Pelvic Inflammatory Disease

Overview

Unhealthy sexual habits combined with several other pathogenic factors can cause numerous diseases in the human body. Some of these diseases may even attain a chronic nature and debilitate a person permanently. A common disease of this nature is “Pelvic Inflammatory Disease”. It is more prevalent in middle-aged and elderly women of the low and middle-income countries. Nearly 88,000 women in the age group of 15-44 were diagnosed with Pelvic Inflammatory Disease in the year 2013 in the United States alone.  According to the statistics published in “The Atlantic” in 2011, around 20% of the women suffering from Pelvic Inflammatory Disease faced infertility problems at some point in time. The reports also suggested that nearly 43% of these women developed chronic pelvic pain in future.

Definition

Pelvic Inflammatory Disease is defined as the microbial infection and inflammation of the upper genital tract. The critical reproductive organs such as- cervix, ovaries, fallopian tubes and uterus are adversely impacted in this condition. The endometrium, pelvic peritoneum, and adjoining tissues are damaged by this disease. The infection starts from the lower genital tract and gradually progresses towards the upper genital tract. The infections are mainly caused by some bacterial agents like Chlamydia and Gonorrhoea. They primarily invade the vagina and cervix. Later, they spread to the uterus, ovaries and fallopian tubes. A tubo-ovarian abscess may result in many cases causing chronic pelvic pain and infertility. This disease is more common in women having an infected sexual partner or multiple partners.

Causes of Pelvic Inflammatory Disease

The pelvic inflammatory disease is mainly induced by bacterial pathogens. Following are the general causes of the disease-

• Infections caused by bacterial species such as Neisseria gonorrhoeae, Chlamydia trachomatis or Mycoplasma genitalium.
• Past occurrences of sexually transmitted diseases like Bacterial Vaginosis, AIDS, Gonorrhoea, Syphilis or Candidiasis.
• Engaging in sexual activities from a very young age, having multiple sexual partners or having an infected sexual partner
• Presence of an Intrauterine Device (IUD) for a long time, which facilitates the entry and spread of bacteria
• History of septic abortion
• Surgical removal of a portion of the reproductive tract
• Recent Hysterosalpingography
• In-vitro fertilization
• Occurrence of Endometriosis wherein inflammation of the endometrium occurs due to plasma cell infiltration
• Occurrence of Adenomyosis, where abnormal glandular tissues are present on the myometrium (uterine wall)
• Diseases like Trapped Ovary Syndrome or Residual Ovary Syndrome, which may be accompanied by vascular adhesions (leads to the enlargement of a particular reproductive organ)
• Pelvic congestion caused by the reduced speed of blood flow through the dilated veins of uterus and ovary
• Presence of ovarian cysts or ovarian torsions (adnexal torsions)
• Damage to the musculoskeletal system due to mechanical trauma
• Renal dysfunctions caused by ureteral calculi or kidney stones that directly affect the pelvic health
• Incidences of visceral hyperalgesia which alters the visceral functions in the pelvic region
• Occurrence of Interstitial cystitis or Painful Bladder Syndrome

Symptoms of PID

The common symptoms of Pelvic Inflammatory Disease are discussed below-

• Pelvic pain that radiates to the groin and the lower extremities
• Pain, discomfort, and tenderness in the lower abdomen (usually occurs on both sides)
• Pain and tenderness in the urethra and the urinary bladder (especially when the bladder is full)
• Painful sexual intercourse (dyspareunia)
• Painful bowel movements
• Painful ovulation
• Abnormal vaginal discharge and bleeding (bleeding between consecutive menstrual cycles or after sexual intercourse)
• Foul smelling urine and vaginal discharge
• Pain, irritation and burning sensation while passing urine
• Unpleasant smell from the vagina
• Low-grade fever
• Nausea and vomiting
• Gastrointestinal disorders
• Uterine and cervical tenderness
• Degradation of bladder capacity
• Erectile dysfunctions in men
• Abdominal cramps (after urination, bowel movements or sexual intercourse)
• Rectal bleeding
• Dull ache in the lower back after sitting or standing for a long time
• Abdominal bloating (due to enlargement of any of the infected reproductive organs)
• Heaviness, pressure, and tenderness of the pelvic region
• Weakness, general body ache, and fatigue

Types of pelvic inflammatory disease

Pelvic Inflammatory Disease is generally categorized into two types- Acute and Chronic. Both the types will be discussed below in details-

• Acute Pelvic Inflammatory Disease: Acute PID is manifested as the sudden onset of pain and inflammation in the uterus, fallopian tubes, pelvis, and ovaries. It is caused by a recent bacterial infection. Peritoneal irritation, scarring of the fallopian tube and ischemic attacks may be observed in this case. This condition is usually short-lived and reversible. The symptoms go away within a few months.
• Chronic Pelvic Inflammatory Disease: In chronic PID, the symptoms are more severe and long-lasting. It usually occurs after repeated occurrences of pelvic diseases. Chronic PID may be cyclic or non-cyclic. It is also caused by bacterial infections and is worsened by other pathophysiological factors. Chronic PID is observed mainly in elderly women (above 65 years old). The symptoms persist for several months or even a year. In young women, chronic PID can be a major contributor to infertility.

Complications of Pelvic Inflammatory Disease

Pelvic Inflammatory Disease, when left unattended for a long time may give rise to some serious complications. These are discussed below-

• PID can lead to primary infertility due to the altered capacity of the uterus and severe damage of the main reproductive organs
• Pelvic diseases in the pre-natal stage can lead to maternal and fetal co-morbidities
• Tubo-ovarian abscess and Pelvic Peritonitis
• Fitz-Hugh-Curtis syndrome accompanied by perihepatitis

Diagnosis

The following diagnostic tests are performed for the proper evaluation of Pelvic Inflammatory Disease-

• Cervical and vaginal swab test
• Blood test
• Transvaginal scan (to detect the presence of adnexal masses)
• MRI scan
• Serum CA125 measurement

Treatment and prevention

Since it is a sexually transmitted disease it is best to have regular visits to your doctor if you are sexually active and refrain from having multiple sex partners. Making sure that you get on an antibiotic course to treat the infection as the long-term effects are far more dangerous and painful. If the symptoms are severe you might have to get admitted to the hospital so that the antibiotics and be given intravenously.

Prevention that could be taken are :

• Abstain from having intercourse till your antis biotics have been completed.
• Use birth control as the infection will have a lesser chance to pass on to your partner and following the instructions that have been provided by your doctor.

 
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