Today we are going to talk about my experience with HyCoSy, Laparoscopy, Hysteroscopy, and the dreaded Shoulder Tip Pain… mostly about Shoulder Tip Pain. Have you had any of these procedures and what was your experience with them? Please comment your tips and tricks along with any must know information I’ve failed to discuss that you feel people need to be aware of about these procedures. Keep in mind, this is my account of and understanding of these procedures. Do not take my information as gospel, do your own research and most importantly, question the your medical professionals; your doctor ordering the procedure, and the doctor performing the procedures.
A Hysterosalpingo-constrast-sonogram, also known as a HyCoSy – like a hysterosalpingogram (HSG) – is used as a diagnostic tool when assessing uterine and endometrial abnormalities, as well as the patency of the fallopian tubes. A catheter is inserted through the cervix, and saline solution is introduced to the uterine cavity, followed by a contrast agent. The fluid movement is monitored through a transvaginal/internal ultrasound to identify if the tubes are patent and if there are polyps, fibroids, or other abnormalities in the uterus that may cause complications when trying to conceive or carrying a pregnancy. A HyCoSy was the first test our gynaecologist (gyno) sent me for.
The optimum time to do a HyCoSy is from when menstruation stops to cycle day (CD) 10 to avoid flushing our any potential ovum or embryos. I had mine booked for what should have been CD 5 which is when I usually stop bleeding. When we booked in my appointment for the HyCoSy, I was given an information sheet detailing what a HyCoSy is, the purpose of the test and guidelines on what to do before hand. One tip was to take two ibuprofen or naprogesic an hour before the HyCoSy as many women experience mild cramping during and after the procedure. The practice I had my procedure done at also does a pelvic ultrasound at the same time, before the HyCoSy is preformed, so I was required to have a full bladder at the time of my appointment.
I mentioned that the test was booked for what should have been CD 5, but it ended up being CD 40. My cycle has never gone longer than 35 days and at that point in time, I was alternating monthly between 28 and 35 day cycles and that month was scheduled to be a 35 day cycle. As my period never came, and home pregnancy tests were coming up negative, I began to freak out. I was terrified the procedure would have to be cancelled, or that I would have finished bleeding by my appointment and again, the procedure would need to be cancelled.
At this time in my personal journey, I was at a very fragile mental stage. Nothing seemed to be straight forward, and our life was being constantly interrupted by all these diagnostic appointments and procedures. When things are out of my control or unknown I become very anxious, and with each day my period was late, I was becoming more consumed by my anxiety. My blessed husband called the practice for me as I was unable to bring myself to hear potential devastation. He asked what my lack of period meant for my procedure. They said it would be fine to have the HyCoSy done, but that they would make me take a pregnancy test prior to the HyCoSy beginning.
The day of the test came, and we were called back into the procedure room. We were given another information sheet about after-care, and given an opportunity to ask questions. The information sheet was a seven point document with recommendations of what to do and what not to do, common side effects of the procedure as well as acceptable medications to take to ease the side effects. I could expect light vaginal bleeding, abnormal discharge, mild cramping for a few days and even shoulder tip pain. We had never heard of shoulder tip pain, so we asked the technician what it is. It was explain to us at the time as the release of gases through the shoulders. We both scoffed at this.
Shoulder tip pain is the result of irritants in the peritoneal cavity, aggravating the diaphragm when you breathe, and releasing itself from the body through the shoulder tip, typically on the right side. In the case of a HyCoSy, it is a result of the contrast fluid escaping into the body from the fallopian tubes. Shoulder tip pain can be experienced during the HyCoSy as well as after and should resolve itself within 48 hours.
The HyCoSy was brutal! It begins with the unpleasant insertion and opening of a speculum. Not too bad for most, and it wasn’t for me. It is all very routine and standard. I began to feel discomfort as the doctor was filling my uterus with the saline solution. This sensation was much like a full bladder, except you can’t relieve the feeling because there is an inflated balloon sitting against your cervix from the inside, preventing the fluid from being released prematurely. The contrast came next, targeted first at my left fallopian tube. I could feel it flush through the tube but all still good; not too uncomfortable. After confirming that my left tube was clear, the doctor adjusted the instruments to target my right fallopian tube and as he began injecting the contrast, it all went to hell.
