Syndrome of chronic pelvic pain at women
Syndrome of chronic pelvic pain at women — the pathological state which is lasting more than 6 months and shown constant pain in the bottom of a stomach which subjective feeling does not correspond to extent of organic violations. Depressive and behavioural frustration are observed. For diagnostics use fizikalny methods, ultrasonography of bodies of a basin, a X-ray analysis, endoscopic and laboratory techniques, a laparoscopy. The scheme of treatment assumes therapy of the main disease, purpose of medicines which normalize work of the peripheral and central parts of the nervous system which are responsible for perception of pain.
Syndrome of chronic pelvic pain at women
The pain syndrome is characteristic of many gynecologic and not gynecologic diseases diagnosed for women. According to researches in the sphere of gynecology, more than 60% of the patients who asked for the specialized help complain of pelvic pain. About 14% of diagnostic hysteroscopies and 40% of laparoscopies are appointed to patients with pains in the bottom of a stomach. At the same time the syndrome of chronic pelvic pain (SCPP) is established not in all cases, and only with certain diagnostic criteria. The disease is usually revealed at women of reproductive and climacteric age with a certain warehouse of character — inclined to morbid depression, uneasiness, rough emotional reaction. According to gynecologists, from this frustration about 5-15% of patients at the age of 18-50 years suffer.
SHTB reasons at women
Pain in the field of a basin usually arises against the background of real-life pathologies of pelvic bodies, first of all — reproductive. There are gynecologic and not gynecologic reasons of chronic pelvic pain at women. 75-77% of patients have a morphological basis following diseases of a female genital:
- Inflammatory pathologies. Chronic endometritises, salpingita, adneksita, ooforita are followed by a periodic and constant pain syndrome.
- Adhesive processes. Pain in a basin — one of characteristic signs of a plastic pelvioperitonit and solderings of uterine tubes.
- Volume new growths. Pain arises at a saktosalpinksa, an ovary cyst, submukozny myoma, cancer of an ovary or body of a uterus, other good-quality and malignant neoplaziya.
- Genital and ekstragenitalny endometriosis. The aseptic inflammation of fabrics owing to cyclic rejection of endometrioidny growths is capable to provoke pain.
- Varicosity of pelvic veins. Pathological expansion of vessels of a basin and the venous stagnation arising on its background render the stimulating effect on the nervous terminations located in a pelvic cavity.
- Allen-Masters's syndrome. Characteristic pelvic pains develop at the women who had at the time of delivery a trauma with a rupture of ligaments of uterus.
In 21-22% of cases chronic pains have an organic not gynecologic basis. Belong to number of such reasons:
- Urological pathology. Pain is observed at an urolithic disease, omission of kidneys, their allotopia and anomalies of development, chronic cystitis.
- Pathology of peripheral nervous system. Chronic pain is characteristic of inflammatory and other defeats of intra pelvic nervous textures.
- GIT diseases. Painful feelings are expressed at a syndrome of the angry intestines, chronic colitis and a proktita, an appendicular and genital syndrome, an adhesive disease.
- Zabryushinnye of a neoplasia. Pains in a basin arise at new growths of the kidneys, ganglionevroma and other volume processes localized behind a peritoneum.
- Diseases of the bone and articulate device. The pain syndrome shows lumbar and sacral osteochondrosis, damages of a lonny simfiz, a tumor and metastasises in pelvic bones, bone tuberculosis, etc.
At 1,1-1,4% of patients of the reason of a chronic pain syndrome are inorganic: pains can disturb at mental and some other violations — abdominal epilepsy, depressions, psychogeniuses, a hyper ventilating syndrome, a spazmofiliya. Less than in 2% of clinical cases the concrete reasons of chronic pelvic pains remain unspecified with women.
Initial link in developing of chronic pain — local haemo dynamic, metabolic, dystrophic and functional changes which happen in the peripheral nervous terminations and knots of sympathetic nervous system. Such violations are followed by strengthening of intensity and frequency of pathological afferent impulses. Local frustration are supplemented with increase in excitability of structures of a spinal cord and pathological changes of TsNS at which even usual impulses from pelvic bodies begin to be perceived as painful. Against the background of violations of an innervation hyperaemia and stagnation of blood in a basin accrues, the tone of muscles of a pelvic bottom pathologically raises that starts the mechanism of "vicious circle", causing still big changes in peripheral and the central nervous system. At late stages of development of a syndrome the gangliya located above and textures are involved in process.
Frustration develops gradually and has phasic character. Distinguish three stages of chronic pelvic pains at women.
- I stage (organ). Painful feelings are localized in the bottom of a stomach. Intensity of pain corresponds to expressiveness of the disease which served as the reason of its emergence or exceeds it a little. Psychoemotional violations are minimum.
- II stage (nadorganny). Pain in pelvic area is supplemented with the reflected pains in the top part of a stomach. Pathological process extends to paravertebralny and paraaortal nervous educations. At this stage the majority of diagnostic mistakes is made.
- III stage (polysystem). Various sites of nervous system are involved in process. Menstrual, sekretorny and sexual functions, digestion, a metabolism are broken. Pains differ in high intensity, are followed by the expressed psychoemotional frustration.
