lumbosacral pain
Introduction
Introduction Scar adhesions caused by chronic pelvic inflammatory disease and pelvic congestion can cause lower abdomen bulge, pain and lumbosacral pain. Often exacerbated after exertion, after sexual intercourse and before and after menstruation.
Cause
Cause
The cause of lumbosacral pain:
Menstrual period does not pay attention to hygiene. Endometrial exfoliation during menstruation, uterine sinus opening, and clots, which is a good condition for bacterial growth. If you do not pay attention to hygiene during menstruation, use sanitary napkins or toilet paper with unqualified hygiene standards, or have sex, it will provide bacteria with a chance of retrograde infection, leading to pelvic inflammatory disease. Inflammation of adjacent organs spreads.
The most common is the occurrence of appendicitis, peritonitis, because they are adjacent to the female internal reproductive organs, inflammation can be directly spread, causing pelvic inflammation in women. In the case of chronic cervicitis, inflammation can also pass through the lymphatic circulation, causing pelvic connective tissue inflammation.
Infection after gynecological surgery. If abortion is not strict or chronic inflammation of the original reproductive system, if the abortion is not strict or the prosthetic system is removed, or if the disinfection is not strict or the original reproductive system is chronically inflamed, abortion or looping surgery, tubal drainage, fallopian tube angiography, endometrial polypectomy, or submucosal uterine myomectomy That may cause postoperative infection. Some patients do not pay attention to personal hygiene after surgery, or do not follow the doctor's advice after surgery, have sex, can also cause bacterial infection, causing pelvic inflammatory disease.
Women infected after childbirth or after abortion. The patient's constitution is weak, and the cervix is not well closed after expansion. At this time, the bacteria in the vagina and the cervix may infect the pelvic cavity upwards; if there is a placenta or residual membrane in the uterine cavity, the chance of infection is greater.
Symptoms mainly include: systemic symptoms are not obvious, sometimes low fever, fatigue. The course of the disease is longer, and some patients may have symptoms of neurasthenia. Scar adhesions caused by chronic inflammation and pelvic congestion can cause lower abdominal bulge, pain and soreness in the lumbosacral region, often exacerbated during exertion, sexual intercourse, and menstruation. Due to pelvic congestion, patients may have increased menstruation, ovarian dysfunction may have menstrual disorders, tubal adhesions can cause infertility.
Examine
an examination
Related inspection
CT examination of bone and joint and soft tissue pelvic tilt test
Examination and diagnosis of lumbosacral pain:
Chronic pelvic inflammatory disease is mainly characterized by lower abdomen bulge, pain and soreness in the lumbosacral region. Sometimes it may be accompanied by anal bulging discomfort. It is often exacerbated after exertion, sexual intercourse and before and after menstruation. This is because of the scar adhesion and pelvic cavity formed by chronic inflammation. Caused by congestion.
The systemic symptoms of chronic pelvic inflammatory disease are sometimes low fever and susceptibility to fatigue. Some patients have symptoms of neurasthenia due to long course of disease, such as insomnia, lack of energy, and general discomfort. Lower abdomen bulge, pain and soreness in the lumbosacral region, often worsened after exertion, after sexual intercourse, before and after menstruation. Due to chronic inflammation, pelvic congestion, menorrhagia, ovarian dysfunction, menstrual disorders, tubal adhesions can cause infertility.
(1) direct smear of secretion: sampling can be vaginal, cervical secretions, or urethral secretions, or peritoneal fluid (after sacral, abdominal wall, or laparoscopic), as a direct thin smear, after drying Dyed with methylene blue or gram. Anyone who sees Gram-negative diplococcus in polymorphonuclear leukocytes is a gonorrhea infection. Because the detection rate of cervical gonococcal is only 67%, negative smears can not exclude gonorrhea, and positive smears are very specific. The fluorescein monoclonal antibody dye can be used for the microscopic examination of Chlamydia trachomatis, and a fluorescent spot with a star-shaped scintillation observed under a fluorescence microscope is positive.
(2) Pathogen culture: The source of the specimen is the same as above, and it should be inoculated on Thayer-Martin medium immediately or within 30 s, and cultured in a 35 ° C incubator for 48 hours, and the bacteria are identified by glycolysis. The new relatively rapid Chlamydia enzyme assay replaces the traditional Chlamydia assay, and can also be used to detect Chlamydia trachomatis antigen in mammalian cell culture. This method is an enzyme-linked immunoassay. The sensitivity averaged 89.5% with a specificity of 98.4%. Bacterial cultures can also be used to obtain other aerobic and anaerobic strains and serve as a basis for the selection of antibiotics.
(3) posterior malleolar puncture: posterior malleolar puncture is one of the most commonly used and valuable diagnostic methods for gynecologic acute abdomen. By puncture, the contents of the abdominal cavity or the contents of the uterus rectum, such as normal peritoneal fluid, blood (fresh, old, coagulation, etc.), purulent secretions or pus, can further confirm the diagnosis, microscopic examination of the puncture And training is more necessary.
(4) Ultrasound examination: mainly B-type or gray-scale ultrasound scanning and radiography. This technique is 85% accurate for identifying masses or abscesses formed by adhesion between the fallopian tubes, ovaries and intestinal ducts. However, mild or moderate pelvic inflammatory disease is difficult to display in B-mode ultrasound images.
(5) Laparoscopy: If it is not diffuse peritonitis, the patient is generally in good condition. Laparoscopy can be performed in patients with pelvic inflammatory disease or suspected pelvic inflammatory disease and other acute abdomen. Laparoscopy can not only confirm the diagnosis and differential diagnosis, but also Preliminary determination of the extent of pelvic inflammatory disease.
