What is uterine tenderness?

Nowadays, many women often suffer from various bacterial inflammations, which lead to gynecological diseases. There are many gynecological diseases nowadays. The more common ones are salpingitis, hydrosalpinx, and mild or moderate swelling of the fallopian tubes. These are enough to cause inflammation in patients and are quite harmful. Therefore, we must strictly control and find the cause of the disease in normal times.

The main pathogens that cause pelvic inflammatory disease are: Staphylococcus aureus, Escherichia coli, anaerobic bacteria, and sexually transmitted pathogens (such as gonococci, Chlamydia trachomatis, mycoplasma, and herpes virus). The main causes of acute pelvic inflammatory disease are postpartum or abortion infection, postoperative infection after intrauterine surgery, poor menstrual hygiene, and direct spread of inflammation from adjacent organs.

Acute pelvic inflammatory disease can cause the body to develop acute endometritis and acute myometritis, acute salpingitis, pyosalpinx, tubo-ovarian abscess, acute pelvic connective tissue inflammation, acute pelvic peritonitis, sepsis and septicemia, etc. Chronic pelvic inflammatory disease is often caused by failure to thoroughly treat acute pelvic inflammatory disease, or by the patient's poor physical constitution and prolonged course of the disease. It can cause chronic salpingitis and hydrosalpinx, salpingo-oophoritis and tubo-ovarian cysts, and chronic pelvic connective tissue inflammation.

1. Chronic salpingitis and hydrosalpinx

Chronic salpingitis is mostly bilateral, with mild or moderate swelling of the fallopian tubes. The fimbria may be partially or completely closed and adhered to the surrounding tissues. In addition, sometimes the mucosal epithelium and fibrous tissue in the isthmus of the fallopian tube proliferate and adhere, causing the fallopian tube to become nodular and thickened, which is called nodular salpingitis. When the inflammation of the fallopian tube is mild, the fimbria and isthmus are adhered and closed, and serous exudate accumulates to form hydrosalpinx; sometimes tubal pus becomes chronic, the pus is gradually absorbed, and the serous fluid continues to seep out of the tube wall and fill the tube cavity, which can also form hydrosalpinx. The surface of the hydrops fallopian tube is smooth, the wall of the tube is very thin, and it is shaped like a sausage or a distillation flask with a curved neck. It curls backwards and may be free or have membrane-like adhesions with the surrounding tissues.

2. Fallopian tube oophoritis and fallopian tube ovarian cysts

When the fallopian tubes become inflamed, they may spread to the ovaries and they may adhere to each other to form an inflammatory mass, or the fimbria of the fallopian tubes may adhere to the ovaries and fluid may seep out to form a fallopian tube-ovarian cyst. It may also be formed by the absorption of pus from a fallopian tube-ovarian abscess.

3. Chronic pelvic connective tissue inflammation: the inflammation spreads to the uterosacral ligament, causing the fibrous tissue to proliferate and harden. If the disease spreads widely, it can cause the uterus to become fixed and the paracervical tissue to thicken.

Diagnosis

1. Key points of diagnosis

1. Symptoms: (1) Systemic symptoms are usually not obvious, but may include low-grade fever and fatigue. Some patients with a long course of illness may have symptoms of neurasthenia, such as lack of energy, general discomfort, insomnia, etc. When the patient's resistance is poor, acute or subacute attacks are likely to occur. (2) Scar adhesions and pelvic congestion caused by chronic inflammation can cause lower abdominal distension, pain, and lumbar pain. It often worsens after fatigue, sexual intercourse, and before and after menstruation. (3) Due to pelvic congestion, the patient may experience increased menstruation; when ovarian function is damaged, there may be menstrual disorders; when the fallopian tubes are blocked by adhesions, it may cause infertility.

2. Physical signs: The uterus is often posterior, with limited movement or adhesions. If it is salpingitis, you will feel thickened fallopian tubes on one or both sides of the uterus, which are cord-like and slightly tender. If it is hydrosalpinx or tubo-ovarian cyst, a cystic tumor will be felt on one or both sides of the pelvic cavity, and movement will be restricted. If it is pelvic connective tissue inflammation, there will be patchy thickening and tenderness on one or both sides of the uterus, and the uterosacral ligament will become thicker, harder, and tender.

2. Inspection and testing

1. Direct smear sampling of secretions can be vaginal, cervical canal secretions, urethral secretions, or peritoneal fluid (obtained through the posterior fornix, abdominal wall, or laparoscopy), and direct thin-layer smears are made. After drying, they are stained with methylene blue or Gram's blue. If Gram-negative diplococci are seen in polymorphonuclear leukocytes, it is a gonorrhea infection. Because the detection rate of endocervical gonorrhea is only 67%, a negative smear cannot exclude the presence of gonorrhea, while a positive smear is very specific. Fluorescein monoclonal antibody dye can be used for microscopic examination of Chlamydia trachomatis. The test is positive if a star-shaped flashing fluorescent spot is observed under a fluorescence microscope.