SHTB symptoms at women
For half a year and more patient the constant dull aching ache or the expressed discomfort in the bottom of a stomach, behind a pubis, in a groin, a vagina, a sacrum, a tailbone, area of a crotch disturbs. Painful feelings usually have no accurate localization, often "migrate". Their irradiation in one or both coxofemoral joints, buttocks, hips, big and small vulvar lips is possible. Expressiveness of a pain syndrome amplifies at an urination, defecation, overcooling, static and dynamic physical activities, after stressful situations. Intensive pain is also noted when carrying out a vaginal research. The ovulyatorny syndrome, a deep dispareuniya are characteristic of clinical picture SHTB .
Women with chronic pain in a basin have a sleeplessness and other sleep disorders, working capacity and efficiency decreases, the mood gradually worsens to depression level. At a part of patients symptoms of morbid depression and a kantserofobiya are noted: they introduce the ideas of existence of oncological or other incurable disease, there take place numerous inspections at doctors of different specialties. Increase of disturbing and depressive frustration is followed by deterioration in subjective perception of pain which begins to seem intolerable, in the woman exhausting, engrossing all attention.
Transition of SHTB to a polyorgan stage is followed by hormonal disorders, violation of menstrual and sexual functions, functional insufficiency of different bodies and systems. However the main consequence of chronic pelvic pain is the accruing social disadaptation with signs of behavioural frustration. The patient becomes closed, irritable, whining, limits physical activity. Violations of behavior can provoke family and sexual problems, cause labor disadaptation. At development of a depression emergence of suicide thoughts and intentions is possible.
As more than in 95% of cases chronic pain arises against the background of other frustration, a key problem of a diagnostic stage is definition of the reasons of a pain syndrome and objective assessment of expressiveness of the main disease. For diagnosis are shown:
- Survey on a chair. During the bimanualny research morbidity at minor changes from a uterus and appendages is expressed. At survey in mirrors cyanosis of a mucous neck of a uterus and vagina is sometimes observed.
- Ultrasonography of pelvic bodies. It is applied as screening to detection of possible anomalies of development, inflammations, volume processes, liquid congestions in cavities of bodies of an urinary and reproductive system.
- Radiological researches. During a beskontrastny and contrast X-ray analysis it is possible to confirm or find diseases of internals and musculoskeletal system.
- Laboratory diagnostics. The research of vaginal dab, its crops on flora with antibiotikogrammy, allow to define PTsR, RIF, IFA the activator at nonspecific and specific inflammatory processes.
- Endoscopic methods. At survey of bodies by means of hysteroscopy, a tsistoskopiya, an ureteroskopiya, a rektoromanoskopiya, a rektosigmoskopiya, kolonoskopiya and others the technician it is possible to estimate visually a condition of mucous, to reveal volume new growths.
- Laparoscopy. The method is applied to detection of solderings, the centers of endometriosis, a gidrosalpinks, a piosalpinks, subserous myomas, cysts of an ovary and other neoplaziya, varicosity, Allen-Masters's syndrome.
In difficult diagnostic cases the plan of inspection is supplemented with MRT, a computer tomography, absorbing densitometry and other techniques. Involve urologists, surgeons, neuropathologists, psychiatrists, gastroenterologists, orthopedists-traumatologists, phthisiatricians, oncologists in inspection of the patient.
According to specialists of the international medical associations which are engaged in studying of this pathology it is possible to speak about presence of a syndrome of chronic pelvic pain at women only at a combination of several criteria. Such pain lasts half a year and more. Subjective feelings of the patient do not correspond to character and expressiveness of damage of fabrics and bodies. Therapy of the main disease is ineffective. There are symptoms of a depression, behavioural frustration, restriction of physical activity accrues.
Treatment of SHTB at women
At a syndrome of chronic pelvic pain the complex therapy combining etiotropny and pathogenetic approach is recommended. For treatment of the disease which provoked emergence of pain, the patient according to indications appoint antibacterial, antiviral, antifungal, hormonal and other medicines, carry out necessary surgical interventions. In parallel carry out the therapy directed to reduction or full elimination of pathological painful impulses. The purposes of pathogenetic treatment are:
- Normalization of local biochemical processes. In the solution of this task the replaceable hormonal therapy, antioxidants, vitamins, enzymes, nonsteroid resolvents and medicines improving a blood-groove in fabrics are effective. Medicamentous therapy is recommended to be combined with physiotherapeutic techniques (action of variation magnetic field and so forth).
- Blockade of pathological impulses. To stop receipt of a pathological painful impulsation in a brain, appoint different types of intra pelvic blockade, alcoholization of nervous fibers, acupuncture. Carrying out small neurosurgical interventions — a presakralny nevrotomiya, a paratservikalny denervation of a uterus is possible.
- Impact on TsNS. For influence on the central link of system of a notsitseption and correction of the accompanying neurotic frustration use sedative medicines, vegetokorrektiruyushchy means, suggestive and rational psychotherapy. Such approach allows to restore or to considerably improve balance of processes of activation and braking in the respective sites of a brain.
An important role in treatment of a disease is played by the nature of relationship between the doctor and the patient. At due level of credibility to the expert the detailed explanation to the woman of the reasons and mechanisms of her disease state allows to rationalize feelings and at the expense of it considerably to reduce intensity of pain even at the minimum medicamentous therapy.
Forecast and prevention
SHTB differs in a current, long, steady against therapy. Its forecast is defined by features of the main disease. Adequate complex treatment allows to reduce significantly painful frustration and to improve quality of life of the patient. For prevention of synchronization of pain timely therapy of the violations leading to development of a pain syndrome is recommended. In the preventive purposes normalization of the mode of a dream and rest, decrease in intellectual and physical activities, occupations by physical culture, respect for the principles of a balanced diet are recommended.