What is chronic pelvic pain. How does it affect women’s daily lives. What are the common causes of chronic pelvic pain. How is chronic pelvic pain diagnosed and treated. When should you see a doctor for pelvic pain.

Understanding Chronic Pelvic Pain: A Comprehensive Overview

Chronic pelvic pain (CPP) is a complex condition that affects many women, characterized by persistent discomfort in the lower abdomen and pelvic region lasting for at least six months. This debilitating condition can significantly impact a woman’s quality of life, interfering with daily activities, work, and personal relationships.

CPP is distinct from other pain disorders, such as vulvodynia, which primarily affects the external genital area. While vulvodynia causes discomfort on the outside of the body, CPP is an internal pain that may radiate to the legs or lower back. In some cases, these two conditions can occur simultaneously, further complicating diagnosis and treatment.

Key Characteristics of Chronic Pelvic Pain

• Pain duration of at least six months
• Internal pain in the lower abdomen and pelvic area
• Possible radiation to legs or lower back
• Constant or intermittent pain patterns
• Potential correlation with menstrual cycles

Recognizing the Symptoms of Chronic Pelvic Pain

The symptoms of CPP can vary widely among women, making it crucial to understand the diverse manifestations of this condition. Identifying these symptoms early can lead to prompt diagnosis and more effective treatment.

Common Symptoms of Chronic Pelvic Pain

• Constant or intermittent pelvic pain
• Low backache preceding menstruation
• Pain during sexual intercourse
• Discomfort during urination or bowel movements
• Painful menstrual periods (dysmenorrhea)
• Severe cramps or sharp pains

Can chronic pelvic pain symptoms change over time? Indeed, the course of CPP is unpredictable and can differ significantly from one woman to another. Symptoms may remain constant, disappear without treatment, or suddenly intensify. Some women experience a reduction in symptoms during pregnancy or after menopause.

The Impact of Chronic Pelvic Pain on Women’s Lives

Chronic pelvic pain can have far-reaching effects on a woman’s overall well-being, extending beyond physical discomfort to impact various aspects of her life. Understanding these broader implications is crucial for developing comprehensive treatment approaches and support systems.

Psychological and Emotional Effects

How does chronic pelvic pain affect mental health? Women with CPP often experience:

• Depression
• Anxiety
• Sleep disturbances
• Stress
• Feelings of hopelessness or frustration

These psychological effects can create a cycle where emotional distress exacerbates physical pain, further impacting mental health.

Social and Relational Impacts

CPP can significantly affect a woman’s social life and relationships. It may lead to:

• Reduced participation in social activities
• Strained intimate relationships
• Difficulties in fulfilling family roles
• Challenges in maintaining employment

These social impacts can contribute to feelings of isolation and further exacerbate the emotional toll of the condition.

Unraveling the Causes of Chronic Pelvic Pain

Understanding the underlying causes of chronic pelvic pain is essential for effective diagnosis and treatment. While the exact cause may not always be identifiable, several conditions are commonly associated with CPP.

Endometriosis: A Leading Cause of CPP

Why is endometriosis so frequently linked to chronic pelvic pain? Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. This misplaced tissue can cause inflammation, scarring, and pain, particularly during menstruation and intercourse. It’s estimated that a significant proportion of women with CPP are diagnosed with endometriosis, making it a primary focus in the evaluation of chronic pelvic pain.

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease is another common cause of CPP. Typically resulting from sexually transmitted infections, PID can lead to scarring and chronic pain in the pelvic region. However, the exact mechanism by which PID leads to chronic pain is not fully understood, as many women recover from PID without long-term complications.

Other Potential Causes

What other conditions can contribute to chronic pelvic pain? Several other factors may be involved:

• Adhesions (scar tissue from previous surgeries)
• Fibroids (benign uterine tumors)
• Pelvic floor muscle dysfunction
• Urinary tract disorders
• Bowel diseases
• Hernias
• Spinal conditions
• Fibromyalgia

It’s important to note that CPP can sometimes result from a combination of these factors, making diagnosis and treatment more complex.

Diagnosing Chronic Pelvic Pain: A Multidisciplinary Approach

Accurately diagnosing chronic pelvic pain often requires a comprehensive and multidisciplinary approach. Given the diverse potential causes and the complex nature of CPP, healthcare providers may need to employ various diagnostic tools and techniques to identify the underlying issue.

Initial Evaluation

The diagnostic process typically begins with a thorough medical history and physical examination. Healthcare providers will inquire about:

• The nature and duration of pain
• Associated symptoms
• Menstrual history
• Sexual history
• Previous surgeries or medical conditions

A pelvic exam is usually performed to check for any visible abnormalities or areas of tenderness.

Imaging Studies

Various imaging techniques may be used to visualize the pelvic structures:

• Ultrasound: Useful for detecting fibroids, ovarian cysts, and some cases of endometriosis
• MRI: Provides detailed images of soft tissues and can help identify endometriosis lesions
• CT scan: May be used to evaluate other pelvic organs and structures

These imaging studies can help identify structural abnormalities that may be contributing to the pain.

Laparoscopy

In some cases, a laparoscopy may be recommended. This minimally invasive surgical procedure allows doctors to directly visualize the pelvic organs and potentially diagnose conditions such as endometriosis or adhesions. It can also be used to take tissue samples for biopsy if necessary.

Specialized Tests

Depending on the suspected cause, additional tests may be ordered:

• Urodynamic testing for bladder function
• Colonoscopy for bowel-related issues
• Nerve conduction studies for neurological causes

These specialized tests can help rule out or confirm specific conditions contributing to CPP.

Treatment Strategies for Chronic Pelvic Pain

Managing chronic pelvic pain often requires a multifaceted approach, tailored to the individual patient’s needs and the underlying cause of the pain. Treatment strategies may include a combination of medical, surgical, and alternative therapies.

Medications

Various medications can be used to manage CPP:

• Pain relievers (NSAIDs, opioids in severe cases)
• Hormonal treatments (birth control pills, GnRH agonists)
• Antidepressants (to address both pain and mood symptoms)
• Anticonvulsants (for neuropathic pain)

The choice of medication depends on the suspected cause of pain and the patient’s overall health status.

Surgical Interventions

In some cases, surgery may be necessary to treat the underlying cause of CPP:

• Laparoscopic removal of endometriosis lesions
• Hysterectomy (in severe cases where other treatments have failed)
• Adhesiolysis (removal of adhesions)
• Neurolysis or neurectomy (for certain types of nerve pain)

Surgical options are typically considered when conservative treatments have not provided adequate relief.

Physical Therapy

Physical therapy can be particularly beneficial for women with pelvic floor muscle dysfunction. Techniques may include:

• Pelvic floor exercises
• Manual therapy
• Biofeedback
• Relaxation techniques

These approaches can help improve muscle function and reduce pain associated with muscle tension or spasms.

Alternative and Complementary Therapies

Many women find relief through alternative therapies:

• Acupuncture
• Yoga
• Mindfulness meditation
• Dietary modifications
• Herbal supplements (under medical supervision)

While scientific evidence for some of these approaches may be limited, many patients report significant benefits in pain management and overall well-being.

Living with Chronic Pelvic Pain: Coping Strategies and Support

Managing chronic pelvic pain extends beyond medical treatments. Developing effective coping strategies and seeking appropriate support can significantly improve quality of life for women with CPP.

Psychological Support

Mental health support is crucial for managing the emotional impact of CPP:

• Cognitive-behavioral therapy
• Support groups
• Counseling
• Stress management techniques

These interventions can help women develop coping skills, manage stress, and address any associated mental health concerns.

Lifestyle Modifications

Certain lifestyle changes can help manage CPP symptoms:

• Regular exercise (as tolerated)
• Balanced diet
• Adequate sleep
• Stress reduction techniques

These modifications can contribute to overall well-being and may help reduce pain intensity.

Pain Management Techniques

Learning specific pain management strategies can be empowering:

• Heat or cold therapy
• Relaxation exercises
• Pacing activities
• Distraction techniques

These techniques can help women manage pain flare-ups and maintain daily activities.

Building a Support Network

A strong support network is invaluable for women with CPP:

• Open communication with partners and family members
• Connecting with other women who have CPP
• Educating loved ones about the condition
• Seeking workplace accommodations when necessary

Having understanding and supportive individuals in one’s life can significantly impact the ability to cope with chronic pain.

Advancing Research and Future Directions in Chronic Pelvic Pain Management

The field of chronic pelvic pain research is continuously evolving, with ongoing efforts to improve diagnosis, treatment, and overall management of this complex condition. Understanding current research trends and future directions is crucial for healthcare providers and patients alike.

Emerging Diagnostic Tools

Researchers are exploring new diagnostic techniques to improve the accuracy and efficiency of CPP diagnosis:

• Advanced imaging technologies
• Biomarker identification
• Genetic testing for predisposition to certain conditions
• AI-assisted diagnosis using pattern recognition

These advancements may lead to earlier and more precise diagnoses, potentially improving treatment outcomes.

Novel Treatment Approaches

Innovative treatment strategies are being developed and tested:

• Targeted drug delivery systems
• Neuromodulation techniques
• Regenerative medicine approaches
• Personalized medicine based on genetic profiles

These emerging therapies aim to provide more effective and tailored treatment options for women with CPP.

Interdisciplinary Research

There is a growing emphasis on interdisciplinary research in CPP:

• Collaboration between gynecologists, pain specialists, and psychologists
• Integration of basic science and clinical research
• Exploration of the mind-body connection in chronic pain
• Investigation of the role of the microbiome in pelvic health

This holistic approach may lead to more comprehensive understanding and management of CPP.

Patient-Centered Research

Increasing focus is being placed on patient-centered outcomes and experiences:

• Quality of life assessments
• Patient-reported outcome measures
• Inclusion of patient perspectives in research design
• Studies on the social and economic impact of CPP

This patient-centered approach ensures that research outcomes are relevant and meaningful to those living with CPP.

As research in chronic pelvic pain continues to advance, it holds the promise of improved understanding, more effective treatments, and ultimately, better quality of life for women affected by this challenging condition. Healthcare providers and patients should stay informed about these developments to make the most informed decisions about care and management strategies.

Pelvic Pain – HealthyWomen

Overview

What Is It?

Chronic pelvic pain (CPP) is characterized by pain in the lower abdomen and pelvic area that has been present for at least six months. Sometimes the pain may travel downward into the legs or around to the lower back. The pain may be felt all of the time or it may come and go, perhaps recurring or intensifying each month with your menstrual period.

In either case, the pain is felt internally, not externally as in another common pain disorder in women called vulvodynia. In vulvodynia (or burning vulva syndrome), the external genital area stings, itches, becomes irritated or hurts when any kind of pressure, from tight clothing to intercourse, is experienced. Chronic pelvic pain and vulvodynia sometimes occur together.

Symptoms of Chronic Pelvic Pain
Women with CPP have one or more of the following symptoms:

• constant or intermittent pelvic pain
• low backache for several days before menstrual period, subsiding once period starts
• pain during intercourse (rarely, some vaginal bleeding after intercourse)
• pain on urination and/or during bowel movements (rarely, blood in urine or stool)
• painful menstrual periods (dysmenorrhea)
• severe cramps or sharp pains

The course of CPP is unpredictable and different in every woman. Symptoms may stay constant, disappear without treatment or suddenly increase. They sometimes decrease during pregnancy and improve after menopause.

The severity of pain is also unpredictable. It may range—even in the same woman—from mild and tolerable to so severe it interferes with your normal activities. Your physical or mental state can also cause the level of pain to fluctuate, so you may experience fatigue, stress and depression. Moderate to severe pain generally requires medical or surgical treatment, although such therapies are sometimes unsuccessful at relieving pain entirely.

Chronic Pelvic Pain Syndrome
Unrelieved, unrelenting pelvic pain may affect your sense of well-being, as well as your work, recreation and personal relationships. You may begin to limit your physical activities and show signs of depression (including sleep problems, eating disorders and constipation), and your sex life and role in the family may change.

When pelvic pain leads to such emotional and behavioral changes, the International Pelvic Pain Society (IPPS) calls the condition “chronic pelvic pain syndrome” and says that the “pain itself has become the disease. ” In other words, the pain is more of a problem than the original cause. In fact, a medical examination may find nothing physically wrong with the area that hurts. Nonetheless, the nerve signals in that area continue to fire off pain messages to the brain, and you continue to hurt.

Causes of Chronic Pelvic Pain
There are two kinds of pain. Acute pain typically occurs with an injury, illness or infection. A warning signal that something is wrong, it lasts only as long as it takes for the injured tissue to recover. In contrast, chronic pain lasts long after recovery from the initial injury or infection and is often associated with a chronic disorder or underlying condition.

Endometriosis
The most common cause of pelvic pain is endometriosis, in which pieces of the lining of the uterus attach to other organs or structures within the abdomen and grow outside the uterus. In practices specializing in the treatment of endometriosis, a significant number of patients with CPP are diagnosed with endometriosis. Two disorders that sometimes accompany endometriosis and are also linked to CPP are adhesions (scar tissue resulting from previous abdominal or pelvic surgery) and fibroids (benign, smooth muscle tumors that grow inside, in the wall of, or on the surface of the uterus). Fibroids often occur in the absence of endometriosis, without any pain at all, and are not a common source of chronic pelvic pain.

Pelvic Inflammatory Disease (PID)
Another common cause of CPP is pelvic inflammatory disease (PID). PID is one of the most common gynecologic conditions, usually related to a sexually transmitted disease. However, many women recuperate fully from STD-related PID, and we don’t know exactly why PID sometimes leads to CPP.

One of the most common contributors to pelvic pain is dysfunction of the pelvic floor and hip muscles. This problem often accompanies pain originating from the reproductive organs but can occur on its own or persist after other sources are successfully treated.

Other Causes of Chronic Pelvic Pain
Other causes of CPP are diagnosed more frequently by other kinds of clinical care specialists, such as urologists, gastroenterologists, neurologists, orthopedic surgeons, psychiatrists and pain management physicians. They include diseases of the urinary tract or bowel as well as hernias, slipped discs, drug abuse, fibromyalgia and psychological problems.

In fact, many women with CPP collect a different diagnosis from each specialist they see. What is going on here? It is likely that CPP represents a general abnormality in the way the nervous system processes pain signals from the pelvic nerves, producing pain that involves the genital organs, the bladder, the intestine, pelvic and hip muscles and the wall of the abdomen, as well as pain involving the back and legs.

Characteristics of Pelvic Pain Patients
Despite the number of possible causes, many women with chronic pelvic pain receive no diagnosis. These are often the women who make the rounds of various specialists seeking relief, only to be told the pain is “all in their heads.” They may also be subjected to multiple tests or even unnecessary surgery. These women may feel that the pain is somehow their fault, when, in fact, the lack of a diagnosis represents the limitations of medical science.

Simply put, there is no simple answer to the question, “What causes chronic pelvic pain?” and no “typical patient.” Still, a woman with pelvic pain is more likely to:

• have been sexually or physically abused
• have a history of drug and alcohol abuse
• have sexual dysfunction
• have a mother or sister with chronic pelvic pain
• have history of pelvic inflammatory disease (PID)
• have had abdominal or pelvic surgery or radiation therapy
• have previous or current diagnosis of depression
• have a structural abnormality of the uterus, cervix or vagina
• be of reproductive age, especially aged 26 to 30 years.

Some of these, like family history, surgery and PID, are obvious risk factors; others (drug abuse, depression) may be risk factors or may result from having chronic pain.

Impact of Chronic Pelvic Pain
An estimated 4 to 25 percent of women have chronic pelvic pain, but only about a third of them seek medical care. It is also one of the most common reasons American women see a physician, accounting for 10 percent of gynecologic office visits, up to 40 percent of laparoscopies and 20 percent of hysterectomies in the United States.

The cost to the patient is also enormous. Studies and surveys show that a quarter of affected women are incapacitated by pain two to three days each month. More than twice that many are forced to curtail their normal activities one or two days each month. Many women with chronic pelvic pain have pain during intercourse, and some have significant emotional changes. For many, the pain and underlying conditions lead to fertility problems, just at the age when they want children.

Diagnosis

As with many pain conditions, chronic pelvic pain (CPP) can be difficult to diagnose. For one thing there is no screening test. For another, because symptoms may be variable, it can be difficult for a woman to define and localize her pain. Finally, there are all those possible causes and associated conditions to investigate.

Conditions that can cause pelvic pain may be divided into several categories:

Gynecologic conditions

• Endometriosis is a condition in which tissue that makes up the lining of the uterus (endometrium), exits the uterus and attaches to the ovaries, fallopian tubes, bowels or other organs in the abdomen. Because endometrial tissue responds to hormonal changes during a woman’s menstrual cycle, the abnormally located tissue swells and bleeds, sometimes causing pain.

  Endometriosis pain is not always restricted to the menstrual cycle. Many women with endometriosis have pain at other times of the month. Endometriosis can also scar and bind organs together, cause tubal (ectopic) pregnancies and lead to infertility, although these outcomes are unusual.

