Role of Physiotherapy In Pelvic Inflammatory Disease

Pelvic Inflammatory Disease(PID) 
Pelvic inflammatory disease (PID) may be the inflammation of the upper genital tract relating to the fallopian tubes as well as the ovaries. The soreness is often bilateral because most from the PID is caused by the ascending or blood borne infection and also the close anatomic association from the ovaries with the fallopian tubes favors the bilateral involvement, though one tube might be more affected compared to other. The Pelvic inflammatory disease treatment aims to lessen this inflammation and stop further damage to the organs.
Pelvic inflammatory disease causes
The most typical cause of PID is std's (STD)
Most common being gonococcal and chlamydial infections
60-75% of PID is brought on by STD, of which gonorrhea accounts for about 30% within the developed countries
Gonoccoci and Chlamydia travel in the genital tract across the mucous membrane to reach the fallopian salpingo-oophoritis
Other organisms directly ascend across the lining of the genital tract
Other organisms that create PID include mycoplasma, tubercular bacillus, viruses and E. coli. Both aerobes and anaerobes are implicated in PID
Pelvic inflammatory disease Pathology Acute Salpingitis
The fallopian tube is swollen, edematous and hyperaemic with visible dilated vessels around the peritoneal surfaces.
The sure manifestation of salpingitis (inflammation of the fallopian tube) may be the discharge of seropurulent fluid in the fimbrial end of the tube.
The inflammatory exudate is discharged in to the lumen of the tube resulting in adhesions and tubal blockage or narrowing from the lumen which may be the cause of ectopic pregnancy or infertility.
Pelvic abscess might be formed due to pus collection within the pelvic cavity.
The ovaries are participating and a tubo ovarian abscess or mass may result.
In rare cases the problem may spread upwards to result in generalized peritonitis, paralytic ileus and even sub diaphragmatic and perinephric abscess.
In PID following postabortal and puerperal infection, the problem spreads through the cervix via lymphatics towards the cellular tissue causing cellulitis. The fallopian tube is affected externally and the mucous membrane last but not least.
Pelvic inflammatory disease treatment within the acute stage helps limit the problem and prevent long term harm to the fallopian tube and ovaries resulting in adhesions formation, infertility etc. In early stage pelvic inflammatory disease treatment may require administration from the antibiotics but in the later stage surgical drainage from the abscess and adhesions breakdown may be required.

