PID and the role of the pelvic floor therapist

Pelvic inflammatory disease (PID) is an infection of one or more of the female reproductive organs, including the uterus, Fallopian tubes and ovaries. PID is caused by bacteria entering the woman’s reproductive tract. Any bacteria can cause PID but the most common are gonorrhoea and chlamydia. Bacteria may also enter during times when the cervix’s normal barrier of protection is disturbed such as menstruation, miscarriage, abortion or after childbirth.

Signs and symptoms of PID include:

- Pain;

- Abnormal and heavy vagina discharge which may be accompanied by an unpleasant odour;

- Abnormal uterine bleeding especially during and after sexual intercourse and between menstrual cycles;

- Pain during sexual intercourse;

- Fever sometimes accompanied by chills;

- Painful, frequent or difficult urination.

Unfortunately, PID may be mild and subtle and, therefore, difficult to recognise. Some women have no symptoms but only realise that there is something wrong when they develop chronic pelvic pain or experience difficulty in getting pregnant. The risk factors that may increase your chance of having PID include:

- Being a sexually active woman younger than 25 years old;

- Having multiple partners;

- Being in a sexual relationship with a person who has more than one partner;

- Having sex without a condom;

- Douching regularly;

- History of PID or sexually transmitted infection (STI);

- Insertion of an intrauterine device (IUD). This risk is small and generally only within the first three weeks after insertion.

PID may cause the formation of abscesses (pockets filled with infected fluid) or scar tissue if left untreated. These changes can cause permanent damage to the reproductive organs.

Some complications which may arise include:

ECTOPIC PREGNANCY: Untreated PID can cause scar tissue formation in the Fallopian tubes. The scar tissue prevents a fertilised egg from making its way down into the uterus to be implanted. The fertilised egg instead implants in the Fallopian tubes.

INFERTILITY: Untreated PID may lead to damage to the reproductive organs which may lead to the inability to become pregnant. The more times a woman has PID, the greater her risk of infertility.

CHRONIC PELVIC PAIN: PID May cause pelvic pain which may last for months or years. The scarring in the different reproductive organs may also lead to pelvic pain during ovulation and sexual intercourse.

TUBI-OVARIAN ABSCESS: PID may cause the formation of an abscess in the reproductive tract. An abscess is a collection of infected fluid (pus). Abscesses most commonly form on the ovaries and Fallopian tubes but may develop in any other reproductive organ. If the abscess is left untreated, it may cause a life-threatening infection known as sepsis.

PREVENTION

- Practise safe sex. Use condoms every time you have sex, limit your number of sexual partners and ask about a potential partner’s sexual history.

- Talk to your doctor about contraception. Barrier methods of contraception protect against the development of PID, e.g., condoms help to reduce your risk.

- Get tested: Do regular testing to always know your status! Early treatment of an STI gives you the best chance of avoiding PID.

- Request that your partner be tested: If you have PID or an STI, advise your partner to be tested and treated. This may prevent the spread of STIs and possible recurrence of PID.

- Do not douche: Douching upsets the natural balance of bacteria in your vagina.

To diagnose PID, the following tests are usually done by your OBGYN:

- Pelvic examination;

- Vaginal Culture;

- Blood & Urine tests;

- Ultrasound.

PHYSIOTHERAPY MANAGEMENT

- SHORTWAVE DIATHERMY: This is a deep heating modality which is used to promote healing and reduce pain in the pelvis.

- ELECTRICAL STIMULATION: The use of electrical stimulation such as interferential current help to manage lower back pain as a result of PID.

- MUSCLE STRENGTHENING: If the muscles of the pelvic floor are found to be weak, exercises are given to strengthen the floor, the muscles surrounding the pelvic floor and the core.

- SOFT TISSUE MOBILISATION: If there are muscle spasms, trigger points or the pelvic floor is in a hypertonic state, Soft Tissue Mobilisation maybe done to decrease this. In the case of a hypertonic pelvic floor, the patient is also taught strategies to relax the pelvic floor muscles.

Dr Savionne Francis is CEO of Muscle Craft Physiotherapy and a certified lymphoedema and wound therapist. Send feedback to savionnegayle@gmail.com .