Ovarian remnant syndrome is a very rare condition that occurs when ovarian tissue is left in the body after an oophorectomy (removal of ovaries) or salpingo-oophorectomy (removal of ovaries and fallopian tubes).

This leftover tissue, although small, can create painful symptoms. For example, the leftover ovarian tissue may enlarge and cause pressure in the pelvis.

Additionally, the ovarian tissue may resume normal function, such as producing hormones or creating follicular cysts. When any of these scenarios happen, it can create symptoms such as:

• Pelvic pain or chronic pelvic pain
• Painful sex
• Abnormal bleeding
• Painful urination
• Painful bowel movements
• Development of a pelvic mass (growth in the pelvis)
• Absence of menopause symptoms
• Hormonal imbalances that may cause hot flashes

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As mentioned before, this condition is caused by ovarian tissue being left in the body after a procedure that had intentions to remove the ovaries.

Leftover tissue is more common in situations where the surgical procedure is more complex or has less visibility for the surgeon.

Complex surgeries or less visibility can occur for a few reasons. It often applies to those who have other conditions such as endometriosis or pelvic inflammatory disease.

This also includes individuals who have scars or adhesions present at the time of the surgery. Adhesions are bands of scar tissue that form between two organs or structures.

Adhesions typically occur in response to healing, such as from injury, inflammation, or surgery.

Therefore, individuals with pelvic adhesive disease or previous surgeries may be more likely to have adhesions present at the time of their oophorectomy or salpingo-oophorectomy.

The presence of these adhesions, as well as other conditions, can make the surgical removal process more complex or difficult—resulting in missed ovarian tissue that gets left in the body.

However, ovarian remnant syndrome can still occur without the presence of other conditions or scar adhesions, due to poor surgical technique or other factors that may make the ovarian tissue more difficult to see or locate.

For example, some studies suggest that laparoscopic oophorectomies (laparoscopic surgeries are minimally invasive surgical methods utilizing small incisions) may have a higher likelihood of causing ovarian remnant syndrome.

In other words, individuals who undergo laparoscopic procedures rather than other methods of ovarian removal may have a higher chance of experiencing ovarian remnant syndrome.

If you are considering laparoscopic surgery, use this article as a tool to have a deeper conversation with your surgeon about the possible side effects, including ovarian remnant syndrome.

If you already have had the procedure and are concerned that you are struggling with this syndrome, this article may still be a useful resource to help you reach out to your provider and discuss your symptoms that could suggest the presence of this condition.

There are minimal methods available to address ovarian remnant syndrome, which usually depend on your preference, symptoms, age, and other medical conditions. For some, additional surgery to remove the leftover tissue may be necessary.

For those who cannot undergo another surgery, your provider may recommend long-term methods of symptom management such as medication to suppress ovarian tissue function, or pelvic floor physical therapy to reduce pain.

While pelvic floor physical therapy is not a cure for ovarian remnant syndrome, it can play a large supportive role for both individuals who choose to undergo surgical removal and those who don’t. Let’s look at how physical therapy can be beneficial in each scenario:

For Those Who Undergo Surgery

As with any pelvic surgery, pelvic floor physical therapy is extremely beneficial for both the preparation and recovery stages.

Both before and after a pelvic surgery, you will want to ensure that your pelvic floor muscles are in optimal health and function in order to reduce pain and prevent pelvic floor dysfunction.

Pelvic floor dysfunction is a condition of the pelvic floor that occurs when the muscles are tight, inflexible, weak, or uncoordinated.

Problems with these important muscles can result in sexual, urinary, and/or bowel dysfunction, so it is important to make sure that these muscles are in good health—especially after a disruptive event such as pelvic surgery.

Those who undergo the laparoscopic surgery mentioned previously will have incision sites in their abdominal area. These areas will hold tension after surgery, similarly to the pelvic floor—luckily, pelvic floor physical therapists can address tension in this area, too.

During recovery from either type of surgery, your pelvic floor therapist can work to restore and improve the strength, flexibility, and coordination of your pelvic floor and abdominal muscles.