• Fibroids are benign (noncancerous) tumors that grow inside, in the wall of or on the outside surface of the uterus. Many women don’t know they have fibroids because often they have no symptoms. However, depending on their location and size, fibroids may cause pelvic pain, backaches, heavy menstrual bleeding, pain during intercourse and such urinary problems as incontinence and frequent urination. They can interfere with fertility or pregnancy if they distort the shape of the inside of the uterus, but this is unusual. Pain with fibroids is uncommon; heavy bleeding is more common.
• Adenomyosis, like endometriosis, involves the abnormal growth of cells from the uterine lining. In this case the cells grow into the wall of the uterus, growing into the muscle fibers there. The result is painful cramps and heavy menstrual bleeding.
• Adhesions are fibrous bands of scar tissue that are caused by endometriosis or pelvic infection, or they may form after surgery. When these bands tie organs and tissues together inappropriately, even normal movements and sex may stretch the scar tissue and cause pain. When adhesions block the fallopian tubes or ovaries, infertility can result. If they wrap around the bowel, they may cause bowel obstruction.
• Pelvic inflammatory disease (PID) includes any infection or inflammation of the fallopian tubes, uterine lining and ovaries. It often begins as a sexually transmitted infection, most commonly chlamydia or gonorrhea. Many women with PID have no symptoms or only mild symptoms (abnormal vaginal bleeding or discharge or pain with intercourse) and may not seek treatment. However, left untreated, PID may cause scar tissue to form that can lead to chronic pelvic pain, abscesses, tubal pregnancies and infertility.
• Ovarian remnants can sometimes cause pelvic pain. After a hysterectomy with bilateral salpingo-oophorectomy, where the uterus, ovaries and fallopian tubes are removed, a small piece of ovary may be left behind, which can later develop a painful cyst.

Urinary Tract Disorders

• Interstitial cystitis (IC) is an inflammatory condition in which the bladder wall becomes chronically inflamed. The lining of the bladder that protects the wall from irritation seems to break down. In its most severe form, ulcers form in the bladder lining. The resulting discomfort ranges from annoying constant sensations of bladder fullness, even immediately after voiding, to intense bladder pain with associated cramping and spasm of the pelvic floor muscles. Symptoms include frequent urination that does not relieve the sensation of bladder fullness, pain or pressure. Ninety percent of IC sufferers are women, and symptoms may flare during menstruation. IC pain often gets worse during or after intercourse. Many women with IC are treated repeatedly for bladder infections, because symptoms overlap. With IC, however, antibiotics provide no relief, and urine testing for infection is negative.
• Chronic urethritis is inflammation and irritation of the urethra (the tube through which urine is eliminated from the bladder) caused by either an infection or noninfectious inflammation. Most urethritis occurs in men, and this rare female condition rarely responds to oral antibiotics and is often also diagnosed as bladder infection, again with negative urine infection test results and minimal or no response to oral antibiotics. Symptoms include a burning pain that may radiate into the vulva or groin, exacerbated by sex or activities that put direct pressure on the groin area, such as biking or horseback riding.

Intestinal disorders

• Irritable bowel syndrome (IBS) symptoms include abdominal discomfort or painful cramping, bloating and gas and constipation or diarrhea (or bouts of both). Stress and depression can increase the symptoms, as can particular foods and beverages. Women are more than twice as likely to have IBS as men, and their symptoms are often worse during their periods.
• Diverticulosis occurs when small pockets develop in the wall of the large intestine. When these pockets get plugged with undigested food, an infection can develop in the bowel wall causing diverticulitis. Usual symptoms are pain in the lower left abdomen, fever, constipation or bloody diarrhea. Diverticulosis is uncommon under the age of 50.

Musculoskeletal disorders

• Pain and tension in the pelvic nerves, pelvic and hip bones and attached pelvic floor muscles are often the primary site of musculoskeletal chronic pelvic pain. Pain from these sources, including sciatica, pudendal neuropathy, sacroiliac inflammation, pelvic asymmetry and psoas muscle spasm, among others, may cause chronic low back, deep pelvic and lower abdominal wall pain symptoms.
• Scoliosis (curvature of the spine), herniated disks in the lower region of the back, spinal stenosis, spine or hip arthritis and other disorders of the bones, nerves and muscles in the pelvic region can result in chronic pelvic pain.

Psychological disorders

• Depression is a common and treatable illness; chronic pain is a common symptom of depression.

Other conditions

• Hernias, which occur when the intestine pushes through the abdominal wall, can cause pelvic pain when the intestines become intermittently or permanently trapped in the hernia defect, effectively obstructing the small intestine. Although they are more common in men, hernias do occur in women. Hernias rarely occur more than once in any individual.
• After abdominal surgery, nerves may get entrapped in the tissue layers of the healed wound, causing pain.

Diagnostic Tests for Pelvic Pain

When you first seek medical help for pelvic pain, you may see either your internist (primary care physician) or gynecologist. In either case, your doctor will consider every possible source of pain. Each may require different diagnostic tests and distinct treatments, including referral to specialists for evaluation of specific organ systems. If you have more than one diagnosis, each can be diagnosed and treated accordingly. Depending on the problem(s) involved, your initial doctor may recommend evaluation with other specialists.

Your doctor, nurse practitioner, midwife or physician assistant will begin by asking you specific questions about your past and present health, your menstrual cycle, sexual history, previous abdominal surgeries, accidents and injuries and your symptoms. You may be asked to describe the kind and severity of your pain (aching, burning, stabbing), where it is and how it affects your life, including activities that worsen or relieve the symptoms.

You should tell your health care professional if the pain is constant or intermittent, related to your period, or worse during urination, bowel movements or sex. Also discuss any urinary or intestinal problems you may be having. Do you have constipation or diarrhea? Can you associate the start of your pain with a bladder infection or backache? Do certain movements or physical activities affect the pain intensity or duration? All information about your pain and other symptoms can help your physician with your diagnosis. Keep a pain diary with detailed information about the pain and associated activities and symptoms.

Because pelvic pain appears to run in families, the clinician will also inquire about related illnesses and problems in your parents and siblings, especially your mother and sisters. You must be prepared to report and, if possible, provide documentation about any tests, treatments and therapies you’ve already undergone for the pain and what the outcomes were.

Following the medical history, your health care professional will conduct a general physical examination, including a pelvic and rectal exam to determine areas of tenderness and find such potential problems as fibroids, pain trigger points, pelvic masses and abdominal wall hernias. If you have muscle pain, skeletal problems or backache, your health care professional may check your posture and gait and look for relations between those problems and your pelvic pain.

Depending on what he or she finds, these simple, standard tests may be ordered:

• blood tests to check for infection (complete blood count or CBC) and inflammation (sedimentation rate or ESR)
• pregnancy test
• urinalysis and other urinary tests
• tests for sexually transmitted diseases
• imaging tests, such as pelvic or abdominal sonography, MRI defecography, spinal imaging, CAT scan of the abdomen and pelvis or other imaging tests

If certain conditions are suspected, endoscopic evaluations or surgery may be recommended. These include:

• cystoscopy (look in the bladder)
• sigmoidoscopy or colonoscopy (partial or complete look in the colon)
• laparoscopy (minimally invasive endoscopic look into the abdomen and pelvis)

Treatment

A diagnosis provides a starting point for treatment. The type of treatment your health care professional recommends depends on you, your reproductive health stage (childbearing years vs. menopause, for example), your condition and your level of pain.

The goals of CPP treatment focus on creating self-management strategies that allow you to manage your pain, restore your normal activities, improve your quality of life and prevent symptoms from recurring. These goals may be difficult to achieve.

The fact is that managing any kind of chronic pain is one of the most difficult jobs in medicine. You may find that your health care professional recommends a “watchful waiting” period using nonmedical therapies such as exercise, relaxation techniques and yoga to see how your symptoms develop or whether they decrease on their own. As hard as this approach may seem at first, it may provide more information about your symptoms and prevent rushing into surgery. It is also important to see a gynecologic specialist with specific experience and training in chronic pelvic pain.

If and when you decide on a specific treatment, a team approach involving specialists in several medical fields often offers the best results. This is especially true if you’ve been diagnosed with several conditions, all of which may represent a single pain-processing problem.

Medications

• Pain-relieving nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (Motrin) and naproxen (Aleve), are available over the counter (OTC) and by prescription.

  Because they reduce the amount of the hormone prostaglandin, which is involved in producing inflammation, these drugs reduce swelling and relieve menstrual cramps and pain. Studies have shown that women with painful periods produce higher than normal levels of prostaglandin. To be most effective, NSAIDs must be taken regularly, but long-term use can lead to serious side effects, including stomach ulcers and intestinal bleeding; discuss these risks with your health care professional.

• Hormonal therapies, like birth control pills and Depo-Provera injections, regulate ovulation and menstruation. These medications help menstrual-related pelvic pain. High-dose progestin and GnRH agonists (gonadotropin-releasing hormone drugs) completely stop menstruation. Danazol, an androgen, helps ease pelvic pain related to endometriosis. Androgenizing side effects, such as increased hair growth, clitoral enlargement, deepening of voice and weight gain are common side effects of danazol therapy, however; as a result, it is usually a therapy of last resort. These drugs all work by stabilizing or reducing the production of estrogen, which causes endometrial tissue to grow. To avoid laparoscopic surgery, which is the only secure way to diagnose endometriosis, clinicians often opt to diagnose endometriosis indirectly, based on clinical response to treatment with leuprolide (Lupron), a GnRH agonist. If leuprolide relieves the pain, a presumptive diagnosis of endometriosis may be made. This conclusion may still be incorrect because other causes for pain, such as adenomyosis or painful uterine fibroids, also tend to improve with Lupron.
• Pain medication may be injected into abdominal or pelvic trigger points, tender areas in the abdominal wall or pelvic muscles to block pain.
• Elmiron (pentosan polysulfate sodium) is an oral drug approved to treat interstitial cystitis. How this drug relieves interstitial cystitis is not completely understood, but it is believed to work by gradually helping repair and restore the damaged bladder lining. While some women find their symptoms improve in as little as four weeks, studies show that it usually take three months to see a significant benefit, and some women never experience a benefit.
• Antibiotics may be prescribed for underlying infections such as PID. However, there is no substantial evidence showing that antibiotics improve residual CPP.
• Antidepressant drugs are often prescribed for chronic pain. They seem to affect pain transmission signals to the brain as well as help relieve any underlying depression.

Surgery

Surgery may be recommended to remove endometriosis, adhesions and fibroids, correct physical abnormalities or remove a diseased or damaged uterus and ovaries that may be contributing to the pain.

• Laparoscopy may be used for both diagnosis and treatment. During the procedure, sites of endometriosis and adhesions may be destroyed by laser beam or electric current or cut out with a specially designed laparoscopic micro-scissor. In experienced hands, even advanced stages of endometriosis can be treated laparoscopically.
• A laparotomy is a more invasive surgical procedure that involves an abdominal incision. It’s used to remove endometriosis, adhesions or ovarian cysts that can’t be removed laparoscopically.
• A hysterectomy is the surgical removal of the uterus. It may be a reasonable treatment for chronic pelvic pain after other options have been considered. Hysterectomies may be performed laparoscopically, vaginally or by laparotomy.

Other Therapies

Various other therapies may be helpful alone or in combination with medical and surgical treatment:

• relaxation and breathing techniques to reduce stress and anxiety
• stretching exercises, massage therapy and biofeedback to reduce muscle tension in the pelvic floor, hips and low back that can cause or enhance pelvic pain
• physical therapy to improve posture, gait and muscle tone and to work with painful muscle groups, especially pelvic floor and hip muscles.
• cognitive behavioral therapy that includes various pain-coping strategies
• counseling to treat depression and associated pain symptoms

The chronic nature and complexity of pelvic pain may require multiple treatment strategies, and the right combination may take some time to discover. Often, a combination of medical, surgical and alternative therapies works best. Counseling and support groups can help you to keep a positive attitude during treatment. Meanwhile, as research continues on the possible causes of chronic pelvic pain, improved drug treatments and less invasive surgical techniques are being developed.

Prevention

Many conditions that cause chronic pelvic pain (CPP) cannot be prevented. However, reducing your risks for developing sexually transmitted infection such as chlamydia or gonorrhea can reduce your chances of developing pelvic inflammatory disease (PID), a common cause of CPP. Regular pelvic exams—once a year after commencing sexual activity or for all women age 18 and older—are also important. Regular pelvic health checkups give you the opportunity to discuss any concerns or symptoms with your physician and help identify health conditions, such as CPP, early in their development. If you experience pelvic pain, don’t wait; make an appointment to discuss your symptoms with your physician.

Facts to Know

1. Chronic pelvic pain (CPP) may be either constant or intermittent pain in the lower abdomen and pelvic area that has been present for six months or more. The exact symptoms and course of disease are unique for each woman. CPP tends to improve after menopause. According to various studies, CPP affects 4 percent to 25 percent of women.
2. Pelvic pain symptoms may include severe menstrual cramps; pain during sex, urination or bowel movement; low backache right before your menstrual period and rectal pain.
3. As with other chronic pain conditions, the unrelenting nature of pelvic pain and the difficulties encountered in its diagnosis and treatment may lead to depression, anxiety, fatigue, behavioral changes and impaired mobility.
4. Common causes of pelvic pain include fibromyalgia, endometriosis, fibroids, adenomyosis, pelvic adhesions related to prior pelvic surgery, endometriosis or sexually transmitted infections, pelvic inflammatory disease, interstitial cystitis, chronic urethritis, irritable bowel syndrome, diverticulitis, spinal problems, muscular dysfunction, hernias and psychological problems.
5. Risk factors associated with CPP include past sexual and physical abuse; sexual dysfunction; a mother or sister with chronic pelvic pain; history of pelvic inflammatory disease; abdominal or pelvic surgery; depression; and congenital structural abnormalities of the uterus, cervix or vagina.
6. The process of diagnosing chronic pelvic pain may take time, involving various tests. The goal is to identify all underlying causes of pain. In some women, no clear diagnosis or underlying cause for chronic pain is established, which can be frustrating for both the patient and physician.
7. The goal of treatment is to manage pain, restore normal activities, improve quality of life and prevent recurrence of symptoms.
8. Treatment may involve a combination of medications, surgery, alternative therapies and counseling. The approach used depends on the individual’s condition(s), level of pain and age.

Questions to Ask

Review the following Questions to Ask about chronic pelvic pain (CPP) so you’re prepared to discuss this important health issue with your health care professional.

1. Why am I having pain? Do I have a condition causing the pain?
2. I’ve tried over-the-counter pain relievers but they’re not enough. What drugs can you prescribe that will relieve my pain? What are their side effects? Will they interact with other drugs I’m taking?
3. Do I need surgery? What kind? What is its success rate in reducing pain or curing the condition? What will happen if I choose not to have surgery?
4. If I have surgery, will that increase my chances of developing adhesions that can cause pelvic pain in the future? What methods do you use during surgery to reduce the chance of adhesions developing?
5. Is there a specialist in laparoscopic surgery you could refer me to?
6. Are there nondrug, nonsurgical therapies that can help reduce my pain and improve my condition? What can I do to cope with the pain and continue my normal activities?
7. Is there a pain management specialist you could refer me to?
8. Are there support groups for chronic pelvic pain? Where can I get more information?

Key Q&A

1. When should I consult a health care professional about pelvic pain?
   Make an appointment with your physician or alternate pelvic health clinician if your periods are painful, if you have vaginal bleeding at times other than during your normal menstrual cycle, if you have pain during intercourse, urination or bowel movements or if you have blood in your urine or stool. If severe pelvic pain suddenly appears, see a health care professional immediately. Generally, a woman with pelvic pain and symptoms will see her primary care physician or gynecologist first. Depending on his or her findings, you may be referred to other specialists such as a urologist, for example, if there is a urinary tract condition contributing to your pain syndrome. Or it may be best to undergo treatment with a gynecologist who specializes in chronic pelvic pain or a colorectal surgeon or rheumatologist, if gastrointestinal or rheumatologic conditions are contributing to your pain. In addition, you may require physical therapy.
2. What kinds of tests will I need for a diagnosis?
   Your physician will first conduct a medical history followed by a comprehensive physical exam, including a pelvic and rectal exam, to locate your pain and find such potential contributing problems as arthritis, pelvic inflammatory disease, endometriosis, colitis, urinary tract conditions, fibroids, pelvic masses and lower abdominal hernias. The doctor may also examine the muscles of the pelvic floor and hips. Your posture and gait may be evaluated to look for relations between musculoskeletal imbalances and your pain. You may also undergo blood tests, urine tests and tests for sexually transmitted diseases. If your doctor suspects certain conditions, he or she may order an exploratory or diagnostic laparoscopy, abdominal or pelvic ultrasound, X-ray, CT scan or MRI.
3. Why can’t I get complete pain relief?
   Complete relief from chronic pain, whether from chronic pelvic pain or other chronic conditions like backache, arthritis and fibromyalgia, can be difficult to achieve. No one medication works on all women with pain symptoms. A personalized combination of therapies that may include medication, surgery, physical therapy, alternative therapies and lifestyle changes will be formulated to manage your chronic pain symptoms.
4. Why did I get this disease? What causes it?
   Although there are risk factors that may have increased your chances for developing chronic pelvic pain, most are not things you could have prevented or controlled. The most common causes of chronic pelvic pain are endometriosis, adenomyosis, PID, muscular problems, interstitial cystitis, irritable bowel syndrome and depression.
5. Why are my symptoms different from a friend’s, who also has chronic pelvic pain?
   Because of the wide range of conditions that can cause or contribute to chronic pelvic pain, symptoms vary from woman to woman. You may find that your own symptoms vary during your monthly cycle or over time.
6. What can I expect from medical treatments?
   Your pain symptoms may not be totally relieved by taking medications. However, by working closely with your team of health care providers and using some self-care techniques, you may be able to reduce the impact your pain symptoms have on your lifestyle.
7. Should I have surgery? When should I consider surgery?
   The recommendation for surgery to diagnose or treat CPP varies from patient to patient, based on the evaluation test results and responses to medical therapies. In general, surgery to relieve pelvic pain succeeds when the cause of the pain is structural, for example adhesions, ovarian cysts, endometriosis or a congenital or acquired abnormality in the uterus that may be treated with surgery. For other conditions that cause chronic pelvic pain, surgery may not be an option. In either case, surgery should be carefully discussed with your physician(s) to determine whether the risks involved in surgery are outweighed by the likelihood that surgery will relieve your pain.

