Pelvic Inflammatory Disease
Juan Luis Alcázar, María Ángela Pascual, Stefano Guerriero in Ultrasound of Pelvic Pain in the Non-Pregnant Female, 2019
Pelvic inflammatory disease (PID) is a pathology of a woman's reproductive organs that originates from an infectious process spread through the cervix to the uterus, fallopian tubes up to the ovaries, and pelvic peritoneum. Frequently, this disease is not correctly diagnosed because of high rates of subclinical cases of this disease, and, for this reason, the real incidence is underestimated. The prevalence has been valuated in 9–27/1000 women in reproductive age. PID is caused by bacteria, most of which are sexually transmitted, such as Chlamydia trachomatis and Neisseria gonorrhoeae. The transmission may occur during unprotected sexual intercourse, but also in the case of childbirth, miscarriage, or use of spiral contraception. This pathology is part of the “nonspecific lower abdominal pain syndrome” (NSLAP) in women in reproductive age, and its clinical presentation is variable and in close correlation with the anatomical relationship between the reproductive organs, the menstrual cycle, and pregnancy. PID is the main gynecological cause of acute pelvic pain in the women, but in many cases it is completely asymptomatic. The most frequent symptoms are lower abdominal pain, fever, symptoms of lower genital tract infection (abnormal vaginal discharge or bleeding, itching and odor, difficult or pain in urination), and dyspareunia. It is important to consider the possible severe short- and long-term sequelae of a PID not readily diagnosed and treated, such as infertility and ectopic pregnancy (for damage of the fallopian tubes), and pelvic chronic pain, which contribute to the increase of associated psycho-physical stress. The sensitivity of the clinical diagnosis of PID is of 60%–70%. Actually, the main diagnostic method is laparoscopy, but it has not demonstrated its reproducibility for the diagnosis of this patology, and moreover, it exposes the patient to a risk of complications, and it is expensive and invasive.
Gynaecology
Andrew Stevens, James Raftery in Gynaecology Health Care Needs Assessment, 2018
Pelvic pain refers to lower abdominal pain that can occur during the reproductive years and includes both gynaecological and non-gynaecological causes. The gynaecological causes include PID, pelvic pathology such as benign and malignant ovarian cysts and fibroids, endometriosis and PMS. The subjective nature of the label of pelvic pain means the epidemiology is unclear. Painful menstruation can either be primary, which is more common in younger women, or secondary to other pelvic pathologies such as PID, endometriosis and fibroids and represent another symptom of diseases whose management is discussed elsewhere. The term ‘severe pain requiring time off work’ has been used to classify the pelvic pain syndrome and is estimated to occur in 3–10% of young women and is the primary cause for these women to visit their GPs. The label pelvic pain now tends to be reserved for the 60–70% of patients with lower abdominal pain who apparently have negative gynaecological laparoscopy. There is some evidence that this is associated with pelvic congestion.
Pain Management Strategies and Alternative Therapies
Nazar N. Amso, Saikat Banerjee in Endometriosis, 2022
The pelvis consists of bones, the ligaments that connect these bones, and the muscles that line their inner surfaces. The pelvic muscles play an important role in producing and maintaining pelvic pain. Piriformis and obturator internus muscles form part of the posterolateral wall while Levator ani is a broad muscular sheet of variable thickness attached to the internal surface of the pelvis and pelvic viscera. It forms the large portion of pelvic floor and consists of pubococcygeus, iliococcygeus and puborectalis and coccygeus muscles. The urethra, vagina and anus pass through the medial border of the two levator ani muscles. The pelvic floor acts as a support to the pelvic organs and has a vital role in urination and defecation as well as sexual function. Myofascial dysfunction of one or more of its muscles leads to disharmony of action and dysfunction resulting in urinary frequency, dysuria, feeling of incomplete void, dyspareunia, constipation and dyschezia. Most of these symptoms are integral parts of endometriosis-related pelvic pain conditions and often are unrecognized or misdiagnosed.
Pelvic ramus fractures in the elderly
Published in Acta Orthopaedica, 2005
Thomas D A Cosker, Adel Ghandour, Sonjay K Gupta, Keith J J Tayton
Background Whilst it is well known that fractures of the pelvic rami in the elderly are frequently associated with posterior ring injuries, the extent of this second injury is less well known. We evaluated this question by MRI scanning a group of elderly patients presenting at our unit with pelvic rami fractures. Patients and methods We investigated 50 consecutive elderly patients (45 women) with fractures of the pelvic rami using an MRI scan of the pelvis in order to assess the competency of the pelvic ring. Results On MRI, 45 (95% CI 42–48) patients had a sacral fracture. At 5-month follow-up, 39 (of 41 reviewed) still complained of posterior sacral tenderness. Interpretation Pelvic rami fractures in the elderly are nearly always associated with posterior ring injuries. This probably explains why these patients take longer to rehabilitate than might be expected if only the anterior injury is considered, and it also explains why they experience long-term back pain.
Pelvic Actinomycosis: a Malignant Appearing Mass. A Case Report
Published in Acta Chirurgica Belgica, 2009
Y. Pirenne, W. Bouckaert, G. Vangertruyden
Pelvic actinomycosis is a rare complication of a long-term intrauterine contraceptive device. Early diagnosis is important, as clinical and radiological imaging may mimic a malignant pathology and lead to radical and unnecessary surgery. We report a case of pelvic actinomycosis in a woman who had used an intrauterine contraceptive device for the last 13 years. The actinomycosis appeared as a malignant pelvic mass with invasion into the sigmoid and left ureter, with high-grade stenosis of these structures. Because of its rapidly developing obstructive character, an urgent Hartmann procedure with resection of the uterus and both ovaries was performed. Histology revealed actinomycosis. With this case we want to illustrate that for a woman presenting with an intrauterine contraceptive device and a malignant appearing mass in the pelvis, pelvic actinomycosis must be considered in the list of differential diagnosis, so that appropriate diagnostic work out and treatment can be made.
Slower Reorientation of Trunk for Reactive Turning while Walking in Hemiparesis Stroke Patients
Published in Journal of Motor Behavior, 2019
Takahito Nakamura, Takahiro Higuchi, Toyo Kikumoto, Takanori Takeda, Hideyuki Tashiro, Fumihiko Hoshi
We examined the behavioral characteristics of reactive turning in hemiplegic stroke patients when they were informed of the turning direction just before turning was required at an unpredictable time. Eleven stroke patients and 20 healthy elderly control people were asked to initiate a turn as soon as a visual cue to inform them of the turning direction was activated unpredictably using a foot switch. Both the segmental reorientation and stepping type when turning 90° while walking were measured. The results indicated preserved segmental reorientation of the head and pelvis in stroke patients. Stroke patients showed delays in pelvic turning but not in head turning. Their delayed pelvic movement might be due to motor dysfunction and the time taken to ensure stability when deciding when to turn.
Related Knowledge Centers
- Lesser Pelvis
- Pubic Bone
- Coccyx
- Sacrum
- Perineum
- Pelvic Diaphragm
- Pelvic Bones