Pelvic inflammatory disease symptoms and signs
The most typical symptom of acute PID is gloomier pelvic pain. Pain is bilateral and limited to lower abdomen.
Pain spreads upwards if general peritonitis ensues.
Pain is severe in acute stage and it is followed by a high temperature. Vomiting could also follow.
Discharge from the vagina and dysuria also occur.
Menstrual irregularity if any, is a result of preceding endometritis in case of ascending infection in order to the antecedent abortion or delivery.
The patient may develop uterine bleeding at any given time when menstruation isn't expected and the bleeding is usually profuse and prolonged.
In case of pelvic abscess, the individual develops severe diarrhea because of rectal irritation.
Investigations in Pelvic inflammatory disease
Haemoglobin, leucocyte count and ESR.
Cervical and vaginal swab culture for both aerobic and anaerobic organisms.
Blood culture if bacteraemia takes hold. C reactive protein distinguishes between infective and non infective mass.
Ultrasound: Tubo-ovarian abscess appears around the ultrasound.
Computed tomography shows a spherical or tubular structure having a low attenuation center.
Pelvic inflammatory disease treatment
Pelvic inflammatory disease treatment aims to lessen the inflammatory process thereby arresting the development of the organisms resulting in the disease. Since 60-75% of PID come from Sexually transmitted diseases, treatment consists of pharmacological therapy (antibiotics) to eradicate the causative organisms together with supportive therapy for the control over other symptoms. Surgical treatment are usually necesary in case of extensive damage.
Pelvic inflammatory disease treatment in Acute stage:
 Pelvic inflammatory disease treatment within the acute stage includes removal of the causative organisms by proper administration from the antibiotics.
 Mild cases are treated at home with antibiotics.
 Moderate and severe cases of Pelvic inflammatory diseases may require hospitalization.
Hospital management includes:
Rest
Intravenous fluids within the presence of dehydration or vomiting and correction of electrolytic imbalance.
Antibiotics are mandatory to become instituted at the earliest for the pelvic inflammatory disease treatment before the diagnosis is made. Initially, intravenous route is resorted to, however when the infection settles down, oral therapy might be started.
Antibiotics like tetracycline, erythromycin, doxycycline, clindamycin work against both aerobic and anaerobic bacteria. Newer antibiotics include cefoxitin, cefotetan, doxycycline etc can be utilized for the pelvic inflammatory disease treatment. Surgical treatment may be required in the following conditions:
Drainage of the pelvic abscess.
Dilatation and evacuation of septic products of conception or for haemorrhage in postabortal sepsis.
Acute spreading peritonitis and intestinal obstruction.
Physiotherapy management within the acute pelvic inflammatory disease aims to lower the pain and inflammation combined with the pharmacological therapy. In mild and moderate cases of Pelvic inflammatory disease in which the patient does not need hospitalization, pain relieving modality like short wave diathermy could be given.
Short wave diathermy is really a deep heating modality, produces heat both in deep and superficial tissues. Within the acute stage very mild or pulsed short wave diathermy can be used to promote healing and lower pain.
For the Pelvic inflammatory disease treatment short wave diathermy could be given for 5-10 minutes for a time of three days a week while using cross- fire method of diathermy. Cross-fire method involves moving the electrodes to some position at right angles for their previous position midway through the treatment. Half the Pelvic inflammatory disease treatment is offered antero-posteriorly through the pelvis using the patients in the lying position and 2nd half in the side lying using the legs curled up or perhaps in sitting position and also the electrodes placed over the pelvic outlets and also the lumbo-sacral area of the spine.
Pelvic inflammatory disease treatment in Chronic stage: 
Physiotherapy control over the pelvic inflammatory disease within the chronic stage is aimed at:-
Relieving pain.
Promote healing round the area.
Treat existing musculoskeletal dysfunction or prevent further musculoskeletal dysfunction.
Increase function.
Pelvic inflammatory disease treatment modalities contain:-
Short wave diathermy: it's widely known that short wave diathermy may be used to reduce pain and swelling, accelerate the soreness process and promote healing in tissues with chronic inflammation. It results in increased circulation round the area by vasodilatation resulting in better healing. Additionally, it increases the metabolic activity from the area leading to more nutrients, more cellular activity and healing and increasing collagen extensibility. It will help in the repair of pelvic microcirculation, thus enabling lysis of scar tissues, relaxation of contracted muscles within the pelvis and pelvic floor.
For the pelvic inflammatory disease treatment within the chronic stage short wave diathermy is offered for 15-30 minutes, two times a day for thrice per week using the cross-fire method of treatment.
Electrical stimulation as Transcutaneous electrical nerve stimulation (TENS) towards the low back for the symptomatic elimination of low back pain can be given. TENS works at both spinal-cord level and higher brain centres to inhibit the transmission of nocioceptors thus relieving the thought of pain.
Moist hot pack could be given the low back to alleviate pain in the back.
The pelvic floor muscles in females in the chronic PID might be in the hypertonic state because of pain, delayed healing, scarring adhesions or generalized spasm through the pelvic floor tissues. Pelvic floor rehabilitation is suggested for the pelvic inflammatory disease treatment such patients.
Teaching control and relaxation from the pelvic floor musculature is important during these patients. Biofeedback including surface EMG may be used to induce relaxation during these muscles.
For strengthening the pelvic floor musculature instruct the individual to tighten the pelvic floor as though attempting to stop the the flow of urine. Hold for 3-5 seconds and relax. Repeat Ten times per session. These exercises are through with empty bladder.
Elevator exercises : instruct the girl to visually imagine traveling in an elevator. As the elevator goes in one floor to the other, contract the muscles a bit more. Relax the muscles gradually, as though the elevator were descending one floor at any given time.
For treating a woman with hypertonus, boost the rest time between your pelvic floor contractions and sets. Focus on relaxation is equally important for weight training in these clients. Utilization of surface EMG for feedback is invaluable for enhancing understanding of holding patterns and resting tone.
Instruct the girl to contract the pelvic floor as with the strengthening exercises then allow total voluntary release and relaxation from the pelvic floor muscles. This activity could be coordinated with breathing. Instruct the girl to concentrate on a slow deep breath slowly and allow the pelvic floor to totally relax.

Surgical treatment might be indicated in the chronic pelvic inflammatory disease in which the extent of damage is much more. Tubal damage may require tuboplasty. Laproscopic breaking of adhesions is indicated when the tubal blockage is due to external adhesions. Overall surgery depends on the age and parity from the patient, the symptoms and pelvic pathology.For prevention against Pelvic inflammatory disease, delivery should be conducted in the hospitals, contraceptive devices like barrier methods can be used to prevent sexually transmitted diseases and also the young women should be educated concerning the risk of STDs and its prevention.