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Chronic Pelvic Inflammatory
Chronic pelvic inflammation is refers to the female internal genital organs and the surrounding connective tissue, chronic inflammation of the pelvic peritoneum.Often in the treatment of acute pelvic inflammation is not thorough, in patients with poor physical condition, the clinical course of acute pelvic inflammatory disease in delay and break out repeatedly, cause chronic pelvic inflammation;But can also be no history of acute pelvic inflammation process, such as chlamydia trachomatis infection caused by salpingitis.Chronic pelvic inflammatory disease is stubborn, can cause menstrual disorders, leucorrhea increase, waist and abdomen pain, and infertility.
The cause of
1. Immune factors
When natural defense function is destroyed, or the body's immune function decline, endocrine change or invasion of exogenous pathogenic bacteria, can cause inflammation.
2. The illness migration
Acute pelvic inflammatory disease treatment, has not been thoroughly, illnesses out and chronic pelvic inflammation;Also may be due to adjacent organs inflammation spread directly, such as appendicitis, spread to the pelvic cavity peritonitis, lead to the occurrence of chronic pelvic inflammatory disease.The pathogen is given priority to with e. coli.
3. The chlamydial infection
Can patients without acute pelvic inflammatory disease, which caused by chlamydia trachomatis infection.
4. The pathological changes
Acute pelvic inflammation for chronic pelvic inflammation pathological changes of the left, there is no pathogens.
5. After postpartum, miscarriage and gynecologic surgery
Liquid such as curettage, fallopian tube, uterus salpingography, hysteroscopy examination, abortion and so on various has certain harm to the pelvic surgery and invasive procedures, or not strictly abide by the principles of sterile and can lead to reproductive tract mucosa damage, hemorrhage, necrosis, lead to the genital tract of endogenous flora pathogens uplink infection.
6. Related to sex and age
Pelvic inflammation in sexually active women, especially the first sexual intercourse age, have multiple partners, frequency of sex and sexual partner sexually transmitted diseases.
7. The lower genital tract infection
The genital tract of sexually transmitted diseases, such as bacteria neisseria gonorrhea sexual cervicitis, chlamydia cervicitis and bacterial vaginal disease be able to connect the lower genital tract with the pelvic, leading to pelvic inflammation.
8. Poor sexual health
Since during menstruation sex, using unclean sanitary towel, bath, etc., all can make pathogens and cause inflammation.In addition, do not pay attention to sexual health care, neglected the vagina flushing, the incidence of pelvic inflammatory disease.
9. The chronic pelvic inflammatory disease (PID) acute episodes
PID caused by pelvic adhesion, tubal damage extensively, fallopian tube defensive ability, easy cause infection again, recurrent illness, acute episodes of chronic pelvic inflammatory disease.
Clinical manifestations of
Chronic pelvic pain (1) chronic inflammation of the formation of scar adhesion and pelvic congestion, often causes lower abdominal pain belly, and lumbar di ministry ache.Often in overworked, prolonged standing, after intercourse and menstrual around intensified.The person that weigh affects my work.
(2) of infertility and ectopic pregnancy, tubal adhesion obstruction can cause infertility and ectopic pregnancy.The incidence of infertility was 20% ~ 30% after acute pelvic inflammatory disease.And with the development of the illness, infertility rates rise.
(3) abnormal menstrual endometrial inflammation often have increased leucorrhea, menstrual disorders, volume more dysmenorrhea, dyspareunia.Pelvic congestion can cause the quantity increase;Ovarian function damage can cause menstrual disorders.
(4) the systemic symptom is not obvious, sometimes only a low-calorie, susceptible to fatigue.Because the course of the disease for a long time, some patients can appear neurasthenia symptoms, such as fatigue, general malaise, insomnia, etc.When patients with poor resistance, easy to have acute or subacute onset.
2. The signs
Pour, after more than general signs: uterine activity limited or adhesion fixed;Or enlargement of the fallopian tube tenderness;Or hit a cystic mass;Or parametric flake thickening of tenderness, etc.
(1) if the endometritis, uterus increases, tenderness;If for salpingitis, at the side of the uterus or touched the cable strip the enlargement of fallopian tube, and had mild tenderness.
(2) if the hydrosalpinx or tubal ovarian cyst, hit either one or both in the pelvic cystic neoplasm, activity more limited.
(3) for pelvic connective tissue inflammation, uterine often assumes the backward of retroflexion, restricted or adhesion fixed, the uterus on one or both sides have a flake thickening, tenderness, palace sacral enlargement often ligament, harden, with tenderness.
1. B ultrasonic inspection
Broadening, thickening can investigate on both sides of the attachment, or an inflammatory mass.
2. The uterus oviduct iodine oil imaging
Can show the situation of the fallopian tube obstruction, including the region and the degree of obstruction, is conducive to symptomatic treatment.
3. Histopathological examination
Microscopically checked organizations of inflammatory hyperplasia.
4. Other tests
Blood routine examination, vaginal examination, tumor markers check, polymerase chain reaction test.In addition, colposcope, laparoscopy also is helpful for diagnosis of chronic pelvic inflammatory disease.
The diagnosis of chronic pelvic inflammatory disease according to the history, symptoms and related inspection of department of gynaecology, general can make a diagnosis.But sometimes the patient subjective symptom more, while no significant history of pelvic inflammatory disease and positive signs, should be more careful in the diagnosis of chronic pelvic inflammatory disease.
Enhance the confidence of the treatment, increase nutrition, exercise, pay attention to the mix, improve the body's resistance.To prevent the spread of infection or infection range again.
2. Physical therapy
Warm can promote pelvic local blood circulation, improve tissue nutrition state, improve metabolism, facilitate inflammation absorption and fade.At the same time, cooperate with related drug treatment, can promote the body's absorption and utilization.Commonly used have shortwave, ultrashort wave, microwave, laser, ion penetration (can join all kinds of drugs such as penicillin, streptomycin, etc.), etc.
3. Antibacterial drugs
Long-term or repeated combination therapy of antibacterial drugs are sometimes no significant curative effect, but for the young to retain reproductive function, or can be applied to acute onset, at the same time adopt best against chlamydia or mycoplasma drug.
4. Other drugs
Application of antimicrobial drugs at the same time, also can use chymotrypsin or hyaluronidase (hyaluronidase), intramuscular injection, the next day 1, 7 ~ 10 times for a period of treatment, to facilitate the absorption of adhesion decomposition and inflammation.Local or systemic appear allergy should be individual patient.In some cases, antibiotics and dexamethasone applications at the same time, oral dexamethasone, 3 times a day, before the withdrawal notice do dexamethasone gradually reduced.
5. Surgical treatment
Applicable to some patients with chronic pelvic inflammatory disease, due to long-term inflammation stimulation, cause adhesion around organs, anti-inflammatory drugs is not easy to enter, cause an illness to break out repeatedly, can use surgical treatment.
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