Gynecologic Facts & Myths

Back Pain: Gynecologic Facts & Myths BY

Mohammad A. Emam Prof. OB& GYN Mansoura Faculty of Medcine Mansoura integrated fertility center (MIFC) EGYPT www.ivfmifc.com

What is backache ? Is stiffness and/or pain in the back

RATIONALE &CONCEPT Although back pain (BaP) is a common complaint, but it is a forgotten topic in most Ob& Gyn text books. BaP represents a dilemma for the gyaecologists ,as many myths, facts and fictions not resolved by evidence- based data. Era of complementary and alternative medicine ( CAM ).

Epidemiology  Female

> male.  The second common complaint after headache  30-90 % in pregnancy.

Epidemiology cont… Rarely due to any

serious disease. Sometimes a clear cause but mostly no cause can be elicited.

Causes of BaP in Women A. Obstetric (pregnancy associated BaP). B. Gynecologic. C. Others:      

Ligaments. Muscular. Bones and joints. Referred (renal, rectal). Psychological. Metabolic.

Gynaecologic Causes          

Prolapse (uterine). RVF. Ch. Cervicitis. Tumours. Endometriosis. Pelvic congestain. PMTS. Ut. Contractrains (polyp). Menst. Molimia. Osteoporosis

Diagnosis (Milestones) 

BaP caused by a gynecologic lesion:  Always diffuse.  Midline OR bilat.  Sacral, lumbo sacral and never high

than L4 (LBP).

 BaP

which can be pointed with a finger tip ± local tenderness not due to intrapelvic lesion.

Role Of Gynaecologist 1. Determine cause: History – Exam – Invest.

2. If no cause:



Reassurance. Correction of posture. Exercises. Simple drugs. Complementay &Alternative medicine.



Psychological.

   

3.Consultation (Referral if serious problem is suspected).

Correction Of Posture Advices: Stand up straight (smart).  Drop your shoulders and relax your knees when standing.

Correction Of Posture cont..  Sit

well back into your chair, legs slightly apart with both feet flat on the ground.

Correction Of Posture cont.. In front of a computer screen:  Sit up straight  Keep your feet

slightly raised off the floor on a footstool or other low object.

Correction Of Posture cont..

 Always

bend from your knees and lift objects and children from a crouching position to minimize the stress on your back.

Correction Of Posture cont.. 

Maintain your weight within the given parameters of weight gain.  Avoid standing for long periods of time.

SPINAL EXERCISES

EXERCISES . Simple exercises (curative). .Activity not bed rest.

1. WAIST ROTATION

2. HIP ROTATION

3. SPINAL STRETCHSIDE TO SIDE

4. SPINAL STRETCHFORWARD AND BACK

5. TORSO-TWIST

6. PELVIC ROCK

Alternative & Complementary Medicine(CAM)  Acupuncture

and acupressure.  Herbs (wheat oil……).  Aromatherapy (essential oils added to bath water).  Massage and manual therapies (Chiropractic care).

Alternative & Complementary Medicine cont….  Hypnosis,

music therapy, yoga as well as breathing exercises.  TENS & PENS.  Cupping.

Praying.

Acupuncture & BaP In early pregnancy is not advised because can promote abortion

TENS & PENS 

TENS: transcutaneous

electric N. stim.  PENS: percutaneous electric N. stim.  PENS

is more effective than TENS because it combines advantages of TENS + elect. Acupuncture.

Cupping (baguanfa) Cupping therapies often follow the point selection pattern that is used for standard acupuncture therapy.

Chiropractic "Chiropractic “comes from the Greek word Chiropraktikos, meaning "effective treatment by hand”  "Science based on the theory that health and disease are life processes related to the function of the nervous system. 

Gynecological Role cont…. Referral to: Physiotherapist.  Osteopath.  when

serious problem is suspected

Back pain with possible serious features (Royal c of radiologists guidelines)

• • • • • • • • •

Onset < 20, >55 yrs. Sphincter or gait disturbance. Saddle anaesthesia. Severe or progressive motor loss. Widespread neurological deficit. Previous cancer. Weight loss. Steroids. Structural deformity.

Psychological In majority No gross lesion.  Patient is handed from physician to Gynecolog. to orthopedic to surgeon.  Anxiety neurosis sequalae. 

FACTS OR FICTIONS;;  Cervical

erosion (ectopy) never causes back pain.  Vaginal prolapse never cause backache.  Uterine prolapse and RVF rarely cause dragging pain on uterosacral and cardinal ligaments.

Myths & Back Pain.  Lifting

E S AL

heavy F objects causes back pain.

E to cure a bad S rest is the bestLway A F back.

 Bed

E cat scans and MRI can always S L A identify the cause F of back pain.

 X-rays,

E back pain will eventually need S L A surgery. F

 Most

OB& GYN, Mansoura Faculty of Medicine Mansoura Integrated Fertility Center (MIFC) EGYPT Telfax 0020502319922 & 0020502312299 Email. [email protected] www.ivfmifc.com