Lifestyle Tips

1. A combination of therapies works best
   Over-the-counter (OTC) or prescription analgesics may not be adequate to relieve your pain. Complementing drug therapy with one or more alternative therapies, including physical therapy, massage and psychological counseling, may also improve pain relief.
2. Pay attention to posture
   Bad posture, lumbar spine disorders and hip problems can all contribute to pelvic pain, as can muscle strength and length imbalances, leg length discrepancy and foot problems. If you have chronic pelvic pain, be sure to get a complete evaluation of your musculoskeletal system from a doctor or physical therapist. If such musculoskeletal problems are detected, range of motion exercises to increase flexibility of the spine, strengthening exercises for certain muscle groups or an orthotic for your shoe may be recommended.
3. Relax to reduce stress
   Stress exacerbates many recurrent and chronic conditions, including chronic pelvic pain. Stress increases blood pressure, reduces the immune system’s ability to fight infection and affects hormone production, increasing cortisone production in the adrenal glands and upsetting the balance of female hormones. Managing stress by learning to relax daily through meditation or other established therapeutic relaxation techniques is an important part of any pain relief program. Relaxation techniques include focused breathing (as women in labor are advised to do), meditation, deep breathing, progressive muscle relaxation and listening to classical music or nature relaxation recordings. Biofeedback techniques require formal instruction and training but can help you improve your ability to recognize which muscles are tense and how to relax them.
4. Heat and hot water relaxes muscles
   Any kind of heat improves blood flow and relaxes tense muscles. A heating pad or hot water bottle applied to the lower abdomen can help relieve menstrual cramps or pain associated with trigger points; use one on your lower back if that is where your pain originates. Treat yourself to a warm bath with relaxing ingredients, such as Epsom salts, added to it.
5. Exercise and eat right
   Regular exercise improves circulation and increases the production of natural pain-relieving substances (endorphins) in your body. By staying fit and active, you will also reduce your chances of increasing pain due to tight muscles. It may also help you to stay positive and ward off depression. Good nutrition and getting enough rest also help you manage pain.

Organizations and Support

For information and support on coping with Pelvic Pain, please see the recommended organizations, books and Spanish-language resources listed below.

American Association of Gynecologic Laparoscopists (AAGL)
Web Site: http://www.aagl.org
Address: 6757 Katella Avenue
Cypress, CA 90630
Hotline: 1-800-554-AAGL (1-800-554-2245)
Phone: 714-503-6200

American College of Obstetricians and Gynecologists (ACOG)
Web Site: http://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: [email protected]

American Society for Reproductive Medicine (ASRM)
Web Site: http://www.asrm.org
Address: 1209 Montgomery Highway
Birmingham, AL 35216
Phone: 205-978-5000
Email: [email protected]

American Urogynecologic Society
Web Site: http://www.augs.org
Address: 2025 M Street NW, Suite 800
Washington, DC 20036
Phone: 202-367-1167
Email: [email protected]

American Urological Association
Web Site: http://www.auanet.org
Address: 1000 Corporate Blvd.
Linthicum, MD 21090
Hotline: 1-800-RING-AUA (1-866-746-4282)
Phone: 410-689-3700
Email: [email protected]

National Association for Continence (NAFC)
Web Site: http://www.nafc.org
Address: P.O. Box 1019
Charleston, SC 29402
Hotline: 1-800-BLADDER (1-800-252-3337)
Phone: 843-377-0900
Email: [email protected]

National Uterine Fibroids Foundation
Web Site: http://www.nuff.org
Address: P.O. Box 9688
Colorado Springs, CO 80932
Hotline: 1-800-874-7247
Phone: 719-633-3454
Email: [email protected]

Society of Interventional Radiology
Web Site: http://www.sirweb.org
Address: 3975 Fair Ridge Drive, Suite 400 North
Fairfax, VA 22033
Hotline: 1-800-488-7284
Phone: 703-691-1805
Email: [email protected]

Books

A Gynecologist’s Second Opinion: The Questions & Answers You Need to Take Charge of Your Health
by William H. Parker and Rachel L. Parker

A Seat on the Aisle, Please! The Essential Guide to Urinary Tract Problems in Women
by Elizabeth Kavaler

A Break in Your Cycle: The Medical and Emotional Causes and Effects of Amenorrhea
by Theresa Francis-Cheung

Coping With Endometriosis: A Practical Guide
by Robert Phillips and Glenda Motta

The Curse: Confronting the Last Unmentionable Taboo: Menstruation
by Karen Houppert

Endometriosis Sourcebook
by Mary Lou Ballweg and The Endometriosis Association

Endometriosis Survival Guide: Your Guide to the Latest Treatment Options and the Best Coping Strategies
by Margot Fromer

Endometriosis: The Complete Reference for Taking Charge of Your Health
by Mary Lou Ballweg

Honoring Menstruation: A Time of Self-Renewal
by Lara Owen

Uterine Fibroids: What Every Woman Needs to Know
by Nelson Stringer, M.D.

What Your Doctor May Not Tell You About Fibroids: New Techniques and Therapies–Including Breakthrough Alternatives to Hysterectomy
by Scott C. Goodwin, David Drum, and Michael Broder

Yale Guide to Women’s Reproductive Health: From Menarche to Menopause
by Mary Jane Minkin and Carol V. Wright

Spanish-language resources

International Association for the Study of Pain
Website: https://www.iasp-pain.org/education/translatedresources?navItemNumber=4353
Address: IASP Secretariat
111 Queen Anne Ave N, Suite 501
Seattle, WA 98109
Phone: 206-283-0311

University of Maryland Medical Center: Prostatitis
Website: http://www.umm.edu/programs/prostate/services/prostatitis
Address: University of Maryland Medical Center
22 S. Greene St.
Baltimore, MD 21201
Hotline: 1-800-492-5538
Phone: 410-328-8667

Pelvic Inflammatory Disease – Our Bodies Ourselves

Pelvic inflammatory disease (PID) is a general term for an infection that affects the lining of the uterus (endometritus), the fallopian tubes (salpingitis), and/or the ovaries (oophoritis). It is caused primarily by sexually transmitted infections that spread up from the opening of the uterus to these organs.

Symptoms

The primary symptom is pain in the lower abdomen. It may be so mild that you hardly notice it, or so strong that you may not even be able to stand. You may feel tightness or pressure in the reproductive organs, or an occasional dull ache.

I had been complaining of the same problem— pain in my lower right abdomen—for a couple of years. I had severe menstrual irregularities, fevers, bleeding between periods, bleeding after intercourse, pains, and general malaise. Several times I was treated with antibiotics, which brought only some temporary relief. Never was the issue resolved as to what was causing this. Never were my sexual partners or practices mentioned.

Part of the reason PID is underdiagnosed is that women may also have some, most, or none of these other symptoms: abnormal or foul discharge from the vagina or urethra, pain or bleeding during or after intercourse or penetration, irregular bleeding or spotting, increased menstrual cramps, increased pain during ovulation, frequent or burning urination, inability to empty the bladder, swollen abdomen, sudden high fever or low-grade fever that comes and goes, chills, swollen lymph nodes, lack of appetite, nausea or vomiting, pain around the kidneys or liver, lower back or leg pain, feelings of weakness, tiredness, depression, and diminished desire to have sex.

The intensity and extent of the symptoms depend on which microorganisms are causing the problem, where they are located (uterus, tubes, lining of the abdomen, etc.), how long you have had PID, what if any antibiotics you have taken, and your general health. PID is characterized as acute, chronic, or silent (when symptoms are not noticeable).

Causes

Most cases of PID are caused by microorganisms responsible for sexually transmitted infections. They can get into the body during sexual contact with an infected person. If you are carrying these microorganisms, certain procedures or reproductive events can push them farther into your body, including miscarriage, childbirth, abortion, or other procedures involving the uterus, such as endometrial biopsy, hysterosalpingogram (X-ray of the reproductive tract), IUD insertion, or donor insemination.

If you have chronic PID and antibiotic treatment doesn’t help, your sexual partner(s) may be reinfecting you. Men can be carrying the organisms that can cause PID without having symptoms, so they must be tested and treated, too, and they should use a condom during intercourse.

The risk for developing PID is higher if you are exposed to infected secretions—especially infected semen—during menstruation and ovu­lation, when your cervix is more open and your mucus is more penetrable. Women using some IUDs are also at higher risk during the first four months after insertion. In some parts of the United States, gonorrhea still causes most PID. In other areas, chlamydia is more often the cause of PID. Current guidelines recommend annual chlamydia screening for women age twenty-five and under who are having sex, to find and treat this infection before it causes PID.

The complications of PID can be very serious. If untreated, PID can turn into peritonitis—a life-threatening condition—or into a tubo-ovarian abscess. It can affect the bowels and the liver (causing perihepatitis syndrome). Months or years after an acute infection, infertility or ectopic pregnancy can result if your fallopian tubes were damaged or clogged by scar tissue. PID can also cause chronic pain from adhesions or lingering infection. In the most extreme cases, untreated PID can result in death.

Preventing PID

Because so much PID is caused by sexually transmitted organisms, preventing PID involves preventing sexually transmitted infections. You can reduce your risk by using condoms and engaging in safer sex practices. For more information, see Safer Sex & Sexually Transmitted Infections.

Diagnosis

If you could know right away exactly which organisms were causing your PID, you could get the right antibiotics. However, pinpointing the organisms often takes some tests that may be expensive and not readily available. Sometimes organisms infecting the uterus and fallopian tubes don’t show up in a cervical culture.

You may be told that your chronic cystitis is caused by trauma to the urethra during intercourse when it’s really a sign of PID, or that you got infected by wiping yourself from back to front, when you really have a sexually transmitted infection. You may be told that you have a spastic colon or an emotional, not a physical, problem, when that is not true. Try to have your situation thoroughly assessed, particularly if symptoms persist despite treatment, or seek a second opinion.

Blood tests can help indicate whether you have an infection but won’t always tell you which one. Sometimes an endometrial biopsy can find hard-to-culture organisms, but if it is not done carefully, this procedure can spread germs from the cervix and vagina to the uterus. In some cases, ultrasound, including vaginal ultrasound, may be useful. A definitive diagnosis often requires laparoscopic surgery.

Medical Treatments for PID

Most experts seem to agree that since your health and fertility are at stake, you should start treatment while waiting for test results. Both you and your partner must be treated. If your partner continues to carry the microorganism(s), you will be reinfected. Taking the wrong drugs can make organisms more difficult to get rid of; however, the practical strategy is to begin treatment, then adjust it according to what cause is found. Once you start taking antibiotics, you cannot get an accurate culture again until at least a couple of weeks after you stop taking them.

Therapy lasts at least 10 to 14 days. You should receive two different kinds of antibiotics, since more than one organism may be involved. Remember to take all your antibiotics, even if your symptoms are gone, so that antibiotic-resistant strains of microbes will be less likely to develop. (For more information about antibiotic resistance, see the Centers for Disease Control and Prevention website.) Antibiotics can cause yeast overgrowth in the vagina, so you may need something to keep the yeast in check while trying to cure the much more serious PID (see Yeast Infections).

Many experts recommend that all women with PID be hospitalized for treatment, but not all physicians follow these recommendations. Most women are hospitalized in the event of an acute attack, to get intravenous (IV) antibiotics. If you’re still not cured, it may be because you got the wrong antibiotic, have a pelvic abscess, or were reinfected by a partner.

You may be urged to have a hysterectomy if the doctor thinks that PID has damaged your pelvic organs beyond repair. Also, emergency hysterectomies are done in some cases of acute PID (for example, when an abscess ruptures). If the infection is in your urinary tract, as it often is, then hysterectomy does not eliminate it. Hysterectomy is rarely necessary for PID, except in cases of persistent, debilitating PID.

Avoid intercourse until you have felt completely well through an entire monthly cycle and your partner(s) have had negative test results for all STIs. You can have a recurrence of PID months after the initial infection is cleared up, particularly if you don’t keep up daily health routines or are under too much stress.

Self-Help

There are some things you can do to help alleviate discomfort while you wait for test results to come back and for antibiotics to start working. Very hot baths and a heating pad applied directly to the lower abdomen help relieve pain and bring disease-fighting blood to your pelvis. You can soak a cotton cloth in castor oil, place it on the abdomen, cover it with plastic wrap, and then put a heating pad or hot water bottle on top to bring a maximum amount of heat to the pelvic area. Ginger root compresses and taro root poultices may relieve pain, keep the area loose and freer from adhesions, and dissolve already formed adhesions. Do not douche or use tampons; doing so may force microorganisms up into your uterus. Do not reuse a douche bag that may be harboring infectious organisms.

Certain herbs and teas may be useful against infection of the reproductive and urinary tracts. Raspberry leaf tea can strengthen the reproductive system; cranberry juice may help with UTIs.

Acute Pelvic Inflammatory Disease: Tests And Treatment

• Reference Number: HEY-801/2016E
• Departments: Gynaecology

You can translate this page by using the headphones button (bottom left) and then select the globe to change the language of the page. Need some help choosing a language? Please refer to Browsealoud Supported Voices and Languages.

What is pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is an inflammation in the pelvis. It is usually caused by an infection spreading from the vagina and cervix (entrance of the uterus) to the uterus (womb), fallopian tubes, ovaries and pelvic area. If severe, the infection may result in an abscess (collection of pus) forming inside the pelvis. This is most commonly a tubo-ovarian abscess (an abscess affecting the tubes and ovaries).

PID is common and accounts for one in 60 GP visits by women under the age of 45 years.

What is ‘acute’ pelvic inflammatory disease?

Acute PID is when there is sudden or severe inflammation of the uterus, fallopian tubes, ovaries and pelvic area due to infection.

Sometimes the inflammation can persist for a long time; this is known as chronic pelvic inflammatory disease (see Are there any long-term effects?).

What causes pelvic inflammatory disease?

Untreated sexually transmitted infections such as chlamydia and gonorrhoea are the most likely causes of PID.  PID may also be caused by a number of less common infections that may or may not be sexually transmitted.  Occasionally PID can develop after a miscarriage or an abortion.

What are the symptoms of pelvic inflammatory disease?

Symptoms vary from person to person. You may have some or all of the following:

• Smelly or unusual vaginal discharge.
• A high temperature (more than 38°C).
• Pain in the lower abdomen, which may be on one side and travel down your legs.
• Pain or bleeding during or after sex.
• Vaginal bleeding between periods.

Many of these symptoms are common and can be caused by other conditions. For instance, pain in the lower abdomen can be due to irritable bowel syndrome, a urine infection, a cyst on the ovary or appendicitis. Bleeding between periods can also be caused by hormonal contraception, such as the pill, an implant, an injection or a hormonal intrauterine device (coil).

Because of this, PID can be difficult to diagnose. If you have any of these symptoms, it is important to seek medical advice as soon as possible.

How do I get a diagnosis?

Consultation and examination

Your doctor will ask you about your symptoms, medical history and sexual history. If your doctor suspects you might have PID, he or she will examine you. You will be asked if you would like a chaperone (someone to accompany you) for this. The examination may cause some discomfort, especially if you do have PID.

Swab test

Your doctor will take samples from your vagina and your cervix with a swab (similar to a cotton bud). It usually takes a few days for the swab result to come back.

• A positive swab result confirms a diagnosis of PID and means you need treatment.
• A negative swab result does not mean you are definitely clear from PID. Swabs can give ‘false negative’ results, which means that the swab has not picked up exactly which infection is causing your PID.

Sometimes an additional swab may be taken from the urethra (the tube through which urine empties out of your bladder). This can increase the rate of detection of chlamydia and gonorrhoea or other infections.

Blood test

You may be offered a blood test. A result with a raised white blood cell count indicates the presence of infection. You may be asked to bring in or give a urine sample.

To exclude a diagnosis of PID, if there is any possibility you could be pregnant, you will be offered a pregnancy test. This is because other conditions such as ectopic pregnancy (when a pregnancy develops outside the uterus) can cause similar symptoms to PID.

Further tests

If your doctor suspects you have a severe infection, you will be referred to your local hospital for further tests and treatment. You may be offered an:

• Ultrasound scan. This is usually a transvaginal scan (where the probe is gently inserted into your vagina) to look more closely at the uterus, fallopian tubes and ovaries. Sometimes it is possible to detect inflamed fallopian tubes or, in very severe cases, the presence of an abscess using ultrasound.
• Operation under a general anaesthetic called a laparoscopy. The doctor uses a small telescope called a laparoscope to look at your pelvis by making a tiny cut, usually into your umbilicus (tummy button). This is also called keyhole surgery. This is especially useful when it is unclear whether you have PID or another condition such as appendicitis.

What are my treatment options?

If you have mild to moderate PID, you will be offered a course of antibiotics. Your doctor or nurse will ask you about any other medicines you are currently taking or you have taken recently. This is especially important if you are taking a contraceptive pill as antibiotics can interfere with its effectiveness.

Your doctor or nurse can give you information about the specific treatment you are given; this should include information about possible side effects.

You will usually be given a two-week course of antibiotic tablets. It is very important to complete your course of antibiotic tablets, even if you are feeling better. Most women who complete their course of antibiotics have no long-term health or fertility problems.  You may also be given medication for pain relief.

When does treatment start?

You should start taking antibiotic tablets as soon as they are prescribed. This is likely to be before you get your test results back – including the swab results. It is important you start taking the antibiotics at this point because any delay could increase the risk of long-term health problems (see Are there any long-term effects?).

Why might I need hospital treatment?

Your doctor may recommend treatment in hospital if:

• Your diagnosis is unclear.
• You are very unwell.
• He or she suspects an abscess.
• You are pregnant.
• You are not getting better within a few days of starting antibiotics.
• You are unable to take antibiotics by mouth.

When you are in hospital, antibiotics may be given intravenously (directly into the blood-stream through a drip). This treatment is usually continued until 24 hours after your symptoms have improved. After that, you will be given a course of antibiotic tablets. The exact type of antibiotics you are given will depend on your own circumstances.

Will I need an operation?

You will usually only need an operation if you have a severe infection or an abscess. An abscess may be drained during a laparoscopy or during an ultrasound procedure. The doctor will discuss these treatments with you in greater detail.

What if I am pregnant?

It is rare to develop PID when you are pregnant.

If there is any chance you could be pregnant, and this has not yet been confirmed, you should tell your doctor or nurse. If a pregnancy is confirmed, certain antibiotics should be avoided. The risks associated with the majority of antibiotics prescribed for PID are low.

What if I have an intrauterine contraceptive device (IUD/coil)?

If your symptoms of PID are not improving within a few days of starting treatment, your doctor may recommend you have your IUD/coil removed. If you have had sex in the previous seven days, you will be at risk of pregnancy and emergency hormonal contraception (morning after pill) may be an option.

Should my partner be treated?

If you know that you have developed PID as a result of a sexually transmitted infection, it is important to contact anyone you have had sex with during the last six months. You should suggest that they have screening for chlamydia and gonorrhoea – even if they are well. Your doctor, local genitourinary medicine clinic or sexual health clinic can help you with this, or do it for you anonymously.

When can I have sex again?

You should avoid having sex until you and your partner have completed the course of treatment. If this is not possible, use a condom.

What about follow-up?

If you have a moderate to severe infection, you will usually be given an appointment to return to the clinic after three days. This is to check that the antibiotics are working. It is particularly important to attend this appointment so your doctor can see that your symptoms are responding to the antibiotics.

Women whose symptoms are not improving may be advised to attend hospital for further investigations and treatment.  If your doctor confirms your symptoms are improving, you will usually be given a further follow-up appointment at four to six weeks to check:

• Your treatment has been effective.
• If a repeat swab test is needed to confirm the infection has been successfully treated – this is particularly important if you have ongoing symptoms.
• You have all the information you need about the long-term effects of PID.
• If another pregnancy test is needed.
• You have all the information you need about future contraceptive choices or your plans for pregnancy.
• Your sexual partner(s) have been screened and treated.

Are there any long-term effects?

Acute PID is an infection that is usually treated successfully. Long-term problems can arise if PID is untreated, if treatment is delayed or if there is a severe infection. The long-term effects can be:

• Scarring of the fallopian tube, which can cause:
  – An increased risk of ectopic pregnancy.
  – Difficulties in becoming pregnant.
• Persistent pain in your lower abdomen (see RCOG patient information Long-term pelvic pain: information for you).

Repeated episodes of PID increase the risk of future fertility problems. You can reduce the risk of further infection by using condoms and by making sure that your sexual partner(s) are treated for sexually transmitted infections.

A glossary of all medical terms is available on the RCOG website at: www.rcog.org.uk/en/patients/medical-terms.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the Royal College of Obstetricians and Gynaecologists (RCOG) guideline Management of Acute Pelvic Inflammatory Disease (originally published by the RCOG in 2003 and revised in November 2008). The guideline contains a full list of the sources of evidence we have used. You can find it online at: www.rcog.org.uk/womens-health/ clinical-guidance/management-acute-pelvic-inflammatory-disease-32.

The RCOG produces guidelines as an educational aid to good clinical practice. They present recognised methods and techniques of clinical practice, based on published evidence, for consideration by obstetricians and gynaecologists and other relevant health professionals. This means that RCOG guidelines are unlike protocols or guidelines issued by employers, as they are not intended to be prescriptive directions defining a single course of management.

This information has been reviewed before publication by women attending clinics in Weston-Super-Mare, Birmingham, and South Yorkshire.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

Pelvic inflammatory disease – NHS

Pelvic inflammatory disease (PID) is an infection of the female upper genital tract, including the womb, fallopian tubes and ovaries.

PID is a common condition, although it’s not clear how many women are affected in the UK.

It mostly affects sexually active women aged 15 to 24.

Symptoms of pelvic inflammatory disease (PID)

PID often does not cause any obvious symptoms.

Most women have mild symptoms that may include 1 or more of the following:

• pain around the pelvis or lower tummy
• discomfort or pain during sex that’s felt deep inside the pelvis
• pain when peeing
• bleeding between periods and after sex
• heavy periods
• painful periods
• unusual vaginal discharge, especially if it’s yellow or green

A few women become very ill with:

• severe pain in the tummy
• a high temperature
• feeling and being sick

When to seek medical advice

It’s important to visit a GP or a sexual health clinic if you experience any of the above symptoms.

If you have severe pain, you should seek urgent medical attention from your GP or local A&E department. 

Delaying treatment for PID or having repeated episodes of PID can increase your risk of serious and long-term complications.

There’s no simple test to diagnose PID. Diagnosis is based on your symptoms and the finding of tenderness on a vaginal (internal) examination.

Swabs will be taken from your vagina and the neck of the womb (cervix), but negative swabs do not rule out PID.

Causes of pelvic inflammatory disease (PID)

Most cases of PID are caused by a bacterial infection that’s spread from the vagina or the cervix to the reproductive organs higher up.

Many different types of bacteria can cause PID. In many cases, it’s caused by a sexually transmitted infection (STI), such as chlamydia or gonorrhoea.

Another type of STI called mycoplasma genitalium is thought to be increasingly responsible for cases of PID.

In many other cases, it’s caused by bacteria that normally live in the vagina.

Treatment for pelvic inflammatory disease (PID)

If diagnosed at an early stage, PID can be treated with a course of antibiotics, which usually lasts for 14 days.

You’ll be given a mixture of antibiotics to cover the most likely infections, and often an injection as well as tablets.

It’s important to complete the whole course and avoid having sexual intercourse during this time to help ensure the infection clears.

Your recent sexual partners also need to be tested and treated to stop the infection coming back or being spread to others.

Complications

The fallopian tubes can become scarred and narrowed if they’re affected by PID. This can make it difficult for eggs to pass from the ovaries into the womb.

This can then increase your chances of having a pregnancy in the fallopian tubes instead of the womb (ectopic pregnancy) in the future, and can make some women infertile.

It’s estimated around 1 in 10 women with PID become infertile as a result of the condition. Women who have delayed treatment or had repeated episodes of PID are most at risk.

But most women treated for PID are still able to get pregnant without any problems.

Preventing pelvic inflammatory disease (PID)

You can reduce your risk of PID by always using condoms with a new sexual partner until they have had a sexual health check.

Chlamydia is very common in young men and most do not have any symptoms.

If you’re worried you may have an STI, visit your local genitourinary medicine (GUM) or sexual health clinic for advice.

If you need an invasive gynaecological procedure, such as insertion of a coil or an abortion, have a check-up beforehand.

Find your local sexual health clinic

Get more advice about STIs

Page last reviewed: 06 August 2018
Next review due: 06 August 2021

Pelvic pain in women: what’s the diagnosis? | Differential diagnoses

Read this article to learn more about:

• identifying the cause of pelvic pain based on a patient’s presenting symptoms
• tests and imaging techniques that can be used to confirm or eliminate differential diagnoses
• treatment and management strategies based on the diagnosis, and red flags for prompt referral.

Guidelines Learning

After reading this article, ‘ Test and reflect ’ on your updated knowledge with our multiple-choice questions. We estimate that this activity will take you 30 minutes—worth 0.5 CPD credits.

The pelvis is the lowest part of abdomen. Various organs are in the pelvis including the bowel, bladder, uterus, and ovaries and any of these organs can cause pelvic pain. Pelvic pain can also originate in the pelvic bones, muscles, nerves, joints, or blood vessels. Lower abdominal and pelvic pain can be diagnostically difficult and the differentiation between gynaecological and surgical causes is sometimes blurred.

Background

Pelvic pain is more common in women than men. It is a common presentation in primary care; between 1991 and 1995, 38 per 1000 women aged 12–70 years in the UK were affected annually.^1,2 Common causes of acute pelvic pain include pelvic inflammatory disease (PID), urinary tract infection (UTI), miscarriage, ectopic pregnancy, and torsion or rupture of ovarian cysts. Chronic pelvic pain can be due to various aetiologies including endometriosis, PID, adenomyosis, and dense adhesions.

Pelvic pain can be classed as acute or chronic based on the onset and duration of symptoms. Chronic pelvic pain (CPP) is defined as: ’intermittent or constant pain in the lower abdomen or pelvis of a woman of at least 6 months in duration, not occurring exclusively with menstruation or intercourse, and not associated with pregnancy.’³ It is a symptom that presents in primary care as frequently as migraine or low back pain.² It may significantly impact on a woman’s quality of life as well as carrying a heavy economic and social burden.

Patients with chronic inflammatory condition of the bladder (characterised by urination urgency, frequency, and pain on holding too long), in absence of another cause or irritable bowel syndrome, often present with CPP.³

In addition, past pelvic or abdominal surgery, or trauma during childbirth may contribute to the genesis of CPP. Social and psychological factors are strongly associated with chronic pelvic pain. History of social issues and psychological issues (such as physical or sexual abuse) should also be investigated during the assessment of CPP.¹

Acute pelvic pain in younger women may indicate problems with pregnancy, such as ectopic pregnancy. In the acute setting, PID and lower genital tract infections (e.g. cervicitis, candidiasis, Bartholin’s abscess) account for almost half of all diagnoses for women with pain caused by gynaecologic disorders. Other common diagnoses include menstrual disorders, non-inflammatory ovarian and tubal pathology (including cysts and torsion), and ectopic pregnancy.⁴

Aiming for accurate diagnosis and effective management from the first presentation will help to reduce the disruption of the woman’s life and may avoid an endless succession of referrals, investigations, and operations.

History taking

A careful history (focusing on pain characteristics, a review of symptoms, as well as taking a gynaecological, sexual, and social history) and physical examination helps to narrow the differential diagnoses. The patient should be asked to describe the pain they are experiencing, for example:

• location
• intensity
• radiation
• timing (in relation to menses, food, micturition, defaecation, and sexual intercourse)
• duration
• any exacerbating and mitigating factors.

The example case studies presented below discuss different presentations of pathologies causing acute and chronic pelvic pain.

Case 1

A 25-year-old woman presents with persistent lower abdominal pain of 1-week duration and smelly vaginal discharge. She has been in a new relationship for the past 4 months. Her past medical history is unremarkable with the exception of a ruptured appendix 1 year ago, which required surgery. On examination, she was febrile with lower abdominal tenderness. She had cervical motion tenderness on bimanual vaginal examination with some adnexal tenderness. A urine dipstick test gave unremarkable results.

Diagnosis

Pelvic inflammatory disease (PID) is a likely diagnosis in this case. Typical symptoms, new sexual relationship, and the findings of the physical examination support the clinical diagnosis of PID (see Figure 1).⁵

Clinicians should consider PID in young women who are sexually active and in other women at risk of sexually transmitted infections (STIs) when they experience pelvic or lower abdominal pain and no other cause is apparent. This is especially true if the patient has cervical motion, uterine, or adnexal tenderness.⁵

The exact incidence of PID is unknown because of the difficulty in making a clinical diagnosis, and because it is often unrecognised if it presents atypically or is asymptomatic. An Office of Population Censuses Survey (1991–1992) of 60 general practices in England and Wales showed that PID was diagnosed in 1.7% of GP attendances by women 16–46 years of age.⁶

Management

All women presenting with pelvic pain should be offered a pregnancy test (where appropriate) to exclude pregnancy, and screening for sexually transmitted infections. Referral of the index case woman and her partner to a genitourinary medicine (GUM) or sexual health clinic to facilitate contact tracing and infection screening should be encouraged.⁵

If clinical diagnosis of PID is suspected then antibiotic treatment should be prescribed promptly, based on local guidelines. It is likely that delaying treatment increases the risk of long-term sequelae such as ectopic pregnancy, infertility, and pelvic pain.⁷

Because of the risk of complications and the lack of definitive diagnostic criteria, a low threshold for empiric treatment of PID is recommended. Appropriate analgesia should be provided. Antibiotic regimens commonly used for outpatients are:⁵

• oral ofloxacin 400 mg twice daily plus metronidazole 400 mg twice daily for 14 days
• intramuscular ceftriaxone 500 mg single dose, followed by oral doxycycline 100 mg twice daily plus metronidazole 400 mg twice daily for 14 days.

Intravenous therapy and hospitalisation is recommended for patients with more severe clinical disease, for example, pyrexia >38 °C, clinical signs of tubo-ovarian abscess, or signs of pelvic peritonitis.⁵

Consideration should also be given to removing an intrauterine contraceptive device in women presenting with PID, especially if symptoms have not resolved within 72 hours.⁸

Clinical Outcome

This patient was offered triple swabs in the surgery and was commenced on combination antibiotic treatment. Her swabs confirmed Neisseria gonorrhoea. She was informed regarding the diagnosis and advised to visit the local GUM clinic with her partner for treatment. She was advised to avoid unprotected intercourse until she and her partner(s) had completed treatment and follow up.

Case 2

A 36-year-old woman presents with a history of left-sided lower abdominal pain for 2 days, which started suddenly and was followed by reddish-brown bleeding. Her periods have been delayed by 3 weeks. She also complains of feeling nauseous and dizzy. She has no previous history of miscarriage but her patient record shows a history of suspected pelvic infections. On examination, she has a pulse rate of 132 bpm and blood pressure is found to be 92/67 mmHg. Urine pregnancy test is positive. Abdominal examination reveals left lower abdominal tenderness with guarding.

Diagnosis

Ectopic pregnancy is the most likely diagnosis until otherwise ruled out.

An ectopic pregnancy is any pregnancy implanted outside of the endometrial cavity. In the UK, the incidence is approximately 11 per 1000 pregnancies, with an estimated 11,000 ectopic pregnancies diagnosed each year.⁹

Due to its life-threatening nature, ectopic pregnancy must be ruled out when a woman of reproductive age presents with acute pelvic pain and a positive pregnancy test. An unruptured ectopic pregnancy produces localised pain due to dilatation of the fallopian tube. Once the ectopic pregnancy is ruptured, the pain tends to be generalised due to peritoneal irritation from the blood and this includes shoulder-tip pain.¹⁰

Risk factors for ectopic pregnancy include tubal damage following surgery or infection, smoking, previous ectopic pregnancy, and in vitro fertilisation; however, the majority of women with an ectopic pregnancy have no identifiable risk factor.⁹ Transvaginal ultrasound (TVS) and serum human chorionic gonadotrophin (hCG) levels are commonly used investigations.

Management

Emergency referral to the local gynaecology unit should be made following a discussion with the on-call specialist.⁹

Laparoscopic management is the norm if:

• the patient is haemodynamically stable, or
• a high index of suspicion remains, or
• the patient complains of increasing pain despite adequate analgesia.

Surgical treatment options for an ectopic pregnancy in the fallopian tube include salpingectomy and salpingotomy. These may be performed laparoscopically or by open procedure.⁹

Methotrexate is a possible pharmacological option for unruptured ectopic pregnancy and works well if the serum hCG is <1500 IU/litre.¹¹ It can only be given in the hospital setting with proper follow up. If hCG levels are <1000 IU/litre and have fallen on a repeat test 48 hours later, a conservative approach can be adopted; watch and wait—monitor hCG levels to ensure they are falling as the ectopic pregnancy can resolve spontaneously.

Caesarean scar ectopic pregnancy and ovarian or cervical pregnancy are rarer ectopic pregnancies and should ideally be managed in centres with expertise in these conditions.

Outcome

In this patient, ultrasound examination confirmed an empty uterus and a significant amount of free fluid. She was offered emergency laparoscopy and left salpingectomy was undertaken for leaking left tubal ectopic pregnancy.

Case 3

A 20-year-old woman presents with a 2-year history of worsening secondary dysmenorrhoea. Her periods are regular but she usually has 2–3 days of spotting with severe pain before her periods are due. She also complains of pain during intercourse and post-coital ache. Abdominal examination is normal. Pelvic examination reveals some nodularity in the uterosacral area.

Diagnosis

The likely diagnosis in this case is endometriosis.