(6) Male partner's examination: This helps the diagnosis of female pelvic inflammatory disease. It may be taken by male urinary tract secretions for direct smear staining or culture of gonorrhea, if it is found to be positive, it is a strong evidence, especially in the absence of symptoms or mild symptoms. Or you can find more white blood cells. If treatment is given to male partners in all PID patients, whether or not they have urethritis symptoms, it is obviously very meaningful to reduce recurrence.
Diagnosis
Differential diagnosis
Symptoms of lumbosacral pain and confusion:
Lumbosacral Pain: The lumbosacral region is the hub connecting the upper body and the lower body (including the pelvis and lower limbs) in the trunk. The structure is more complicated. Four out of five adults have experienced significant lumbosacral pain in one person. It usually occurs after being exposed to the cold. In people under the age of 45, it is the most common cause of loss of working ability due to low back pain.
Pain in the lumbosacral or lower back: The lumbosacral fat is mainly characterized by pain in the affected side of the lumbosacral or lower back, mostly pain, soreness and dull pain, generally not serious, but affects walking. The disease is more common in obese women after middle age, most of them have a history of production, and some patients may have varicose veins of the lower extremities, uterine prolapse, femoral hernia and other diseases.
The lumbosacral skin is hairy and abnormally pigmented: patients with tethered cord syndrome, especially children, should be alert to a clinical manifestation of this disease: the lumbosacral skin is hairy and abnormally pigmented. Tethered cord syndrome (TCS) is a syndrome in which a spinal cord or a cone is pulled due to various congenital and acquired causes, resulting in a series of neurological dysfunctions and malformations. Because the spinal cord is pulled more often in the lumbosacral medulla, causing the cone to be abnormally low, it is also called the lower spinal cord.
Brachial plexus and lumbosacral injuries after radiation: Radiotherapy is the best treatment option for breast, neck, testicular, and lymphoma, and is also most likely to cause brachial plexus and lumbosacral damage after radiation. Physical examination showed abnormal motion sensation and reduced sputum reflex. The upper brachial plexus and the lower brachial plexus are often involved at the same time. Very few patients involve the phrenic nerve, causing diaphragmatic paralysis.
Chronic pelvic inflammatory disease is mainly characterized by lower abdomen bulge, pain and soreness in the lumbosacral region. Sometimes it may be accompanied by anal bulging discomfort. It is often exacerbated after exertion, sexual intercourse and before and after menstruation. This is because of the scar adhesion and pelvic cavity formed by chronic inflammation. Caused by congestion.
The systemic symptoms of chronic pelvic inflammatory disease are sometimes low fever and susceptibility to fatigue. Some patients have symptoms of neurasthenia due to long course of disease, such as insomnia, lack of energy, and general discomfort. Lower abdomen bulge, pain and soreness in the lumbosacral region, often worsened after exertion, after sexual intercourse, before and after menstruation. Due to chronic inflammation, pelvic congestion, menorrhagia, ovarian dysfunction, menstrual disorders, tubal adhesions can cause infertility.
(1) direct smear of secretion: sampling can be vaginal, cervical secretions, or urethral secretions, or peritoneal fluid (after sacral, abdominal wall, or laparoscopic), as a direct thin smear, after drying Dyed with methylene blue or gram. Anyone who sees Gram-negative diplococcus in polymorphonuclear leukocytes is a gonorrhea infection. Because the detection rate of cervical gonococcal is only 67%, negative smears can not exclude gonorrhea, and positive smears are very specific. The fluorescein monoclonal antibody dye can be used for the microscopic examination of Chlamydia trachomatis, and a fluorescent spot with a star-shaped scintillation observed under a fluorescence microscope is positive.
(2) Pathogen culture: The source of the specimen is the same as above, and it should be inoculated on Thayer-Martin medium immediately or within 30 s, and cultured in a 35 ° C incubator for 48 hours, and the bacteria are identified by glycolysis. The new relatively rapid Chlamydia enzyme assay replaces the traditional Chlamydia assay, and can also be used to detect Chlamydia trachomatis antigen in mammalian cell culture. This method is an enzyme-linked immunoassay. The sensitivity averaged 89.5% with a specificity of 98.4%.
Bacterial cultures can also be used to obtain other aerobic and anaerobic strains and serve as a basis for the selection of antibiotics.
(3) posterior malleolar puncture: posterior malleolar puncture is one of the most commonly used and valuable diagnostic methods for gynecologic acute abdomen. By puncture, the contents of the abdominal cavity or the contents of the uterus rectum, such as normal peritoneal fluid, blood (fresh, old, coagulation, etc.), purulent secretions or pus, can further confirm the diagnosis, microscopic examination of the puncture And training is more necessary.
(4) Ultrasound examination: mainly B-type or gray-scale ultrasound scanning and radiography. This technique is 85% accurate for identifying masses or abscesses formed by adhesion between the fallopian tubes, ovaries and intestinal ducts. However, mild or moderate pelvic inflammatory disease is difficult to display in B-mode ultrasound images.
(5) Laparoscopy: If it is not diffuse peritonitis, the patient is generally in good condition. Laparoscopy can be performed in patients with pelvic inflammatory disease or suspected pelvic inflammatory disease and other acute abdomen. Laparoscopy can not only confirm the diagnosis and differential diagnosis, but also Preliminary determination of the extent of pelvic inflammatory disease.
(6) Male partner's examination: This helps the diagnosis of female pelvic inflammatory disease. It may be taken by male urinary tract secretions for direct smear staining or culture of gonorrhea, if it is found to be positive, it is a strong evidence, especially in the absence of symptoms or mild symptoms. Or you can find more white blood cells. If treatment is given to male partners in all PID patients, whether or not they have urethritis symptoms, it is obviously very meaningful to reduce recurrence.