2. The pathogen culture specimens come from the same sources as above and should be inoculated on Thayer-Martin medium immediately or within 30 seconds and cultured in a 35°C incubator for 48 hours. Bacterial identification should be performed based on glycolysis. New relatively rapid chlamydial enzyme assay replaces traditional chlamydia detection methods and can also be performed using mammalian cell culture

3. Posterior fornix puncture

Posterior fornix puncture is one of the most commonly used and valuable diagnostic methods for gynecological acute abdomen. The contents of the abdominal cavity or the rectouterine fossa obtained through puncture, such as normal peritoneal fluid, blood (fresh, old, clotted blood, etc.), purulent secretions or pus, can further clarify the diagnosis. Microscopic examination and culture of the punctured material are even more necessary.

4. Ultrasonic examination mainly includes B-type or grayscale ultrasound scanning and filming. This technology has an 85% accuracy in identifying masses or abscesses formed by adhesions of fallopian tubes, ovaries and intestinal tract. However, mild or moderate pelvic inflammatory disease is difficult to show characteristics on B-mode ultrasound images.

5. Laparoscopy

If it is not diffuse peritonitis and the patient's general condition is good, laparoscopy can be performed on patients with pelvic inflammatory disease or suspected pelvic inflammatory disease and other acute abdominal diseases. Laparoscopy can not only make a clear diagnosis and differential diagnosis, but also make a preliminary judgment on the severity of pelvic inflammatory disease.

6. Examination of the male partner helps in the diagnosis of pelvic inflammatory disease in women. The urethral secretions of the male partner can be taken for direct smear staining or culture of gonococci. If the result is positive, it is strong evidence, especially in those who are asymptomatic or have mild symptoms. Or a higher number of white blood cells may be detected. If all male partners of PID patients are treated, regardless of whether they have urethritis symptoms or not, it will obviously be very meaningful to reduce recurrences.

1. Psychotherapy

General treatment relieves patients' mental concerns, enhances their confidence in treatment, increases nutrition, exercises the body, pays attention to the combination of work and rest, and improves the body's resistance.

2. Traditional Chinese medicine treatment

Chronic pelvic inflammatory disease is mostly of damp-heat type, and the treatment principle is to clear away heat and dampness. The main function of the prescription is to promote blood circulation and remove blood stasis. The prescription uses: Salvia miltiorrhiza 18g, Red Peony Root 15g, Costus Root 12g, Peach Kernel 9g, Honeysuckle 30g, Taraxacum Mulberry 30g, Poria 12g, Moutan Bark 9g, and Rehmannia Glutinosa 9g. If the pain is severe, add 9g of Corydalis yanhusuo. Some patients are of the cold stagnation and qi stagnation type, and the treatment principle is to warm the meridians and dispel the cold, promote qi and activate blood circulation. Guizhi Fuling Decoction is often used with modifications. For those with qi deficiency, add 15g of Codonopsis pilosula, 9g of Atractylodes macrocephala, and 15g of Astragalus membranaceus.

3. Physical therapy

The benign stimulation of warmth can promote local blood circulation in the pelvic cavity. Improve the nutritional status of tissues and enhance metabolism to facilitate the absorption and disappearance of inflammation. Commonly used ones are shortwave, ultrashort wave, iontophoresis (various drugs such as penicillin, streptomycin, etc. can be added), wax therapy, etc.

Because the female reproductive system has a natural defense function, under normal circumstances, it can resist bacterial invasion. Pelvic inflammatory disease will only occur when the body's resistance decreases or the female's natural defense function is destroyed due to other reasons.

5. Surgical treatment

Patients with lumps such as hydrosalpinx or tubo-ovarian cysts can undergo surgical treatment; patients with small foci of infection and repeated inflammation are also suitable for surgical treatment. The principle of surgery is complete cure to avoid recurrence of residual lesions. Unilateral oophorectomy or radical hysterectomy plus bilateral oophorectomy is performed. For young women, ovarian function should be preserved as much as possible. The effect of single therapy for chronic pelvic inflammatory disease is poor, and comprehensive treatment is appropriate.

6. Traditional Chinese Medicine Treatment

Inflammatory bowel disease is a common gynecological disease and is the abbreviation for inflammation of the female pelvic reproductive organs, including metritis, pelvic peritonitis, pelvic gland inflammation and fallopian tube oophoritis. Traditional Chinese medicine also has some good ways to treat pelvic inflammatory disease.

Traditional Chinese medicine divides pelvic inflammatory disease into five categories. By combining syndrome differentiation and treatment with Western medicine, it can achieve the effect of treating both the symptoms and the root cause.

(1) Heat toxicity type: high fever, chills, headache, lower abdominal pain, vaginal discharge with a large amount of pus and foul odor, yellow urine and constipation, red tongue with yellow coating, and slippery or stringy pulse.

(2) Damp-heat type: low-grade fever, burning pain in the lower abdomen, dry mouth and loss of appetite, heavy vaginal discharge with a yellow or red-yellow texture, red tongue with a greasy yellow coating, and a slippery and rapid pulse.