Endometriosis is defined as the growth of endometrial-like tissue outside the uterus.¹² It is often associated with dysmenorrhea, pelvic pain, subfertility, and mainly affects women of reproductive age.¹³ Dysuria and haematuria can be presenting features in cases where there is bladder involvement; painful defecation and blood in stools sometimes occur in cases where there is bowel involvement. Population based studies report a prevalence of around 1.5% compared with 6–15% in hospital-based studies.^12,13 There is a hereditary element to endometriosis as the condition tends to run in families.

Management

To confirm a diagnosis of endometriosis, laparoscopy or transvaginal ultrasound should be considered in women who do not respond to conservative treatment or have subfertility. Abdominal ultrasound, magnetic resonance imaging, and computed tomography are only useful in presence of pelvic or adnexal masses—a diagnosis of endometriosis should not be excluded if the abdominal or pelvic examination, ultrasound, or MRI are normal.^12,13

The primary treatment goal for endometriosis is essentially pain relief and/or improving fertility.¹³

Management can be medical or surgical. Medical management involves:¹²

• pain management—
  • NSAIDS, paracetamol (alone or in combination), or codeine-based analgesics
• hormonal treatment—
  • the oral contraceptive pill, progestins/progesterone, gonadotrophin-releasing hormone (GnRH) analogues, danazol, or levonorgestrel-releasing intrauterine system.

Hormonal therapies have varying degrees of side-effects and, unfortunately, for many patients, pain relief may be only temporary. If medical management is tried, review the woman after 3–6 months (earlier if symptoms are troublesome) and refer to a gynaecologist if there is no improvement in symptoms during this period.¹⁴

Laparoscopic surgery is the only definitive way to diagnose endometriosis, and in most cases the disease can be diagnosed and treated in the same procedure. Pelvic clearance (abdominal hysterectomy and bilateral salpingo-oophorectomy) can be offered to women for whom fertility is not a priority.¹⁵

Clinical Outcome

The patient was initiated on a 21-week trial of the combined oral contraceptive pill, but had little improvement in her symptoms. The patient had laparoscopic excision of endometriosis and insertion of levonorgestrel-releasing intrauterine system. At a follow-up appointment after 4 months the patient had become amenorrhoeic and pain during intercourse had improved significantly.

Case 4

A 17-year-old woman presents as an emergency with sudden-onset pain in the left side of her lower abdomen following exercise, progressively getting worse in last 10 hours. Pain was radiating to her pelvis and left thigh. The patient had associated nausea and two episodes of vomiting. On further questioning, the patient admitted having similar but less severe episodes in last few months. Abdominal examination showed tenderness in the left lower quadrant. Urine dipstick analysis was clear and pregnancy test was negative. Pelvic examination revealed fullness in left adnexa. Ultrasound revealed left adnexal pelvic mass.

Diagnosis

The likely diagnosis of this patient is ovarian cyst torsion.

Changes in ovarian axial morphology, which are typically secondary to ovarian cysts (most commonly dermoids), can undergo torsion around the ovarian pedicle. Persistent torsion progresses to occlusion of the venous drainage of the ovary, which leads to congestion, ovarian enlargement, thickening of the ovarian capsule, and subsequent infarction. Pain is typically colicky and eventually becomes severe and is accompanied by nausea, vomiting, and restlessness. Infarction also leads to fever and mild leukocytosis. On pelvic exam, a tender unilateral mass in the anterior pelvis may be palpable.¹⁶

Conservative management with laparoscopic detorsion with or without cystectomy and oophoropexy is recommended.¹⁶ In older and postmenopausal women, salpingo-oophorectomy is the treatment of choice to completely remove the risk of re-torsion.

Outcome

The patient had a pelvic ultrasound, which confirmed a 7 cm ovarian cyst. She underwent laparoscopic de-torsion, ovarian cystectomy, and made a good recovery.

Conclusion

Pelvic pain is a common presentation in primary care. Full history and detailed examination is required to establish possible causes of the pain. Further investigations in the form of urine examination, blood tests, and imaging are undertaken based on history in order to establish the diagnosis and plan treatment and management. Depending on the diagnosis, patients can be managed in primary care but some may require referral to secondary care if there is doubt about the diagnosis, pain is unresponsive to conservative management, or if the cause of pelvic pain merits surgical intervention.

Even if no explanation for the pain can be found initially, attempts should be made to treat the pain empirically and to develop a management plan in partnership with the woman. Women can also be directed to organisations and websites for further information and/or support (see Box 1).³

Box 1: Organisations and websites for women with pelvic pain

Endometriosis UK

UK charity dedicated to providing information and support to people with endometriosis.

IBS Network

The UK’s national charity for IBS, offering information, advice and support to patients with IBS and working with healthcare professionals to facilitate IBS self management.

Pelvic Pain Support Network

The Pelvic Pain Support Network supports those with pelvic pain whether they have a diagnosed condition or not.

Patient.info—pelvic pain in women

Guidelines Learning

After reading this article, ‘ Test and reflect ’ on your updated knowledge with our multiple-choice questions. We estimate that this activity will take you 30 minutes—worth 0.5 CPD credits.

References

1. Latthe P, Mignini L, Gray R et al. Factors predisposing women to chronic pelvic pain: systematic review. BMJ 2006; 332 (7544): 749–751.
2. Zondervan K, Yudkin P, Vessey M et al. Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. Br J Obstet Gynaecol 1999; 106 (11): 1149–1155.
3. Royal College of Obstetricians and Gynaecologists (RCOG). The inital management of chronic pelvic pain. Green-top Guideline 41. RCOG, 2012. Available at: www.rcog.org.uk/globalassets/documents/guidelines/gtg_41.pdf
4. Marx J, Hockberger R, Walls R. Acute pelvic pain in women. In: Rosen’s emergency medicine—concepts and clinical practice. Amsterdam: Elsevier, 2013: 266–272.
5. British Association for Sexual Health and HIV (BASHH) Clinical Effectiveness Group. UK national guideline for the management of pelvic inflammatory disease. BASHH, 2011. Available at: www.bashh.org/documents/3572.pdf
6. Simms I, Rogers P, Charlett A. The rate of diagnosis and demography of pelvic inflammatory disease in general practice: England and Wales. Int J STD AIDS 1999; 10 (7): 448–451.
7. Centers for Disease Control and Prevention (CDC). Sexually transmitted disease treatment guidelines, 2015. MMWR Morb Mortal Wkly Rep 2015; 64 (3): 1–135.
8. Royal College of Obstetricians and Gynaecologists (RCOG). Management of acute pelvic inflammatory disease. Green-top Guideline 32. RCOG, 2008. Available at: www.pelvicpain.org.uk/uploads/documents/PelvicInflamatoryDisease2008-guidelines.pdf
9. Elson C, Salim R, Potdar N et al on behalf of the Royal College of Obstetricians and Gynaecologists. Diagnosis and management of ectopic pregnancy—Green-top Guideline 21. Br J Obstet Gynaecol 2016;123: e15–e55.
10. NICE. Ectopic pregnancy and miscarriage: diagnosis and initial management. Clinical Guideline 154. NICE, 2012. Available at: nice.org.uk/cg154
11. Stovall T, Ling F, Gray L. Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol 1991; 77 (5): 754–757.
12. NICE. Endometriosis: diagnosis and management. NICE Guideline 73. NICE, 2017. Available at: www.nice.org.uk/ng73
13. Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ 2014; 348: g1752.
14. NICE. Clinical knowledge summaries—endometriosis. NICE, 2014. cks.nice.org.uk/endometriosis (accessed 5 October 2017).
15. Dunselman G, Vermeulen N, Becker C et al. Management of women with endometriosis. Hum Reprod 2014; 29 (3): 400–412.
16. Poonai N, Poonai C, Lim R, Lynch T. Pediatric ovarian torsion: case series and review of the literature. Can J Surg 2013; 56 (2): 103–108.

Pelvic Inflammatory Disease | Michigan Medicine

Topic Overview

What is pelvic inflammatory disease?

Pelvic inflammatory disease, or PID, is an infection of a woman’s reproductive organs.

Treating PID right away is important, because PID can cause scar tissue in the pelvic organs and lead to infertility. It can also cause other problems, such as pelvic pain and tubal (ectopic) pregnancy.

What causes PID?

PID is caused by bacteria entering the reproductive organs through the cervix. When the cervix is infected, bacteria from the vagina can more easily get into and infect the uterus and fallopian tubes.

You’re more likely to get PID if you:

• Have a sexually transmitted infection (STI). The most common causes of PID are gonorrhea and chlamydia.
• Are at risk for STIs. If you are young and you don’t use condoms when you have sex, you’re more likely to get STIs. Having more than one sex partner also increases your risk for STIs.
• Have bacterial vaginosis.
• Douche.
• Have recently had an IUD inserted or had an abortion.
• Have had PID before.

What are the symptoms?

At first, PID may not cause any symptoms. Or it may cause only mild symptoms, such as bleeding or discharge from the vagina. Some women don’t even know they have it. They only find out later, when they can’t get pregnant or they have pelvic pain.

As the infection spreads, the most common symptom is pain in the lower belly. The pain has been described as crampy or as a dull and constant ache. It may be worse during sex, during bowel movements, or when you urinate. Some women also have a fever.

How is PID diagnosed?

Even when PID causes mild or no symptoms, it can still cause serious problems. So you need to see your doctor if you have any unusual symptoms.

Your doctor will ask about your lifestyle and symptoms. He or she will examine you and do tests to see if you have PID. The test results may take some time. For this reason, your doctor will treat you for the disease before the test results are ready. Treating PID early is important to prevent problems later on.

Your doctor may test you for the most common causes of PID and may also do blood tests to look for signs of infection. Your doctor may also order an ultrasound to see if there are other possible causes of your symptoms. An ultrasound may also show if there is damage to the fallopian tubes, uterus, or ovaries from PID.

How is it treated?

To treat PID, you will take antibiotics. Take them as directed. If you don’t take all of the medicine, the infection may come back.

If your infection was caused by a sexually transmitted infection, your sex partner(s) will also need to be treated so you don’t get infected again. Do not have sex until both of you have finished your medicine. And be sure to follow up with your doctor to make sure that the treatment is working.

If you have a very bad case of PID or are also pregnant, you may need to stay in the hospital and get antibiotics through a vein (intravenous). Sometimes surgery is needed to drain a pocket of infection, called an abscess.

Can you prevent PID?

Your risk of infertility increases each time you have PID, so it is very important to prevent future infections. Using a condom each time you have sex can reduce your chance of getting a sexually transmitted infection that could lead to PID.

Cause

Pelvic inflammatory disease (PID) is caused by bacteria entering the reproductive organs through the cervix. When the cervix is infected, bacteria from the vagina can more easily get into and infect the uterus and fallopian tubes.

Sexually transmitted infections

Pelvic inflammatory disease (PID) is usually caused by a sexually transmitted infection (STI) that infects the cervix.

When the cervix, which connects the upper vagina to the uterus, is infected with an STI, other bacteria in the vagina can more easily get into and infect the uterus and fallopian tubes.

The most common STIs that cause PID are gonorrhea and chlamydia.

PID caused by chlamydia may have milder symptoms or no symptoms (compared with PID caused by gonorrhea), which can delay diagnosis. PID caused by chlamydia is most common among teenagers and young adult women.

Bacterial vaginosis

Bacterial vaginosis (BV) is a drop in the vagina’s “good” organisms and an increase in its potentially “bad” organisms.

When this happens and the problem organisms spread into the uterus and fallopian tubes, PID can result. BV is not sexually transmitted.

PID and intrauterine devices (IUDs)

Inserting an IUD while there is infection in the vagina or the cervix can cause PID. This is especially likely if bacterial vaginosis or an STI is present at the time of insertion.

Symptoms

Symptoms of pelvic inflammatory disease (PID) range from none at all to severe. They often don’t appear until infection has spread.

Symptoms tend to be more noticeable during menstrual bleeding and sometimes in the week following.

You may have one or more of these symptoms:

• Pain in the lower belly, usually described as crampy or as constant and dull. This is the main symptom. It may get worse during bowel movements, sexual intercourse, or urination.
• A sense of pressure in the pelvis.
• Low back pain. Sometimes this pain spreads down one or both legs.
• More discharge from the vagina than usual, or discharge that is yellow, brown, or green.
• Fever.
• Pain during sex.
• Irregular menstrual bleeding.
• Urinary symptoms, such as burning or pain when you urinate.

What Happens

Pelvic inflammatory disease (PID) causes inflammation in the uterus and fallopian tubes. In turn, the inflammation can form scar tissue in the abdominal cavity and the reproductive organs. This doesn’t always cause symptoms. But the scar tissue can cause:

• Infertility. Scarring inside the fallopian tubes is permanent and can twist or block the tubes. When the tubes are blocked, a woman’s eggs can’t get to the uterus.
• Tubal (ectopic) pregnancy. Sometimes the scarring traps a fertilized egg in the fallopian tube, where it begins to grow. This requires emergency treatment.
• Chronic (ongoing) pelvic pain. For more information, see the topic Chronic Female Pelvic Pain.

PID may also occur inside the belly as:

The longer treatment is delayed, the more likely you are to have permanent damage. And the more often you have repeat infections, the higher your chances of having problems.

What Increases Your Risk

You are more likely to get pelvic inflammatory disease (PID) if you:

• Are at risk for sexually transmitted infection (STI). Sexually active teens and young women have the highest rate of STIs. Having sex without using a condom increases your risk for STIs.
• Have had PID before. If you have had PID once, your reproductive tract may be less able to fight a new infection because of scar tissue from past PID.
• Have had chlamydia before. A second infection can cause more irritation and pelvic organ damage that is worse than the first time.
• Douche. Doctors advise against douching, because it can cause vaginal and pelvic infections.

Some medical procedures can increase your risk of PID by introducing bacteria into the reproductive tract. These include:

• Scraping the lining of the uterus (D&C) or taking a tissue sample (biopsy).
• Inserting an IUD. Your risk of infection can be reduced if:
  • You are tested and treated for STIs and bacterial vaginosis (if detected) before IUD insertion.
  • The insertion is done carefully to minimize the chance of infection (clean technique).
• Examining the uterus or fallopian tubes with a lighted viewing tube (hysteroscopy) or with an X-ray using dye injected into the uterus and fallopian tubes (hysterosalpingogram).
• Inducing abortion.

In some cases, PID can spread from tuberculosis bacteria that have spread to the pelvic area.

PID is rare in women who aren’t sexually active, don’t have menstrual periods, are pregnant, or have had their uterus or ovaries removed.

When should you call your doctor?

Pelvic inflammatory disease and several other conditions with similar symptoms require prompt treatment.

Call your doctor right away if you have belly pain and any of the following:

• A positive home pregnancy test
• Fever of 101°F (38.3°C) or higher
• Pain or difficulty urinating

Call your doctor soon if you:

• Have a dull pain, unusual cramping, or a feeling of pressure in the lower belly.
• Have pain during sex, especially in the belly.
• Have abnormal vaginal bleeding, bleeding between menstrual periods, or bleeding after sex or douching.
• Have a vaginal discharge that is yellow or green or smells bad.
• Need to urinate often or have pain, burning, or itching with urination for longer than 24 hours.
• Think you may have been exposed to a sexually transmitted infection, or you have a sex partner who has symptoms, such as discharge, genital sores, or pain in the genital area.

Who to see

The following health professionals can diagnose and treat pelvic inflammatory disease:

Complications are usually treated by a gynecologist.

Exams and Tests

Pelvic inflammatory disease (PID) is diagnosed by the combination of your medical history, your symptoms, a physical exam, and lab test results.

Medical history

Your doctor may ask you a number of questions, such as what your symptoms are, what method of birth control you use, and whether you or your partner engage in high-risk sexual behaviors.

Physical exam

Your exam for PID will include a pelvic exam.

You will also be tested for gonorrhea, chlamydia, and bacterial vaginosis.

Lab tests

• A

  pregnancy test
  is done to rule out the possibility of a tubal (ectopic) pregnancy.

• Blood tests are used to look for signs of inflammation or infection. Tests include:
• A blood or urine

  culture
  is used to look for infection.

Imaging tests

• Pelvic or transvaginal ultrasound
  . It can show internal organs on a computer screen to see if there are any other causes of pain.

• Laparoscopy
  . The doctor inserts a lighted viewing instrument into the belly to look for signs of infection and scar tissue.

• MRI

  or

  CT scan
  . These tests are used in rare cases if symptoms aren’t improving with treatment or an ultrasound has shown a possible growth or abscess that needs to be further evaluated.

Early detection

Yearly chlamydia testing for young, sexually active women is thought to reduce the number of cases of PID. This screening is recommended by experts.

Treatment Overview

Antibiotics are the main treatment for pelvic inflammatory disease (PID). And it’s important to treat PID right away, even if you have only one or two symptoms. This is because waiting several days to treat you could raise your risks of fallopian tube damage and infertility.^{footnote 1}

You may be given medicine even before lab results have come back, based on your medical history and a physical exam.

Most cases of PID are cured with antibiotics. But sometimes surgery is needed to drain an abscess or cut scar tissue.

Your doctor will recommend hospitalization if you are pregnant, are very ill, are vomiting, may need surgery for a tubo-ovarian abscess or ectopic pregnancy, or aren’t able to treat yourself at home.

If you have an IUD and you get PID, you may not need to have the IUD removed, depending on how severe the infection is.^{footnote 1}

Treatment for your sex partner(s)

If your PID was caused by a sexually transmitted infection (STI), anyone with whom you have had sex in the last 60 days should be checked and treated.

