Once the manual exams and ultrasound are completed, an MRI of the pelvis with contrast is done. This allows the doctor to see the amount of tissue involved and if the kidneys, ureter, and bladder are affected.²

Treatment

Surgery is the treatment method for frozen pelvis. It is typically done using advanced laparoscopy, which is minimally invasive surgery. In some cases, open abdomen surgery may be needed.²

The surgical team includes different specialists depending on the organs that are involved. The endometriosis scar tissue is carefully removed from all of the affected organs. The surgery can take up to 6 hours.

Depending on the areas affected in the frozen pelvis, other surgical procedures may be needed. These can include bowel resection or shaving of lesions. Some people have a hysterectomy in addition to removal of the adhesions.^2,5

Things to consider

Frozen pelvis is fairly uncommon. Because it is rare, many doctors may not know how to treat it and its related symptoms when it affects various organs. Finding a specialist who has experience with frozen pelvis can help you get the right diagnosis and treatment.