(3) Damp-heat stasis type: abdominal distension and pain, bitter and dry mouth, thick yellow vaginal discharge, turbid urine, dry and hard stools, dark red tongue, yellow or white tongue coating, and stringy or rapid pulse.

(4) Blood stasis type: persistent pain in the lower abdomen that is resistant to pressure, or irregular menstruation, or heavy menstrual flow with clots, dark purple tongue, or with ecchymosis, thin tongue coating, and deep, stringy or astringent pulse.

(5) Chong and Ren deficiency cold type: cold pain in the lower abdomen, likes warmth and pressure, has a lot of white and thin vaginal discharge, is afraid of cold and has cold limbs, has a pale tongue, has a thin white coating, and has a deep and fine pulse. The commonly used Chinese patent medicine oral pill Fuyan Pill has the effects of clearing away heat and detoxifying, promoting blood circulation and removing blood stasis, and can be used as a comprehensive medicine.

Diseases in any aspect of the female reproductive system may cause pelvic inflammatory disease. This problem can be serious or minor and can easily lead to infertility, so it must be treated. Pelvic effusion refers to the presence of inflammatory exudate in the pelvic cavity. It can occur after the endometrium becomes inflamed. It is a slightly viscous fluid that exudes from the swollen cells of the endometrial tissue and is gradually wrapped by the surrounding tissue to form a cystic mass.

Pelvic inflammatory disease not only brings a lot of unspeakable physical pain to patients, but may also cause various terrible complications. Therefore, patients with pelvic inflammatory disease should especially strengthen the cultivation of their own hygiene awareness and pay attention to various matters, and also take care of themselves during treatment. Experts put forward eight principles of precautions for pelvic inflammatory disease.

1. Prevent all kinds of infection routes, keep the perineum clean and dry, wash the vulva with clean water every night, and use Hua Yang Chu Rui Essence once every three days. Do not use your hands to wash the vagina, and do not use hot water, soap, etc. to wash the vulva. During pelvic inflammatory disease, the amount of leucorrhea is large and sticky, so you should change your underwear frequently and avoid wearing tight or synthetic underwear.

2. Fever patients usually sweat a lot when the fever subsides. They should pay attention to keeping warm and keeping the body dry. Change clothes after sweating and avoid air conditioning or direct convection wind.

3. Pay attention to the quantity, quality, color and taste of leucorrhea. If the amount of leucorrhea is large, the color is yellow and thick, and there is a foul odor, it means that the condition is serious. If the leucorrhea turns from yellow to white (or light yellow), the amount changes from large to small, and the taste tends to be normal (slightly sour), it means that the condition has improved.

4. If there is vaginal bleeding during menstruation, after abortion, or after gynecological surgery such as IUD insertion or removal, sexual intercourse, swimming, tub bathing, or sauna bathing must be avoided. Sanitary napkins must be changed frequently. This will reduce the body's resistance and allow pathogens to enter the body easily, causing infection.

5. Patients with acute or subacute pelvic inflammatory disease should keep their bowels open and observe the nature of their stools. If you see pus in your stool or have a feeling of urgency and heaviness in your abdomen, you should go to the hospital immediately to prevent pelvic abscess from rupturing the intestinal wall and causing acute peritonitis.

6. Patients diagnosed with acute or subacute pelvic inflammatory disease must follow the doctor's instructions and actively cooperate with treatment. The patient must rest in bed or take a semi-recumbent position to facilitate localization of inflammation and discharge of secretions. Patients with chronic pelvic inflammatory disease should not overwork, and should combine work and rest, and exercise in moderation to avoid worsening of symptoms.

7. Some patients suffer from chronic pelvic inflammatory disease and take antibiotics on their own when they feel a little uncomfortable. Long-term use can cause vaginal flora disorder, which can cause increased vaginal secretions and present as white, bean curd-like leucorrhea. At this time, you should go to the hospital immediately to rule out candidal vaginitis.

8. Patients with pelvic inflammatory disease should pay attention to diet and strengthen nutrition. During the fever period, it is advisable to eat light and easily digestible food. Patients with high fever and loss of body fluid can be given pear juice, apple juice, watermelon juice, etc. to drink, but they should not be drunk after being chilled. Patients with yellow, heavy and thick leucorrhea have damp-heat syndrome and should avoid fried, greasy and spicy foods. Patients with cold pain in the lower abdomen, fear of cold, and back pain belong to the cold stagnation and qi stagnation type. They can be given warm foods such as ginger soup, brown sugar water, and cinnamon pulp. People who suffer from fever in the five parts of their body and lower back pain mostly suffer from kidney yin deficiency. They can eat meat, eggs and other blood and living things to nourish and strengthen their body.

9. Do a good job in contraception and try to minimize the trauma of artificial abortion. Strictly follow aseptic operation during surgery to avoid the invasion of pathogenic bacteria

10. The benign stimulation of warmth can promote local blood circulation in the pelvic cavity. Improve the nutritional status of tissues and enhance metabolism to facilitate the absorption and disappearance of inflammation.