Having sex too soon after treatment could cause your infection to come back, so it’s important to wait. The amount of time you must wait depends on what type of treatment you have. Talk to your doctor to be sure.

Follow-up treatment

Follow-up visits to your doctor are important for making sure that treatment is working and to prevent complications, such as chronic pelvic pain and infertility.

Your doctor will want to check you 2 to 3 days after you’ve started treatment to see if you are improving or if you need a different antibiotic.

After you’ve had PID, you will need to have any further pelvic symptoms checked promptly. Your doctor will want to examine you for signs of another infection, possible pelvic organ damage (adhesions), and other possible causes of your symptoms.

Prevention

You can prevent pelvic inflammatory disease (PID) by using condoms. This helps protect you from sexually transmitted infections that cause PID. To learn more, see the topic Safer Sex.

Avoid douching, which increases your risk for vaginal and pelvic infections.

Home Treatment

Use the following home treatment measures to support your recovery.

• Rest. Rest as much as possible until your symptoms start to get better (usually a couple of days). Then return to your usual activities slowly.
• Pain medicine. Take regular doses of a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, for pain. Be safe with medicines. Read and follow all instructions on the label. If pain doesn’t improve within 48 to 72 hours, tell your doctor.

Resuming sex

It’s very important that you don’t have sexual relations until your treatment is completed. Otherwise, there is a risk that the infection will come back. Talk to your doctor about when it is safe for you to start having sex again.

Medications

Pelvic inflammatory disease (PID) is usually treated with a broad-spectrum antibiotic, which kills more than one type of bacteria.

How long you need to take antibiotics depends on your infection and the type of antibiotic used. Although you may feel better before you have taken all of your pills, don’t stop taking them. If you stop too soon, your infection may return.

Treatment usually takes 14 days. But the number of days you continue to take antibiotics depends on your infection and the type of antibiotic medicine. You may also be able to use a nonsteroidal anti-inflammatory drug (NSAID) to relieve PID pain or discomfort.

It sometimes takes more than one course of medicine to cure PID. Sometimes bacteria can become resistant to an antibiotic. This means that the antibiotic is no longer effective against the bacteria. In this case, you’ll need to try another type of antibiotic.

Medicine choices

Surgery

Surgery isn’t usually done to treat pelvic inflammatory disease (PID) unless it is needed to:

• Drain or remove a pocket of pus, such as a tubo-ovarian abscess.
• Cut scar tissue that is causing pain. This hasn’t been shown to relieve pain when the scarring is severe.^{footnote 2}

Surgery—usually laparoscopy— is sometimes used when a diagnosis is still unclear after other tests are done or when antibiotic treatment is not working.

Surgery choices

Procedures that may be used to diagnose and treat the complications of PID include:

• Laparoscopy. The surgeon inserts a lighted viewing instrument through a very small cut (incision). He or she can look for signs of ectopic pregnancy or infection and scar tissue and can make repairs if needed.
• Laparotomy. The surgeon makes a small cut to look inside the belly and make repairs if needed.
• Drainage of an abscess using a needle and syringe. The doctor usually uses ultrasound to clearly see where the needle is going. This makes an incision unnecessary.

References

Citations

1. Centers for Disease Control and Prevention (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR, 64(RR-03): 1–137. http://www.cdc.gov/std/tg2015. Accessed July 2, 2015. [Erratum in MMWR, 64(33): 924. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a9.htm?s_cid=mm6433a9_w. Accessed January 25, 2016.]
2. American College of Obstetricians and Gynecologists (2004, reaffirmed 2010). Chronic pelvic pain. ACOG Practice Bulletin No. 51. Obstetrics and Gynecology, 103(3): 589–605.

Other Works Consulted

• Wiesenfeld H, Paavonen J (2010). Pelvic inflammatory disease. In SA Morse et al., eds., Atlas of Sexually Transmitted Diseases and AIDS, 4th ed., pp. 94–110. Philadelphia: Saunders.

Credits

Current as of:
July 17, 2020

Author: Healthwise Staff
Medical Review:
Kathleen Romito MD – Family Medicine
Martin J. Gabica MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine
Kevin C. Kiley MD – Obstetrics and Gynecology

5 Signs That You May Have Pelvic Inflammatory Disease

The symptoms of pelvic inflammatory disease are relatively easy to catch once you know what to look for. Prevent serious health complications and possible infertility by consulting your gynecologist as soon as you recognize PID symptoms.

Pelvic inflammatory disease (PID) is the term used to describe an infection of your reproductive organs caused by bacterial irritation. PID is a common infection, with over one million women in the United States contracting it yearly.

If left untreated, pelvic inflammatory disease can cause serious fertility complications—it is actually the leading cause of preventable infertility in women. PID can be the result of complications from a number of sexually transmitted infections, so seek treatment as soon as you notice any of the following symptoms of pelvic inflammatory disease:

1. Lower Abdominal or Pelvic Pain

When your reproductive organs are subjected to the bacteria introduced by a sexually transmitted disease, inflammation occurs—which can cause intense pain. Some lower abdominal pain is normal during your menstrual cycle, but pain caused by pelvic inflammatory disease is much more aggressive and noticeable than regular menstrual cramping.

If you experience intense cramping or shooting pain in your lower abdomen or pelvis, consult your gynecologist immediately—especially if you are not on your period.

2. Vaginal Discharge with an Odor

Small amounts of clear vaginal discharge are normal, but if you notice an excessive amount of discharge accompanied by an unusual odor, it could be a symptom of pelvic inflammatory disease. You may not experience accompanying pelvic pain if the infection has not yet reached your uterus through your cervix.

Catching the symptoms of pelvic inflammatory disease before they reach your reproductive organs is the best way to prevent permanent infertility. If you notice an abundance of vaginal discharge and an accompanying odor, consult your gynecologist.

3. Painful Urination

Painful urination is most often a symptom of a bladder infection. If left untreated, a bladder infection can worsen and travel into your uterus or ovaries, causing pelvic inflammatory disease. If you are experiencing pain while urinating, your gynecologist will most likely test your urine for infection. Be sure to communicate with your gynecologist about your pain level. Extreme pain while urinating is a classic PID symptom, and may need to be treated with a stronger round of antibiotics than a mere bladder infection.

4. Fever Over 101 Degrees

A fever of over 101 degrees is a sign that your body is fighting an infection. If your fever lasts more than a few days, see your doctor to evaluate your symptoms. A high fever does not always indicate PID. However, if your fever is accompanied by pelvic pain or vaginal discharge, it is a strong indication that you are experiencing the symptoms of pelvic inflammatory disease.

Please note that any fever that lasts longer than two days requires immediate attention from a medical professional.

5. Pain During Intercourse

If you experience pain during intercourse—especially if it is a recent development—it can be an indication of pelvic inflammatory disease. It is also possible that you have a bladder or yeast infection, or that the area has been irritated by frequent or energetic sexual activity. Infections can result in pelvic inflammatory disease if left untreated.

If you catch pelvic inflammatory disease early, it can be treated with a simple round of antibiotics. Do not let your symptoms go unchecked or your pelvic inflammatory disease could possibly leave you sterile and cause long-term health problems. When you notice any of these common PID symptoms, schedule an appointment with your gynecologist as soon as possible.

If you are experiencing symptoms of pelvic inflammatory disease, contact The Woman’s Clinic at (501) 664-4131 to schedule a consultation with one of our experienced gynecologists.

90,000 Leg pain

Leg pain: causes of the condition

A large number of factors can cause a condition such as leg pain. Some of them are associated with injuries, some with diseases. If the leg hurts, then the patient needs a diagnostic examination, which will determine the origin of the ailment, the appointment of a suitable treatment regimen.

Sources of origin

Common causes of leg pain include a variety of sports-related injuries, traffic accidents, accidental falls, and accidents.Sports training without the participation of a trainer can lead to inflammatory processes in the periosteum due to repetitive overuse.

Pathological origin

The reasons why a leg may hurt are presented:

1. Arthritis is an inflammatory disease affecting the joints. Pathology leads to acute outbreaks of pain, impaired mobility in problem areas.
2. Varicose veins – unpleasant sensations appear at the end of the day, after a long stay in a statistical position.A leg may hurt after taking hot baths, visiting saunas, baths, steam rooms, against the background of changes in hormonal levels in women.
3. Myofascial pain syndrome – formed spasmodic areas provoke increased muscle tone and autonomic disorders.
4. Restless legs syndrome – the disease is manifested by discomfort in the lower extremities, which occurs in a state of absolute rest, more often at night. The patient is forced to make movements to get rid of discomfort.The problem is often associated with insomnia.
5. Thrombophlebitis – inflammation in the walls of venous vessels is associated with the formation of blood clots in their lumens. Symptoms of the disease include an increase in body temperature, redness of the skin, the appearance of sharp, pulling pains, a feeling of fullness in the lower extremities.
6. Infringement of nerve endings in the spinal canal itself or when leaving it – occurs under the influence of the destruction of the intervertebral discs, followed by the formation of stenosis or cartilaginous hernia.Pathologies arise against the background of injuries of the spinal column or as a result of abnormal formation of the spine with a narrowed canal.

Pain in the leg area can form with erysipelas, osteomyelitis, diabetic nephropathy, metabolic disorders, bone tuberculosis, flat feet, tumors, etc.

Physiological

Leg pain can form due to prolonged physical exertion, overwork. The onset of oxygen starvation causes the cessation of the withdrawal of lactic acid and other decay products.

Prolonged stay in a monotonous position, standing or sitting, leads to dull, stabbing and aching pain syndrome. The problem is associated with stagnation of blood in the veins of the lower extremities, lack of oxygen in muscle tissues. Muscle spasms are considered a common pathology in the elderly. They appear as a result of age-related changes and occur at night.

Physiological sources, due to which it hurts in the leg area, do not require special therapy.It is enough for the patient to reconsider his lifestyle, increase physical activity and do a light warm-up in a statistical position associated with monotonous work.

In other cases, a full diagnostic examination is required at the medical center, which will help determine the source of discomfort, select a treatment regimen. Prolonged neglect of a non-standard condition can lead to the development of complications and the transition of pain syndrome to a chronic course with frequent exacerbations.

Legs hurt. Causes, symptoms of leg pain

Why do my legs hurt and what to do if my legs hurt? The point is that pain is a symptom of unhappiness. But is leg pain really related directly to the leg, and yes and no, very often leg pains have a characteristic picture, pains appear most often in the supine position. These pains are often associated with changes in the weather, do not have a specific localization, that is, they can be in one place and after a while will move to another place.Often these pains are combined with unusual factors such as seizures. These pains prevent the patient from falling asleep, or the patient wakes up with pain in the legs. Sometimes these pains are combined with symptoms such as a feeling of crawling, tingling, numbness, or, conversely, a feeling of hot in the leg. Such pains can be located in any part of the leg, they can be in the foot, in the calf muscle, in the thigh, they can be combined with pains that bother a person in the lumbar spine, in the gluteus muscle.Here lies the root of the origin of this kind of pain. Of course, such pains, due to their very high frequency and the large number of people in whom they occur, are a very common problem, they are combined with varicose veins, with chronic venous insufficiency, with problems associated with inflammation of the joints, skin, inflammation that occurs in the form of erysipelas problems on the leg, but still such pains and their causes are quite specific.

Causes of leg pain

The fact is that such pains, even if they are combined with varicose veins, are not a sign of venous disease, not a disease of the venous system, but inflammation of the sensitive nerve fibers in the leg, and the sensitive nerve fibers themselves become inflamed due to problems associated with deformation of the lumbar spine …These pains usually form with age in people and are closely related to such problems in women as hormonal changes, the development of menopause, when the hormonal background changes, which means that the metabolism in the bone tissue also changes, this change in the metabolism in the bone tissue leads to active loss of calcium by bones. Bone tissue in its various areas becomes more fragile and easily deformed even with the seemingly usual body weight. Thus, changes in bone density, a process that starts as early as 30-40 years old and reaches its peak and speed during menopause in women or around this age in men, is often the basis of problems associated with leg pain.

How to treat leg pain?

It is impossible to effectively treat pain in the leg, neither attaching importance nor counteracting the processes of deformation of the bones of the spine. The processes of deformation of the bones of the spine, in turn, indicate a gradual change in the density of bone tissue and the entire musculoskeletal system with age in the patient, that is, these are reflections of aging of bone tissue. It is extremely important to note here that no treatment of such pains gives a lasting result, unless a special scheme is used to restore bone density, returning bone density to a younger, denser state.We have developed a special scheme that allows patients to get rid of these pains, it consists in special drugs that stimulate osteogenesis, which make the bone tissue not weaken with age, but strengthen. Such schemes have been used for six months and they give excellent results, and if a patient begins to do such prophylaxis treatment early, he does not develop a huge number of diseases that are associated with aging of the musculoskeletal system. These diseases include, first of all, osteochondrosis of various parts of the spine, deforming arthrosis of the knee joints, hip joints, shoulder joints, arthrosis of the ankle joint, these also include heel spurs.You see a huge pool of illnesses that affects an elderly person, can be ruled out and may never occur. If you pay attention to the first appearance of such pains in time, and take active measures to eliminate the causes of the development of this pain syndrome. Therefore, we recommend not to delay time if such symptoms appear, in order to find out exactly what is the cause of these pains, contact our center and we can correctly diagnose you, understand the nature of these pains, and most importantly, prescribe an effective treatment for these problems. which will not allow the development of complications and the formation of independent diseases, in the form of arthrosis, osteochondrosis.

Leg pain due to problems with the musculoskeletal system

Particularly pronounced pain occurs in patients in cases where similar problems such as osteochondrosis lead to such deformation of the vertebrae that uneven pressure on the intervertebral discs occurs and these discs squeezing out in a certain direction the jelly-like contents of the intervertebral nucleus press on the nerve roots, and a herniated disc or Schmorl’s hernia already appears. Such pains are unbearable and often lead to atrophy of the leg muscles, and all this can be avoided if, during menopause, or even a little earlier, think about the aging processes of their own musculoskeletal system, because doctors warned them about such a possibility.In addition to such pains, there are, of course, pains that are caused by local processes, but as a rule they are all associated with deformation processes of the musculoskeletal system, for example, pain in the knee joint, pain in the knee joint is local pain and it occurs due to the fact that bone tissue in the area of ​​the knee joint, it is deformed and causes destruction and damage to the cartilaginous tissue on which the higher bone stands. It is the pressure of the upper bone that leads to the fact that the cartilaginous base, on which the bone stands and which is the support of the joint, is erased, and this damage to the cartilage causes disruptions in the production of synovial fluid and forms dryness of the joint, which further leads to rapid depletion and destruction of the cartilaginous base of the joint meniscus, most often the internal meniscus, a degenerative meniscus rupture occurs, areas of the destroyed cartilage begin to float directly in the form of fragments in the joint cavity and interfere with the normal movement of flexion of the joint.Thus, a similar situation leads to the development of such phenomena as inflammatory synavitis, and such fragments are called cartilaginous mice, and this all actually requires active medical intervention. If these fragments do not appear in large numbers, then naturally the issues of arthrosis can be eliminated by conservative measures, it is possible to inject a liquid cartilaginous implant into the joint, improving the structure of its own cartilaginous tissue, but nevertheless, the basic treatment for all these problems, including arthrosis, is treatment with osteogenesis stimulants, without which it is impossible to expect a reliable effective treatment of this problem.

In addition, leg pains can be triggered naturally by some local processes, for example, inflammation of the skin in the area of ​​an ulcer, or, for example, neuropathic pain associated with damage to nerve fibers in diabetes mellitus, but this is a separate story and a separate nature of pain. Help to understand this variety of pains, a variety of problems that arise with injuries of the musculoskeletal system, with the expansion or contraction of the vessels of the lower extremities, the task is already a specialist, and you need to start with a specialist felebologist who will help determine the nature of pain and help outline a rational treatment plan …Often veins on their own, which do not cause pain, but when they expand, they can irritate the inflamed nerve fibers. Thus, the varicose veins itself turns into a problem that aggravates the pain syndrome, which is based on the deformation of the bones of the spine. Therefore, as you can see, a huge number of problems associated with the aging of the musculoskeletal system, advanced chronic venous insufficiency, with venous congestion in the subcutaneous venous system, with the formation of diabetes mellitus and the influence of sugar surges on the nerve fibers in the foot area, all this can lead to the occurrence of various pain syndrome in the legs.Therefore, such a thing as pain in the leg can be clearly and clearly described only by good specialists who have extensive experience in examining the lower extremities. We suggest that you quickly and without wasting time, when such symptoms appear, contact the center and find experienced specialists who can answer the main question, what is the cause of pain in this leg, then the first step to treatment will be made, in the future you can outline a clear a treatment regimen that will definitely give a result. Depending on the speed of your circulation, the result can either be achieved after one course of treatment, or it will require multiple, restorative courses that will last for several months, or even years.Therefore, do not waste time, because you have no other option except for the correct treatment for the normal preservation of the quality of life, come to the center and conduct the necessary examinations.

Previous article

Causes of varicose veins. Hereditary?

Current item

Cause of leg pain

Next article

Symptoms of hemorrhoids

90,000 Foot pain – causes of occurrence, under what diseases it occurs, diagnosis and treatment methods

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication.In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For a diagnosis and correct treatment, you should contact your doctor.

