Backache, abdominal distension, delayed menstruation

Symptoms such as lower back pain, abdominal distension and delayed menstruation are very consistent with the characteristics of pelvic inflammatory disease. The characteristics of pelvic inflammatory disease are that it lasts a long time and is relatively stubborn and not easy to cure in one go. In addition, pelvic inflammatory disease is very harmful and can seriously lead to female infertility. Therefore, if you experience symptoms such as lower back pain, abdominal distension, and delayed menstruation, you should determine as soon as possible whether it is caused by pelvic inflammatory disease. Once the diagnosis is confirmed, you should receive treatment as soon as possible.

There are two types of pelvic inflammatory disease: acute and chronic:

1. Acute pelvic inflammation

The symptoms are lower abdominal pain, fever, increased vaginal discharge, and persistent abdominal pain that worsens after activity or sexual intercourse. If the condition is severe, there may be chills, high fever, headache, and loss of appetite. Those who develop the disease during menstruation may experience increased menstrual flow and prolonged menstruation. If pelvic inflammatory disease forms a pelvic abscess, it may cause local compression symptoms. Compression of the bladder may cause frequent urination, painful urination, and difficulty urinating; compression of the rectum may cause rectal symptoms such as tenesmus. Further development of acute pelvic inflammatory disease can cause diffuse peritonitis, sepsis, septic shock, and in severe cases can be life-threatening.

2. Chronic pelvic inflammation

It is caused by the failure to thoroughly treat acute pelvic inflammatory disease or the patient's poor physical condition and prolonged course of the disease. The symptoms of chronic pelvic inflammatory disease are lower abdominal distension, pain and lumbar and sacral soreness, which are often aggravated by fatigue, after sexual intercourse, and before and after menstruation. The second is abnormal menstruation and irregular menstruation. When the disease lasts for a long time, some women may experience symptoms of neurasthenia such as lack of energy, general discomfort, and insomnia. It often takes a long time to heal and recurs repeatedly, leading to infertility and fallopian tube pregnancy, seriously affecting women's health.

1. Minimum Standards

Cervical motion tenderness or uterine tenderness or adnexal tenderness.

2. Additional Standards

The body temperature is over 38.3℃, there is mucopurulent secretion in the cervix or vagina, a large number of white blood cells are seen in the 0.9% NaCl smear of vaginal secretions, the erythrocyte sedimentation rate is increased, and the C-reactive protein is elevated; the laboratory confirms that the cervix is ​​positive for Neisseria gonorrhoeae or Chlamydia.

Endometrial biopsy revealed histologic evidence of endometritis, transvaginal ultrasonography or magnetic resonance imaging revealed tubal wall thickening, luminal fluid, with or without concurrent pelvic effusion, or tubo-ovarian abscess, and laparoscopy revealed abnormal findings consistent with PID.

For patients with a history of acute pelvic inflammatory disease and symptoms and signs, diagnosis is usually not difficult. However, sometimes patients have many symptoms but no obvious history of pelvic inflammatory disease or positive signs. At this time, the diagnosis of chronic pelvic inflammatory disease must be made with caution to avoid making a hasty diagnosis and causing mental burden to the patient. Sometimes pelvic congestion or varicose veins within the broad ligament can also produce symptoms similar to chronic inflammation. Chronic pelvic inflammatory disease and endometriosis are sometimes difficult to distinguish. Endometriosis causes more obvious dysmenorrhea, and the feeling of typical nodules will help with diagnosis. Laparoscopy can be performed when differentiation is difficult. Hydrosalpinx or tubo-ovarian cysts need to be differentiated from ovarian cysts. In addition to a history of pelvic inflammatory disease, the former has a sausage-shaped lump with a thin cyst wall and adhesions around it; while ovarian cysts are generally more round or oval in shape, have no adhesions around them, and move freely. Pelvic inflammatory adnexal masses are adhered to the surrounding area and are immobile, which can sometimes be confused with ovarian cancer. Inflammatory masses are cystic while ovarian cancer is solid. B-mode ultrasound examination can help to differentiate them.

Acute and chronic pelvic inflammatory disease can be diagnosed based on history, symptoms, and signs. However, differential diagnosis must be done well. The main differential diagnoses of acute pelvic inflammatory disease include acute appendicitis, ectopic pregnancy, ovarian cyst pedicle torsion, etc.; the main differential diagnoses of chronic pelvic inflammatory disease include endometriosis and ovarian cancer.