CHRONIC PELVIC INFECTION
Chronic pelvic infection is a distressing clinical entity not only to the patients but also to the physicians. It results:
- Following acute pelvic infection—the initial treatment was delayed or inadequate.
- Following low grade recurrent infection.
- Tubercular infection.
The first two types are predominantly due to pyogenic organisms. There is often history of previous acute pelvic infection. Tubercular infection is chronic from the beginning and is described as a separate entity.
PATHOLOGY: - The pathology in the uterus is most often spared because of periodic shedding of the endometrium. The tubal changes are secondary to the changes induced by previous acute salpingitis. The tubal epithelium is usually lost, especially in gonococcal infection, the wall gets thickened with plasma cell infiltration and the openings are blocked. These result in hydrosalpinx, with loss of the lining mucosa with its plicae. The peritoneal surface is involved in recurrent infection producing either flimsy (gonococcal) or dense (non-gonococcal pyogenic) adhesions. The tubes are thus kinked and may get adherent to the ovaries, uterus, Intestine, omentum and pelvic peritoneum. A tubo ovarian mass or a frozen pelvis results. The serum and lymphatic exudate in the parametrium of acute infection coagulates, which later either completely resolutes or becomes fibrotic. The fibrosis pulls the uterus, the cervix in particular to the same side.
CLINICAL FEATURES: -
- The entity may remain asymptomatic.
- There may be previous history of acute pelvic infection following childbirth or abortion.
Recurrent episodes of reinfection is often present.
The use of IUCD is highly corroborative.
- Chronic pelvic pain of varying magnitude and the pain aggravates prior to menstruation due to congestion.
- Dyspareunia, which is deep and may be located unilaterally or bilaterally.
- Congestive dysmenorrhea.
- Lower abdominal pain.
- Menorrhagia or polymenorrhagia are due to congestion.
- Vaginal discharge is almost a constant manifestation and may be mucoid or mucopurulent.
- Infertility, which may be primary or more commonly secondary.
Important factors for infertility are - Cornual block, loss of cilia, loss of peristalsis due to thickening of the tubal wall, closure of the abdominal ostium and distortion of the tube due to peritubal adhesions.
HOMEOPATHIC MANAGEMENT OF PELVIC INFECTIONS: -
Merc Sol: - Used when there is excessive vaginal discharge. The symptoms that indicate the need for merc Sol include acrid, excoriating, and itchy discharge that cause a burning sensation in the vagina.
Phosphorus: - When there is bleeding from the uterus between periods. The uterine bleeding tends to be profuse. Weakness usually follows the menstrual bleeding. Other symptoms include Ovarian pain.
Sabina: - When there are heavy periods. The periods are profuse and gushing in nature. The bleeding is bright red colored with dark clots in it. The blood may have an offensive odour.
Medorrhinum:- When women experience intensely painful periods. There is an excruciating pain in the pelvic area along with Ovarian pains that get better with pressure.