Pain in the foot: causes of occurrence, in what diseases it occurs, diagnostics and methods of treatment.

Definition

The foot consists of 26 bones, which, when connected to each other, form several joints, held together by numerous elastic muscles and strong ligaments.The entire weight of the human body rests on it, so pain in the foot causes not only discomfort, but in many cases limits motor activity.

Foot pain is a common symptom that can be caused by a variety of reasons.

In some cases, when collecting an anamnesis, the doctor suffices such characteristics of foot pain as its location and conditions of occurrence, as well as the presence of concomitant diseases and other symptoms that accompany this pain (numbness of the foot, itching of the skin, etc.). In others, the search for the cause of pain requires a thorough laboratory and instrumental examination.

Varieties of pain in the foot

Distinguish by duration:

1. Acute pain in the foot – this phenomenon is most often associated with injuries – bone fractures, rupture or sprain of ligaments, severe bruising.
2. Chronic pain that bothers the patient for a long time, in some cases, in the absence of proper treatment, a person develops a forced type of gait, which is associated with attempts to maintain the function of movement, while sparing the affected limb.The reasons for this condition can be both diseases of the foot itself, and pathologies of various body systems.

Distinguish by localization:

1. Diffuse pain – captures the entire foot.
2. Local pain – clearly limited to a specific area.

Possible causes of foot pain

One of the main causes of pain is Traumatic injuries of the foot (bruises, sprains, bone fractures).With fractures, the pain is sharp, there is a rapid increase in edema. In many cases, the support function of the foot is lost. Bruises and sprains are characterized by moderate pain, swelling, and bruising. The support is preserved, sometimes limited.

The next reason is inflammatory processes affecting the joints of the foot. These include gout, chondrocalcinosis (pseudogout), and rheumatoid arthritis.

Gout is a disease that occurs as a result of a metabolic disorder of uric acid.The deposition of uric acid salts in the joints is called gouty arthritis. In this disease, the first metatarsophalangeal joint is most often affected, which is manifested by a severe attack of pain, redness of this joint, edema, and fever. Usually, an exacerbation of gouty arthritis lasts 6-7 days.

Rheumatoid arthritis is a systemic disease in which, among other things, the joints of the feet and hands are affected. Morning stiffness and pain in the hands and feet are characteristic.

Pain in the foot can be a symptom of pathology of bone structures . In this case, we can talk about such diseases as osteomyelitis, osteoporosis, bursitis of the metatarsal head, etc.

Osteomyelitis can result from open fractures, infected wounds, or foot surgery. It is manifested by an increase in pain, a deterioration in the general condition. The pain is pulsating, bursting, aggravated by any movement.

In osteoporosis, due to a decrease in bone density, its strength is impaired.This condition is facilitated by hormonal changes in women during menopause and during pregnancy, some endocrine diseases, insufficient intake of calcium and phosphorus from the outside, as well as excessive loads on the musculoskeletal system.

Pain in the feet with this disease is permanent, increases with movement.

Bursitis of the heads of the metatarsal bones is a change in the articular capsules of the joints of the foot associated with their increased trauma due to age-related thinning of the fatty layers that protect them.It is manifested by the appearance of painful “bumps” in the projection of the joints of the feet.

To diseases of the ligamentous apparatus feet with pain syndrome include, for example, plantar fasciitis. The calcaneal fascia is a plate of connective tissue that starts from the heel bone and ends at the attachment to the metatarsal heads. With increased loads, overweight, flat feet, the fascia is stretched and injured, which causes the development of inflammation in it. This condition is called plantar fasciitis and is manifested by pain in the instep and on the sides of the foot.

A distinctive feature of this disease is also that the pain occurs in the morning, after a night’s rest, increases with exertion, and in some situations can lead to lameness.

A condition when the fascia ossifies at the site of its attachment to the heel bone and severe pain in the heel occurs when walking is called a heel spur.

The cause of pain in the feet can be diabetes mellitus – a disease in which the vessels of the microvasculature also suffer due to impaired glucose metabolism.Diabetic osteoarthropathy (a type of diabetic foot) predominantly affects the metatarsoparasitic joints. Pain in the feet is initially not intense, but as the pathological process develops, it becomes prolonged, appears even at rest, and a gross deformity of the feet is formed.

With the neuropathic form of a diabetic foot, zones with hyperkeratosis are formed, painful ulcers and cracks form in their place.

The ischemic form of the diabetic foot is characterized by pain when walking, persistent swelling of the feet, and weakening of the pulsation of the arteries.

Diabetic foot with the development of gangrene, along with obliterating atherosclerosis and endarteritis, is one of the most serious complications in diabetes mellitus.

Flat feet is characterized by a change in the shape of the arch of the foot, which leads both to a redistribution of the load on the bones and muscles of the foot, and to the compression of the vessels and nerves passing through that part of the sole, which normally does not participate in the act of walking. The reasons for the development of flat feet include rickets transferred in childhood, wearing improperly selected uncomfortable shoes, weightlifting, congenital weakness of connective tissue, congenital difference in the length of the legs, etc.

Inflammatory processes in the soft tissues of the foot also cause pain. If an infection gets into small wounds during a pedicure or trauma to the skin of the toes, panaritium (purulent inflammation of the periungual tissues) may develop.

Panaritium is characterized by shooting pain in the affected finger, disturbing sleep, discharge of pus from the wound, redness and swelling of the finger.

An ingrown nail (onychocryptosis) is an ingrowth of the nail plate into the lateral edge of the nail fold.This condition is manifested by twitching pain in the affected finger, edema; a complication in the form of infection is possible.

Which doctor should i contact for pain in the foot

Pain in the foot brings significant discomfort and often makes it difficult to move, so you should decide in advance which doctor to contact in order to avoid long standing in lines and unnecessary trips to the clinic. As a rule, an orthopedist deals with the diagnosis, treatment and rehabilitation of people with deforming or traumatic damage to bones, joints, muscles, ligaments of the musculoskeletal system.However, patients with diabetes should first of all make an appointment with
endocrinologist, and with vascular problems – to a phlebologist. Rheumatologists treat diseases associated with chronic lesions of the connective tissue. Traumatologist consults patients with foot injuries. If symptoms appear that resemble the clinic of an ingrown nail, osteomyelitis or panaritium, it is necessary to consult a surgeon.

In most cases, care can be provided on an outpatient basis, but sometimes hospitalization is required.

Diagnostics and examinations for foot pain

The diagnosis of “Osteoporosis” is made on the basis of bone x-rays and blood tests for calcium, phosphorus and other necessary parameters. 90,000 CAUSES OF PAIN IN THE FOOT AND FOOT JOINT

Inflammation of the Achilles tendon (tendonitis) may occur:

• when overloading the legs, if you walk or run an unusually long distance;
• doing this in low-quality or worn-out sports shoes;
• if a person begins intense physical activity without warming up the muscles of the legs.

However, there may be more obscure causes of Achilles tendon inflammation. Often the cause of the problem is not in the tendon, but, for example, in the way of life – if a person smokes, drinks heavily, or is overweight. Inflammation of the Achilles tendon can also be the result of improper posture or differences in the anatomy of the foot, leg, or knee, resulting in an uneven distribution of stress on the legs.

Inflammation of the Achilles tendon is indicated by:

• pain and stiffness, which are more pronounced in the morning and the next day after physical activity;
• lump in the tendon;
• edema that worsens during the day with stress on the leg.

If the symptoms of inflammation persist within two to three days, you should consult an orthopedic traumatologist.
Inflammation of the Achilles tendon is treated with non-steroidal anti-inflammatory drugs, various injections and physiotherapy. In some cases, tendonitis is treated with surgery.

If acute tendonitis is left untreated, the inflammation can become chronic. If left untreated, Achilles tendon inflammation recurs, which increases the chance of rupture of the tendon.The longer chronic inflammation of the Achilles tendon lasts, the more difficult it is to treat.

Achilles tendon rupture can cause the same causes that cause inflammation. The moment of rupture of the tendon is characterized by a sound and sensation, as if a wide stretched elastic band had burst. After the rupture of the Achilles tendon, it is impossible to stand on tiptoes, swelling quickly forms and intensifies, and severe pain appears. However, while these symptoms are very common, they can indicate other injuries, such as muscle rupture.

The experience of the doctors of the ORTO clinic shows that the most effective and reliable solution in case of rupture of the Achilles tendon is its suturing. The longer this process is delayed, the greater the distance between the ends of the ruptured tendon becomes. To connect them, it may be necessary to lengthen the tendon. After a timely operation – within the first five days after the rupture – a scar of ~ 5 cm. When the ends of the tendon are removed, a larger incision should be made and tendon plastic surgery is required.

Ankle fracture. The ankle can break if it is twisted badly, or if it falls or is bruised. A fracture of the ankle is indicated by immediate acute pain, swelling, hemorrhage, pain intensifies when a person puts his foot down and tries to walk, the foot may be at an unusual angle, since a dislocation was formed as a result of an injury. Considering that the symptoms caused by damage to the ligaments (dislocation) may not differ from the signs indicating a bone fracture, it is necessary to consult an orthopedic traumatologist.

Depending on the specifics of the fracture, it can be treated with plaster cast fixation. If the fracture is complex and soft tissue is damaged, surgical treatment may be required.

Dislocation of the ankle. When a person unsuccessfully places his foot, the ligaments of the foot are unevenly loaded. Depending on the strength with which we perform the wrong movement, some of the ligaments are torn. In everyday life, this injury is called dislocation, and in medicine – damage to the ligaments of the foot. The first symptom of dislocation is pain that appears at the time of injury.Pain may be accompanied by swelling and hemorrhage. After mild dislocations of the ankle, you can walk, and after more serious dislocations, it is difficult to put your foot on the ground due to severe pain. If pain is severe and does not improve within 48 hours of injury, see an orthopedic trauma surgeon.

First aid after dislocation: limit movement by fixing the foot with an elastic bandage. Within two days, ice compresses should be used, wrapping pieces of ice and applying them to the swollen area for 10-15 minutes.This procedure must be repeated every 3-4 hours. After 48 hours have passed since the injury, instead of cold procedures, you need to do warming procedures and compresses. This improves blood flow and reduces inflammation.

It is advisable not to load the foot, if necessary, take painkillers. After serious sprains (tears of several ligaments), the consequences of which are felt for several months, after consulting an orthopedic traumatologist, you need to start a course of physiotherapy to train the muscles of the foot and restore the elasticity of the ligaments.At home, you need to do circular movements of the feet, as well as stretching and relaxation exercises.

Pain in the heel – plantar fasciitis causes tears and inflammation of the fibrous tissue of the connective tissue of the heel, caused by an overload of the connective tissue of the foot. The inflammation results in pain in the heel area. This problem more often affects overweight women, as well as people who spend most of the day standing. Heel pain can also appear in athletes – with a load on the leg while running or walking for a long time.

Plantar fasciitis usually develops gradually. Pain is characteristic in the morning, when the foot is again subjected to stress after sleep. Pain also occurs when moving after sitting for a long time.
If plantar fasciitis is left untreated, it can become chronic. A person with persistent pain usually develops an irregular gait, resulting in knee, hip, and back problems.

For the treatment of plantar fasciitis, orthopedic traumatologists usually prescribe non-steroidal anti-inflammatory drugs and physiotherapy.The goal of physiotherapy is to teach the patient specific exercises to stretch the ligaments of the foot. Heel pain can be reduced by injecting steroids. During treatment, it is recommended to wear comfortable shoes and use special orthopedic liners that relieve stress on the connective tissue of the foot. In about 90% of cases, with this treatment of inflammation, the pain goes away within two months. In some chronic cases, it is recommended to undergo surgery.

Heel pain can also be caused by compression of the nerves in the back, ankle or foot, a fractured heel bone, or chronic conditions such as osteoarthritis.Therefore, it is important to find out the real cause of heel pain.

Calcaneal spurs is a thickening of the calcaneus (increased mass) in its lower part. Usually, these growths are painless, but in some cases they can cause pain, especially when walking, jumping or running. Heel spurs form when the ligaments, muscles and fibers of the foot are overloaded, for example, if you run or jump a lot.

The disease is characterized by pain in the morning, when the person again loads the leg after sleep.Pain also occurs when moving after sitting for a long time.

Orthopedic traumatologists usually prescribe non-steroidal anti-inflammatory drugs and physiotherapy to treat heel spurs. The goal of physiotherapy is to teach the patient specific exercises to stretch the ligaments of the foot. Heel pain can be reduced by injecting steroids. During treatment, it is recommended to wear comfortable shoes and use special orthopedic liners that relieve the load on the connective tissue of the heel.

If effective treatment results have not been achieved within 9-12 months, surgery is recommended.

Osteoarthritis of the foot joint is a degenerative disease of the hip joint that is associated with general aging of the body and usually occurs in people over 50 years of age. Osteoarthritis can be caused by a previous fracture of the joint of the foot or other injury. As the articular cartilage wears down, its ability to effectively protect the bones of the joints from direct contact with each other decreases.The result is pain and inflammation. Signs that may indicate osteoarthritis: swelling, stiffness, pain. Gradually, deformity of the foot joint joins these symptoms, joint mobility decreases and difficulties arise when walking.

The intensity of symptoms may vary, sometimes there is a feeling of complete recovery, and at times – very pronounced disorders.

Osteoarthritis does not go away, but you can limit the development of this disease and maximize your quality of life.To do this, you need to take care of your weight, under the supervision of a physiotherapist, study and regularly do a set of exercises to strengthen the ligaments and muscles of the ankle, protect the foot joint from heavy load, and also take anti-inflammatory and analgesic drugs after consulting a doctor. Osteoarthritis is also treated surgically – options include arthroscopic surgery (to remove parts of the joint’s cartilage, inflamed tissue and spurs (osteophytes)), as well as endoprosthetics of the foot joint.

Hallux rigidus is a consequence of osteoarthritis. A stiff toe causes pain in the joint of the big toe. The pain is worse when walking. There is stiffness in the joint of the finger and restriction of movement. This disease develops more often in people with deformed anatomy of the foot, as well as after foot injuries.

Osteoarthritis does not go away, but you can limit the development of this disease and maximize your quality of life.
To reduce the disturbance caused by a stiff finger, doctors usually prescribe nonsteroidal anti-inflammatory drugs and pain relievers, and also suggest injecting steroids into the painful joint of the finger.During treatment, it is recommended to wear comfortable shoes and use special orthopedic liners that relieve stress on the thumb joint.

Stiff toes are also treated surgically – options include cleaning the joint, replacing the thumb joint, or closing the joint.

Morton’s neuroma is caused by improper loading of the foot, for example, prolonged wearing of shoes with a narrow toe. Symptoms of Morton’s neuroma: sharp, sudden pain in the balls of the feet near the 3rd and 4th or 4th and 5th toes.Symptoms are caused by a thickening of a nerve around the 3rd and 4th or 4th and 5th toes at the bottom of the foot. With an increase in the volume of the nerve, adjacent tissues begin to press on it. As a result, pain and inflammation can occur.

To reduce the disorders caused by Morton’s neuroma, doctors usually prescribe nonsteroidal anti-inflammatory drugs and pain relievers, and also suggest injecting steroids to quickly relieve pain. During treatment, it is recommended to wear comfortable shoes and use special orthopedic liners that relieve stress on the ball of the foot.

Morton’s neuroma is also treated surgically by removing the thickened nerve. In some cases, the neuroma can be successfully treated with radio frequency (by burning the thickened nerve with a special instrument).

Halux valgus or deformity of the first metatarsal bone – The inner bone of the foot (first metatarsal bone) extends outward. It is commonly referred to as bone growth and people often think of this process as bone enlargement. The bone doesn’t actually grow. But instead of being vertical to the big toe, the bone begins to move outward.The more this progression of the bone progresses, the more the relationship with the adjacent bones changes, as a result of which the second toe may not be next to, but above the big toe.

Halux valgus provokes the regular wearing of high-heeled shoes, as well as the natural aging process of a person. When choosing such shoes, the foot is not evenly loaded, and the toes have to withstand the increased load. This disease also often develops simultaneously with flat feet.The outward extension of the inner bone of the foot can also be caused by endocrine diseases, osteoporosis, or a genetic predisposition.

Bone deformity is slow, and comfortable, appropriate footwear should be chosen and worn in this condition. Bone inflammation is treated with non-steroidal anti-inflammatory drugs. If the deformity becomes so severe that it is difficult to wear shoes, and the bone is regularly inflamed and sore, surgery is the solution.

Flat feet can appear and progress in both children and adults.The main task of the instep of the foot (longitudinal arch of the foot) is to provide body balance and shock absorption when walking. The less the lift, the more load our locomotor apparatus has to withstand – legs, joints, spine. The consequence of pronounced flat feet can be pain in the legs, knees, hips, sacrum and back.

Signs of flat feet: an increase in the size of the foot, both in width and in length, shoe trampling along the entire inner edge, pain and fatigue in the feet after a long walk or physical exertion.

If during the consultation, the orthopedic traumatologist did not find a serious deformation, and the person does not have complaints of frequent, uncomfortable pain, the condition of the foot can be improved by choosing comfortable and high-quality shoes, studied under the guidance of a physiotherapist and regularly performing special exercises, the purpose of which – to strengthen the ligaments and muscles of the foot.

Flat feet can be treated surgically by implanting a special screw between the bones of the foot, which will further ensure the correct bending of the arch of the foot.The main indication for foot bone surgery is pain and gait disturbances, not aesthetic considerations.

