Gyn backpain

Back PainBack Pain: : GynecologicGynecologic CausesCauses

BYBY

Hieder A`alaHieder A`ala

601601

MUST UNIVERSITYMUST UNIVERSITY

What is backacheWhat is backache ? ?

Is stiffness Is stiffness andand//oror pain in the backpain in the back

RATIONALE &CONCEPTRATIONALE &CONCEPT

Although back pain Although back pain is a common is a common complaint, but it is a forgotten topic in complaint, but it is a forgotten topic in most Ob& Gyn text books.most Ob& Gyn text books.

backache represents a dilemma for backache represents a dilemma for the gyaecologists ,as many myths, the gyaecologists ,as many myths, facts and fictions not resolved by facts and fictions not resolved by evidence- based data.evidence- based data.

EpidemiologyEpidemiology The second common The second common

complaint after headachecomplaint after headache 30-90 % in pregnancy30-90 % in pregnancy..

Epidemiology Epidemiology cont…

Rarely due to any Rarely due to any serious disease.serious disease.

Sometimes a clear Sometimes a clear cause but cause but mostly mostly no cause can be no cause can be elicited.elicited.

Causes of BaP in Causes of BaP in WomenWomen

A. Obstetric (pregnancy associated BaP).A. Obstetric (pregnancy associated BaP).

B. Gynecologic.B. Gynecologic.

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

Gynaecologic CausesGynaecologic Causes Prolapse (uterine).Prolapse (uterine). RVF.RVF. Ch. Cervicitis.Ch. Cervicitis. Tumours.Tumours. Endometriosis.Endometriosis. Pelvic congestain.Pelvic congestain. PMTS.PMTS. Ut. Contractrains (polyp).Ut. Contractrains (polyp). IUDIUD OsteoporosisOsteoporosis

Diagnosis (Milestones)Diagnosis (Milestones) backache caused by a gynecologic backache caused by a gynecologic lesion:lesion:

Always diffuse.Always diffuse. Midline OR bilat.Midline OR bilat. Sacral, lumbo sacral and never high Sacral, lumbo sacral and never high than L4 (LBP).than L4 (LBP).

backachebackache which can be pointed which can be pointed with a finger tip with a finger tip ±± local tenderness local tenderness

not due to intrapelvic lesion.not due to intrapelvic lesion.

Role Of GynaecologistRole Of Gynaecologist

1.1. Determine cause:Determine cause:History – Exam – Invest.History – Exam – Invest.

2.2. If no cause:If no cause: Reassurance.Reassurance. Correction of posture.Correction of posture. Exercises.Exercises. Simple drugs.Simple drugs. Complementay &Alternative medicine.Complementay &Alternative medicine.

Psychological.Psychological.

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

Correction Of PostureCorrection Of Posture

Advices:Advices:Stand up straight (smart).Stand up straight (smart).

Drop your shoulders and relax Drop your shoulders and relax your knees when standing.your knees when standing.

Correction Of PostureCorrection Of Posturecont..cont..

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


In front of a In front of a computer screen:computer screen:

Sit up straightSit up straight

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


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


Maintain your weight within the given Maintain your weight within the given parameters of weight gain. parameters of weight gain.

Avoid standing for long periods of Avoid standing for long periods of time.time.

SPINAL EXERCISESSPINAL EXERCISES

EXERCISESEXERCISES

. Simple exercises (curative).. Simple exercises (curative).

..Activity Activity not bed rest.not bed rest.

1. WAIST ROTATION1. WAIST ROTATION

2. HIP ROTATION2. HIP ROTATION

3. SPINAL STRETCH-3. SPINAL STRETCH-SIDE TO SIDE SIDE TO SIDE

4. SPINAL STRETCH-4. SPINAL STRETCH-FORWARD AND BACK FORWARD AND BACK

5. TORSO-TWIST5. TORSO-TWIST

6. PELVIC ROCK6. PELVIC ROCK

Alternative & Complementary Alternative & Complementary MedicineMedicine(CAM)(CAM)

Acupuncture and acupressure.Acupuncture and acupressure.

Herbs (wheat oil……).Herbs (wheat oil……).

Aromatherapy Aromatherapy (essential oils added (essential oils added to bath water)to bath water)..

Massage and manual therapies Massage and manual therapies ((Chiropractic care).Chiropractic care).

Alternative & Complementary Alternative & Complementary Medicine Medicine cont….

Hypnosis, music therapy, yoga as Hypnosis, music therapy, yoga as well as breathing exercises.well as breathing exercises.

TENS & PENS.TENS & PENS.

Cupping.Cupping.

Acupuncture & Acupuncture & backachebackache

In early pregnancy In early pregnancy is not advised is not advised because can because can

promote abortionpromote abortion

TENS & PENSTENS & PENS

TENS:TENS: transcutaneous transcutaneous electric N. stim.electric N. stim.

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

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

ChiropracticChiropractic "Chiropractic “comes from the "Chiropractic “comes from the Greek word Greek word Chiropraktikos,Chiropraktikos, meaning "effective treatment by meaning "effective treatment by hand”hand”

"Science based on the theory "Science based on the theory that health and disease are life that health and disease are life processes related to the function processes related to the function of of the nervous system.the nervous system.

Gynecological Role Gynecological Role cont….cont….

ReferralReferral to:to:Physiotherapist.Physiotherapist.

Osteopath.Osteopath.

when when serious serious problem is problem is suspectedsuspected

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

guidelines)guidelines)

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

PsychologicalPsychological

In majorityIn majority No gross lesion.No gross lesion. Patient is handed Patient is handed from physician to from physician to Gynecolog. to Gynecolog. to orthopedic to orthopedic to surgeon.surgeon. Anxiety neurosisAnxiety neurosis

sequalae. sequalae.

FACTS OR FICTIONS;;FACTS OR FICTIONS;;Cervical erosion Cervical erosion (ectopy)(ectopy) never never causes back pain.causes back pain. Vaginal prolapse never cause Vaginal prolapse never cause backache.backache.Uterine prolapse and RVFUterine prolapse and RVF rarely rarely cause dragging pain on uterosacral cause dragging pain on uterosacral and cardinal ligaments.and cardinal ligaments.

Myths & Back Pain.Myths & Back Pain.

FALSE

FALSE

FALSE

FALSE

Lifting heavy objects causes back pain.Lifting heavy objects causes back pain.

Bed rest is the best way to cure a bad backBed rest is the best way to cure a bad back..

X-rays, cat scans and MRI can always X-rays, cat scans and MRI can always identify the cause of back pain.identify the cause of back pain.

Most back pain will eventually need surgery.Most back pain will eventually need surgery.

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Gyn backpain