Back Pain:Gynecologic Causes BY Hieder A`ala 601 MUST UNIVERSITY
What is backache ?Is stiffness and/or pain in the back
RATIONALE &CONCEPT Although back pain is a common complaint, but it is a forgotten topic in most Ob& Gyn text books. backache represents a dilemma for the gyaecologists ,as many myths, facts and fictions not resolved by evidence- based data.
Epidemiology 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 WomenA. Obstetric (pregnancy associated BaP).B. Gynecologic.C. Others: Ligaments. Muscular. Bones and joints. Referred (renal, rectal). Psychological. Metabolic.
Diagnosis (Milestones) backache caused by a gynecologiclesion: Always diffuse. Midline OR bilat. Sacral, lumbo sacral and never high than L4 (LBP).backache which can be pointedwith a finger tip ± local tenderness not due to intrapelvic lesion.
Role Of Gynaecologist1. 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 PostureAdvices: Stand up straight (smart). Drop your shoulders and relax your knees when standing.
Correction Of Posture cont..Sit well back into your chair, legsslightly apart with both feet flat onthe ground.
Correction Of Posture cont..In front of acomputer 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 yourknees and lift objectsand children from acrouching position tominimize the stress onyour back.
Correction Of Posture cont..Maintain your weight within the givenparameters of weight gain.Avoid standing for long periods oftime.
Alternative & Complementary Medicine(CAM)Acupuncture and acupressure. Herbs (wheat oil……). Aromatherapy (essential oils addedto bath water). Massage and manual therapies(Chiropractic care).
Alternative & Complementary Medicine cont…. Hypnosis, music therapy, yoga as well as breathing exercises. TENS & PENS. Cupping.
Acupuncture & backache In earlypregnancy isnot advisedbecause can promote abortion
TENS & PENSTENS: transcutaneouselectric N. stim. PENS: percutaneouselectric N. stim.PENS is more effectivethan TENS because itcombines advantages ofTENS + elect. Acupuncture.
Chiropractic "Chiropractic “comes from theGreek word Chiropraktikos,meaning "effective treatment byhand” "Science based on the theorythat health and disease are lifeprocesses related to the functionof 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 majorityNo gross lesion. Patient is handedfrom physician toGynecolog. toorthopedic tosurgeon. 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 heavy objects E L Scauses back pain. FA SEBed rest is the best way to cure a bad back. FALX-rays, cat scans and MRI can alwaysidentify the cause of back pain. AL SE FMost back pain will eventually need surgery. AL SE F