Everything hurt in my pelvic region from my bowels; to my uterus. I seldom vocalise pain exasperations; I have a high pain threshold, but I was grunting and whimpering. It started with a strong urge to release my bowels and bladder which I was able to vocalise. The doctor assured me the procedure was nearly complete, only a few more minutes and then the shoulder tip pain commenced. I was crying because the combination of the various pains, shoulder tip pain being the worst and the humiliation of not being able to handle the intensity of the HyCoSy. I wanted it to stop, but I did not want to have to redo the procedure. Very quickly, it was over. It was so painful because the doctor was trying to get the contrast through a fallopian tube that is not connected to my uterus. This was when he identified that I have a unicornate uterus.
Moral here; don’t scoff at shoulder tip pain. It is a real thing! I experienced shoulder tip pain intermittently over the next few days. It was spontaneous and often triggered by rapid movements. Nothing so bad that I felt like it was unbearable like it had been during the HyCoSy. My next encounter with shoulder tip pain was post surgery after my laparoscopy and hysteroscopy.
My gynaecologist strongly recommend I have a laparoscopy and hysteroscopy post-HyCoSy so we could have a full understanding of what was actually going on inside my body: what was attached to what, the health of my reproductive organs, and to confirm there was no other obstacles we were up against.
Laparoscopies and Hysteroscopies are day surgery procedures performed under a general anaesthetic. Both are surgical procedures used for diagnostic purposes and treatment of such conditions as endometriosis and fibriods. A laparoscopy is also used in opposition to open surgery where possible. When a laparoscopy is preformed, a laparoscope is inserted (generally through the naval) to investigate the abdominal cavity. It minimises recover time with often only two small incisions made in the abdomen. A hysteroscopy examines the inside or the uterus by inserting a hysterscope through the cervix.
To prepare for the surgery, I had been advised to take a week off from work for recovery and told not to consume any food or water after 8pm the night before. The morning of my surgery, I had to insert three pessaries (I cannot recall what the medication was called) to dilate my cervix, to minimise the invasiveness of my hysteroscopy.
We arrived at the hospital and at 8am sharp, I was called back to pre-op to get ready for my surgery. All the staff I dealt with were incredibly pleasant and very compassionate, especially when I asked naive questions about general anaesthetic such as ‘Will I be aware of what is going on while I am under?’ My surgery was delayed due to complications during the surgery before mine, but went off without a hitch. I remember being told to count back from ten, I think I got to eight, and then the next thing I recall was nurses discussing my food allergies and what they were going to feed me in recovery. I felt pretty good given I had just come out of anaesthetic and been probed and prodded. I recall thinking there was no way I would need the whole week off work. The nurses gave me a salad to eat, got me up to pee, helped me get my bra on, and called my husband to come pick me up and sent me on my way with a prescription for Panadeine Forte if I needed it.
As I walked out of the hospital with Rob, I felt fine and super hungry and we drove home. Rob stopped off at the shops, left me in the car to go get my script filled and get some lunch. He could not have been gone for long when the shoulder tip pain exploded! It was worse than I experienced with the HyCoSy. I was in tears, I could not get in a position that eased the pain. I tried reclining the chair, putting my feet up on the dashboard, on my sides sitting up, on my sides lying down, stretched out as much as my incision sites would allow, nothing helped. I messaged Rob to just get my script, that I needed to get home right now. He could not have been gone ten minutes in total, I could not believe how spontaneously and intensely that should tip pain came on.
For the next week and a half, I did not go long without experiencing shoulder tip pain. There was no rhyme or reason as to when the pain would hit me; it came irrespective of what position I was in or what I was doing. When it hit, I almost always cried. The only thing that gave me any relieve was a heat pack. The Panadeine Forte only helped the first day post surgery while I was still coming out of the anaesthetic. Heat was the only thing that gave me any relief some intense shoulder tip pain.
As I was writing this post, researching about these procedures to make sure I am giving you all accurate information, most of what I found neglected to note shoulder tip pain as a side effect. I also recall this was true when I looked them up before I had them done. When I googled shoulder tip pain, it was only mentioned in relation to an ectopic pregnancy. This could be because of my lack of ‘googlefoo’, maybe I did not use the right words, regardless, there is not a lot of information out about shoulder tip pain or treatment.
It hurts, a lot. Worse than the incisions themselves. My tip to all out there due for any of these procedures or alike, shoulder tip pain is a real thing. Not everyone experiences it, but for those of you who do, apply heat to effected areas!
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