Ingrown toenails on the feet are a common problem when the edges of the nails grow into soft tissue. This causes pain, redness, swelling, and inflammation. This problem most commonly affects the toenail. It is recommended to consult an orthopedic traumatologist if this problem persists and causes inconvenience. Shoes with narrow toes contribute to ingrowth of toenails, the habit of trimming the nails too short, cutting out the corners, and nail injury.

Inflammation that occurs when toenails grow into soft tissue can cause inflammation of the thumb bone and lead to a serious bone infection.

To reduce the discomfort caused by an ingrown toenail, the doctor may free up part of the ingrown toenail by placing a small splint between the nail and the skin. A nail fixed in this way can change the direction of growth and stop growing into soft tissues. To solve the ingrown toenail problem, sometimes partial or complete surgical removal of the toenail is required.

90,000 Pain in the legs. Diagnostics and treatment in Izhevsk. Experienced doctors. Alan Clinic

There is a common phrase that the beginning of old age is not wrinkles on the face, but pain in the legs. And according to Eastern philosophy, a person needs to take care of his feet in the same way as the roots of a tree.

Why are people in the 21st century so frivolous about their feet? For ancient physicians, foot diseases were a major concern. And compresses, massage were used … Now, of course, everything has changed, however, massage has remained indispensable as before.The patient is only required to see a doctor in time. Procrastination is dangerous, you cannot sit and wait until your legs begin to fail.

Leg pain occurs for a variety of reasons. Problems in the spine, joints, diseases of the vessels of the legs, or muscles – this is what responds with pain in the legs.

The main group of diseases that cause pain in the legs are diseases of the spine. Pain appears, which “gives off” to the leg. At the same time, in the spine itself, a person may not feel pain.

Often, leg pain is caused by joint problems. Moreover, exacerbation can be with a change in the weather. If the disease is neglected, the pain becomes truly excruciating.

Only a doctor can establish the cause of pain, make an accurate diagnosis and choose an effective treatment.

Important Information:
Dear Patients! If you are diagnosed with rheumatoid arthritis , you need to see a rheumatologist.With a rheumatological profile, in addition to joints, internal organs (heart, kidneys, etc.) may also suffer, so rheumatoid arthritis should be treated by a rheumatologist. The treatment of allergic, gouty and infectious arthritis is carried out by specialists of the appropriate profile (allergists, rheumatologists and cardio-rheumatologists).

Orthopedic doctors are successfully treating all other types of arthritis in children and adults (caused by sports and household injuries, overweight, age-related changes in the joints).

Leg pain and problems

Anatomy of the foot

The foot is one of the most difficult parts of the body. It consists of 26 bones connected by many joints, muscles, tendons, and ligaments. The leg is subject to many stresses. Foot problems can cause pain, inflammation, or injury. These problems can lead to restrictions on movement and mobility.

What are the different types of foot problems?

Pain in the legs is often caused by malfunctioning of the foot.Poorly fitting shoes can worsen the condition and, in some cases, cause foot problems. Shoes that fit well and provide good support can prevent irritation of the joints of the foot and skin. There are many types of foot problems that affect the heels, toes, nerves, tendons, ligaments, and joints of the foot.
Symptoms of foot problems may look like other diseases and problems. Always see your doctor for a diagnosis.

What are heel spurs?

A heel spur is the growth of a bone on the heel bone.It is usually located on the underside of the calcaneus, where it attaches to the plantar fascia, a long strip of connective tissue that runs from the heel to the ball of the foot. This connective tissue holds the arch together and acts as a shock absorber during activity. If the plantar fascia is overwhelmed by running, wearing poorly fitted shoes, or being overweight, pain can result from stress and inflammation of the tissue that pulls the bone. Over time, the body builds additional bone in response to this stress, resulting in heel spurs.Treatment options may include:

• Cold packs
• Anti-inflammatories such as ibuprofen
• Correct stretching and massage before activity
• Correct shoes, insoles and shoe inserts
• Corticosteroid injections
• Surgery (for more severe, long-term conditions)
• Remaining

What are calluses?

Calluses – yellowish – skin growths that usually develop on the tops of the toes. Calluses develop due to abuse or stress.Often, a callus develops where a toe rubs a shoe or another toe. Calluses can cause severe discomfort and pain. Treatment may include:
• Trimming off dead skin
• Cushioning around the corn area
• Wearing oversized shoes
• Surgery
To avoid the development of calluses, always buy shoes that fit and are comfortable for you.

What is a bone?

Bursitis is a protrusion of bone or tissue around a joint.Bones can occur at the base of the big toe and often occur when a joint is under tension for a period of time. Women get boned more often than men because they have worn or are wearing tight, pointed, and restrictive high-heeled shoes.

Bone treatment may vary depending on pain and deformity. Treatment may include:
• Wearing comfortable, well-fitting shoes (especially shoes that fit the shape of the foot and do not create pressure zones)
• Surgery (for pain, not for cosmetic purposes)
• Using pads in the affected area
• Medications such as ibuprofen
A fused tubercle, also known as hallux valgus, develops on the joint of the thumb when the bones of the thumb are displaced.It looks like a big bump on a toe. The thumb is at an angle to the second toe and, in severe cases, may overlap or pull under the second toe. Underwire is more common in women than in men due to high-heeled shoes.

What is Morton’s neuritis?

Morton’s neuroma is an accumulation of benign (noncancerous) tissue in the nerves that run between the long bones of the foot. Morton neuroma occurs when two bones rub and compress the nerve between them.Most often, neuromas develop between the bones, leading to the third and fourth fingers. Morton’s neuroma often causes swelling, discomfort, and pain. If the pain becomes severe, it can cause tingling, numbness, and burning in the toes. This usually happens after standing or walking for a long time. Treatment for this condition may include resting or changing shoes that do not restrict the foot. If the problem persists, cortisone injections or surgery may be considered.
This condition is a thickening of the nerve sheath that surrounds the nerve in the ball of the foot. It most often develops between the third and fourth toes. This sometimes occurs between the second and third toes.

What are hammers?

Hammer is a condition in which a toe bends, causing the middle joint of the affected toe to protrude. Skin-tight boots that put pressure on the shins often make this condition worse.Callus often develops in this place. Hammer treatments may include:
• Applying a toe pad specifically positioned over the bony prominence
• Changing shoes to accommodate the deformed toe
• Surgical removal
This condition is a deformity in which the toe bends downward at the middle joint. The second toe is most likely affected, but the deformity can occur in other fingers as well. Sometimes more than one toe is affected.

What is ankle sprain?

Ankle sprain is damage to the ligaments of the foot in the ankle joint.Ligaments are tough bands of elastic tissue that connect bones to each other. Ankle sprains can occur if the ankle rolls, twists, or twists outside of its normal range of motion. Ankle sprains can be caused by uncomfortable feet, uneven surfaces, weak muscles, loose ligaments, or spiked heels. Symptoms of a sprain will depend on how much the ligaments are stretched or torn, but usually include swelling, pain, or bruising.Treatment will depend on the severity of the sprain, but may include:
• Resting the ankle
• Wrapping the ankle with an elastic band or tape
• Using an ice pack (to reduce inflammation)
• Raising the ankle
• Non-steroidal anti-inflammatory drugs such as ibuprofen to help reduce pain and inflammation
• Gradually return to walking and exercise
• Walking (for moderate sprains)
• Surgery (for severe dislocations)
• Physiotherapy
Ligaments are fibrous, elastic bands of tissue that connect and stabilize bones …Ankle sprains are a common painful injury that occurs when one or more of the ankle ligaments are stretched beyond their normal range of motion. Sprains can result from sudden twists, turns, or movements.

What is a foot fracture?

We have 26 bones in the foot, and almost any of them can be broken. Many fractures do not require surgery or even casting as they heal on their own with some support.When a leg is broken, the site of the fracture is usually painful and swollen. The site of the fracture will determine the course of treatment, if necessary, including:
• Ankle fractures. These fractures can be serious and require immediate medical attention. Ankle fractures usually require a cast, and some may require surgery if the bones are too separated or misaligned.
• Metatarsal fractures. Fractures of the midfoot metatarsal bone often do not require a plaster cast.Stiff-soled shoes can be all you need to support the healing of your foot. Surgery is sometimes required to correct misaligned bones or segment fractures.
• Sesamoid bone fractures. The sesamoid bones are 2 small, round bones at the end of the metatarsal bone of the thumb. Usually, soft soles can help relieve pain. However, sometimes the sesamoid bone can be surgically removed.
• Fractures of toes. Toe fractures usually heal with or without a cast.

What is leg pain?

Leg pain can impair an active lifestyle. Leg pain can have many sources, from fractures and sprains to nerve damage. The following are 3 common areas of leg pain and their causes:

• Pain in the ball of the foot . Pain in the ball of the foot, located on the bottom of the foot behind the toes, can be caused by damage to the nerves or joints in that area. In addition, benign (non-cancerous) growths such as Morton’s neuroma can cause pain.

Injecting corticosteroids and wearing support pads or orthopedic shoes can help relieve pain. Sometimes surgery is required.

• Plantar fasciitis . Plantar fasciitis is characterized by severe pain in the heel of the foot, especially when standing after rest. This condition is associated with excessive damage to the sole of the foot and leads to inflammation of the fascia, the tough fibrous tissue that connects the heel bone to the base of the toes.

Plantar fasciitis is more common in women, overweight people, people with occupations who need to walk or stand a lot on hard surfaces, people with flat feet, and people with high arches.

Walking or running, especially with tight calf muscles, can also cause illness.

Treatment may include:
• Rest
• Ice packs
• Nonsteroidal anti-inflammatory drugs
• Stretching of the Achilles tendon and plantar fascia
Plantar fasciitis is an irritation of the plantar fascia. This thick strip of connective tissue runs through the bottom of the foot between the toes and heel.Supports the natural arch of the foot. It stretches and becomes taut whenever the leg is carrying weight.
• Injury of the Achilles tendon . The Achilles tendon is the largest tendon in the human body. It connects the calf muscle to the heel bone. However, this tendon is also the most common site for rupture or tendinitis, an inflammation of the tendon due to overuse.
Achilles tendonitis is caused by overuse of the tendon and calf muscles.Symptoms may include mild pain after exercise that gradually gets worse, stiffness that disappears as the tendon warms up, and swelling. Treatment may include
• Remaining
• Non-steroidal anti-inflammatory drugs
• Supportive devices and / or bandages for muscles and tendons
• Stretching
• Massage
• Ultrasound
• Reinforcement exercises
• Surgery

Diabetes and vascular disease

Diabetes affects nerves and blood vessels and blood flow throughout the body, including the legs and feet.People with diabetes should have their feet checked regularly to identify wounds or wounds on their feet before complications arise. In addition, they will need to see a podiatrist to help manage their diabetic foot problems.

Source: https://www.hopkinsmedicine.org/healthlibrary/conditions/orthopaedic_disorders/foot_pain_and_problems_85,P00914

causes, symptoms, diagnosis and treatment

Coming home in the evening, people often experience heaviness and pain in their legs.This may be due to fatigue, standing for a long time. Such symptoms after physical exertion disappear, as a rule, in the morning. But there are times when pain is repeated very often and does not disappear after a long rest. This indicates that the body has serious disorders of internal organs and systems. And in order to avoid serious consequences, you need to undergo an examination and identify the cause of the disease.

Reasons

Pain in the legs when lying down can occur for many reasons:

Send request

Diseases of the legs for the above reasons are increasing every year.This is due to the fact that in the modern world people lead the wrong way of life: they eat fatty high-calorie foods, smoke a lot, consume alcohol, and exercise little. In addition, the ecological situation is deteriorating. All this in general provokes the development of various pathologies.

Vascular diseases are the most common cause of pain and heaviness in the legs. Depending on what kind of violation occurred, the following types of insufficiency are distinguished:

• chronic. When damage to superficial veins occurs.
• valve. Injury of the vessels connecting the superficial and deep veins.
• sharp. Disturbance of the deep veins.

Diagnostic Methods

The most effective and affordable research method that provides information in 3d volume. MRI scans are a visual illustration of what is happening at the moment with the patient’s spine, joints or other structures.

A method for quickly assessing the state of internal structures by obtaining an image using X-ray radiation that has passed through an object. Fast, inexpensive, informative.

Examination of the body using ultrasonic waves. Ability to evaluate organs in motion. Passing through structures of various densities, ultrasound is reflected from them – this gives a picture of the state at the time of the study.

This is a blood test. Show me your tests and the doctor will tell you who you are.This is the fastest and most accurate way to find out everything about the biochemical processes in the patient’s body. Inexpensive, fast, effective.

Electrocardiography is a study of the electrical activity of the heart. For measurement, special electrodes are applied, the cardiograph records changes in the work of the heart and displays them in the form of a cardiogram.

Symptoms

Pain in the legs in the supine position associated with vascular diseases are accompanied by symptoms such as a feeling of heaviness and distention in the legs, increased sensitivity, the formation of spider veins under the skin, general fatigue.

Depending on the disease, its characteristic symptoms appear.

With vascular atherosclerosis difficulty in movement appears, lameness occurs. The skin on the legs turns pale, there is a tingling sensation and numbness. Sweating increases.

With varicose veins , the pain is dull aching in nature, but it is acute and throbbing. It is more often manifested in the ankle and lower leg.

With thrombophlebitis , a person also experiences acute pain and burning, which intensify precisely in the supine position.

Diagnostics and treatment

Reasons for urgent need to see a doctor:

• pain in the legs does not disappear for a long time and pain medications do not work on them
• painful sensations are accompanied by numbness, loss of sensitivity, swelling
• the skin on the legs became bumpy and changed color
• pain occurs in other parts of the body

To diagnose and determine the severity of vascular lesions, you must visit a phlebologist or vascular surgeon who can prescribe the following studies: vascular ultrasound, vascular X-ray, CT and MRI.The following conservative methods are used for treatment: taking medications (pain relievers and anti-inflammatory drugs, drugs that improve blood circulation, vitamin complexes), physiotherapy exercises, massage, physiotherapy. In the presence of serious damage to the vessels, surgical methods of treatment are used: atroscopy, sclerotherapy, laser coagulation, cryoflebextraction.

Our patients

Meet our patients

Age 64 years Diagnosis Arthrosis of the 2nd stage. Treatment result Patient satisfied

Sergei Igorevich “I was treated in a polyclinic … did not give much effect! After the first procedure of plasmacythophoresis, I feel filling in the joint, mobility has improved! ”

Age 70 years Diagnosis Osteoarthritis Treatment result Patient satisfied

Galina Fedorovna “During the procedure of plasmacythophoresis, I felt a slight bursting, and then everything became fine! The clinic helped me! ”

Age 70 years Diagnosis Osteochondrosis Treatment result The patient is satisfied

Lyudmila Emelyanovna “At our age, the main thing is to maintain clarity of mind and the ability to move.I have already advised the clinic to my friends! ”

Age 72 years Diagnosis Osteochondrosis, arthrosis Treatment result Patient satisfied

Boris Khazievich “I had pain in the lower back and in the hip joint. After the treatment, I began to fall asleep without pain, I sleep normally! ”

Age 77 years Diagnosis Osteoarthritis Treatment result Pains gone

Tamara Grigorievna “I had a very painful kneecap, I could not walk.Now my joint is being restored and I can walk without pain! Already after the 2nd procedure, there was an improvement. ”

Age 60 years Diagnosis Osteoporosis, arthrosis Treatment result Pain passed

Hans Harvig “I am from Holland, I could not walk and stand without crutches, neither in Germany nor in Holland they could help me. They helped here. Now there is no pain, I am satisfied. ”

Age 66 years Diagnosis Osteoarthritis Treatment result Patient satisfied

Vladimir Mikhailovich “There was a high pain sensitivity in the knee joints when standing up and squatting.The clinic did not help me properly. And here everything is on time, calmly and without nerves! ”

Age 65 years Diagnosis Arthritis Treatment outcome Fully satisfied

Elena Antonovna “There was very severe pain in my knee, I could not even walk. And after the first procedure, it helped me a lot. I wanted to run right away, but the doctor did not allow me to run. ”

Age 71 years Diagnosis Trophic ulcer Treatment result Autodermoplasty performed

Lyudmila Viktorovna Lyudmila Viktorovna got rid of an ulcer in a month! And after autodermoplasty there was no trace of an ulcer! Now she has a healthy leg, the ulcer has healed!

Age 64 years Diagnosis 3rd degree arthrosis Treatment result Pain has passed

Valentina Alekseevna After the first injection of a liquid prosthesis into the joint capsule, the knee began to unbend, the amplitude of joint movement increased, and the patient’s quality of life improved.

Our medical center MEDICUS uses the most effective methods for the diagnosis and treatment of vascular diseases. And you can get an appointment with a doctor via the Internet by filling out an online form or by calling 986-66-36.

We know how to make our patients’ lives better

• We have ALL Your DISCOUNT CARDS *.
• Refund of personal income tax for medical services – minus 13% of the cost of the procedure.
• FREE installment plan for treatment.
• THOUSAND PATIENTS got rid of disabilities and crutches thanks to our help.
• Discounts for pensioners (55+ everything is fair!), Disabled people, blockade soldiers, participants of the Great Patriotic War.
• The newest TECHNOLOGIES , which are not available in polyclinics. DISCOUNTS up to 30%!

* You can use discount cards of all medical centers of St.