This can reduce symptoms of pain and solve symptoms of pelvic floor dysfunction such as painful sex, incontinence, difficult bowel movements, and more. To achieve this, your pelvic floor therapist can provide many different treatments.

One common treatment to target tight muscles and trigger points caused by pelvic floor dysfunction is manual therapy. Manual techniques can be performed either internally via the vagina or rectum, or externally via the pelvis, hips, lower back, or abdominals.

Manual therapy can help improve muscle function and flexibility, and is also used to address scar tissue from surgical incisions. Massage and manipulation of scar tissue can help reduce scar pain and improve flexibility.

To further reduce pressure on the pelvis and reduce tension throughout the pelvic floor, your physical therapist will work to improve your posture and address any muscle imbalances of the body.

This will require a curated exercise routine to improve core strength and muscle function, which will lessen the strain on your pelvis and pelvic floor.

After pelvic or abdominal surgery, you will need to regain control and function of your pelvic floor. Not only does surgery heavily impact your muscles, but any pain you experience before and after surgery can lead to an increase in pelvic floor muscle tension.

Therefore, your pelvic floor therapist will utilize treatments such as neuromuscular reeducation and biofeedback, which will help you gain better awareness of your pelvic floor muscles.

These treatments will allow you to regain control over the contraction and relaxation of these muscles, and therefore help reduce tension.

Lastly, your physical therapist will want to ensure that you are familiar with habits that may be contributing to your pelvic floor tension. They will correct any harmful postures you may be holding while standing, sitting, or using the toilet.

They’ll discuss how certain bathroom habits, such as straining on the toilet or holding urine for long periods of time could be contributing to your muscle tension.

You can expect to make lifestyle changes that will help prevent pelvic floor dysfunction in the long run!

For Those Who Do Not Receive Surgical Removal

Individuals who cannot undergo additional surgery to remove ovarian tissue will definitely want to look for methods to better manage their symptoms.

Pelvic floor physical therapy can address pelvic pain and reduce the likelihood of other symptoms arising from pelvic floor dysfunction.

Some main goals of pelvic floor physical therapy for individuals who do not undergo surgery is to:

• Manage pain
• Relieve and prevent muscle tension
• Maintain muscle balance, function, and flexibility
• Prevent pelvic floor dysfunction

Pain associated with ovarian remnant syndrome or other conditions can lead to a gradual buildup of tension in the pelvic muscles.

This is because the body has a natural “guarding” response to pain that, over time, can create other complications from tight, tense muscles. As mentioned earlier, muscle tension can create pelvic floor dysfunction.

To prevent pelvic floor dysfunction from arising simultaneously with pain and other symptoms from leftover ovarian tissue, it is highly recommended to engage in pelvic floor physical therapy.

Not only will your pelvic floor therapist be able to help you maintain good pelvic floor health and prevent symptoms of dysfunction, but they can also manage your pain from ovarian remnant syndrome with treatments like manual therapy, cupping, tissue scraping, dry needling, and more.

Additionally, your physical therapist can teach you methods of relaxation such as diaphragmatic breathing, which can not only relax your pelvic floor muscles but also reduce stress and anxiety associated with your symptoms.

It is important to prevent the worsening of tension in the pelvic region, as it can worsen your symptoms of ovarian remnant syndrome.

To help reduce and prevent tension, your physical therapist will teach you proper postures and body mechanics that will reduce strain and pressure on your pelvis.

In addition to correcting postures, your physical therapist will create an exercise and stretching routine for you.

This will ensure that the muscles of your pelvis, hips, abdomen, and low back are all balanced; which will prevent excess strain on the pelvic region overall, as well as reduce the likelihood of pelvic floor dysfunction.

As you can see, pelvic floor physical therapy can play a very useful role in management or treatment of ovarian remnant syndrome.

Whether it be managing pain, ensuring proper recovery, or preventing worsened symptoms, the pelvic floor therapists at Hive Therapy and Wellness are trained and ready to help!

They will create a unique and comprehensive plan of care for your needs, consisting of treatments that are suitable for your symptoms.

This treatment plan may include any of the follow physical therapy treatments:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback