Homoeopathic management in Pelvic inflammatory disease
Abstract
Pelvic inflammatory disease is the inflammation of upper genital tract, due to infection in women. Most frequently women ages of 15 to 25 years are mostly affected, most common micro organisms which cause pelvic inflammatory disease are Chlamydia trachomatis and Neisseria gonorrhoeae and Genital Mycloplasm Homoeopathic treatment is effective in acute and chronic pelvic inflammatory disease and also prevents from further complications.
Key words
Pelvic inflammatory disease , microorganisms – neisseria gonorrhoeae, Chlamydia trachomatis , genital mycloplasms , homoeopathic management .
Introduction
Pelvic inflammatory disease is the inflammation of upper genital tract involving uterus ,fallopian tubes and ovaries .the ovaries are anatomically closely linked to fallopian tubes so usually ovaries gets involved in infections . mumps is only condition were ovaries only are selectively affected .
Pathogenic organisms from lower genital tract ascends to endocervix causing endometritis , salphingitis and even sometimes peritonitis .
Epidemiology
Hospital admission rates of pelvic inflammatory disease are 17% to 40% of gynecological admissions in sub-Saharan Africa, 15% to 37% in Southeast Asia, and 3% to 10% in India. Incidence of pelvic inflammatory disease in India varies from 1-2%.
Current changes in epidemiology are Chlamydia infection is seen than gonorrhea , clinical presentation .
Risk factors
The women of reproductive age group especially under 25 years , multiple sexual partners , unprotected sexual intercourse , women living in area were prevalence of sexually transmitted diseases are high .
Etiology
The microorganisms commonly causing pelvic inflammatory disease are Chlamydia trachomatis and Neisseria gonorrhoeae and genital mycoplasma . Gonorrheal infection is usually asymptomatic were commonly presents with vaginal infection or dysuria , though being asymptomatic gonorrhoea can cause serious complications .chlamydia is most common sexually transmitted bacteria , in the life cycle of Chlamydia it has two morphologically distinct life stages: elementary bodies and reticulate bodies. Elementary bodies are spore-like and infectious, whereas reticulate bodies are the replicative stage and are seen only within host cells. Mostly asymptomatic or produce minimum symptoms and therefore infection goes unnoticed but damage it causes to fallopian tube is devastating than gonorrhoea . Genital mycloplasm ( M. hominis and M.urealyticus ) commonly occurs as sexually transmitted and the women who had taken lot of antibiotics , this organism has resistance to antibiotics , symptom’s are mostly similar to that of Chlamydia infection.
Pathophysiology
• There are several natural barriers to prevent the ascent of the pathogens to the upper genital tract. Intact hymen prevents ascending infection.
• The acidity of vaginal secretion often inhibits growth of bacteria, cervical canal has relatively small lumen and is filled with alkaline mucus .
• The ciliary movement of the endometrial lining of uterus and cervix often directed downwards and prevents ascending of microorganism to the cavity of the uterus .
This protective mechanism is disrupted due to menstruation, abortion, delivery were the cervical canal becomes dilated, the protective epithelium of the endometrium and is shed , the vaginal PH is increase rendering the genital tract more vulnerable to the infections .
• The procedures like dilatation and curettage, manual removal of placenta, intrauterine contraceptive device also is a source of infection when it is not done under aseptic condition.
• In addition, antibiotic treatment of sexually transmitted infections can disrupt the balance of endogenous flora in the lower genital tract, causing normally nonpathogenic organisms to overgrow and ascend.
Signs and symptoms
o Pain in lower abdomen, bilaterally, back and vagina. pain will be severe in acute stages and accompanied with high temperature, vomiting may also be accompanied
o Pain circumstances : during sexual intercourse and urination
o Cervical motion tenderness and vaginal discharge and vaginal odor
o Painful menstruation, menstrual irregularities, prolonged inter-menstrual bleeding, also history of amenorrhea is seen .
o In case of pelvic abscess in addition to above symptoms there will be severe diarrhea and passes small quantity of loose motions due to rectal irritation.
Clinical diagnosis
Lower abdomen pain
Cervical motion tenderness
High temperature
Muco purulent discharge per vagina
Investigations
Identification of Organism – Discharge from urethra
Cervical Canal -C. trachomatis
Serological test includes- raised ESR
Leucocytosis
Laproscopy
sonography – Abdomen and Pelvis
Culdocentesis
Complications
Immediate :
pelvic peritonitis
septicemia
Late :
Dyspareunia ,
Infertility -50% after 3 episodes of infection
Formation of adhesions in fallopian tube
Hydrosalpinx
Chronic pyosalpinx
Chronic pelvic pain
Increased risk of ectopic pregnancy.
HOMEOPATHIC MANAGEMENT
THERAPEUTICS
Agnus castus
Scanty, menses abhorrence of sexual intercourse. Relaxation of genitals, with leucorrhoea .sterility, leucorrhoea staining yellow, transparent.
Alumina
Menses too early and scanty followed by exhaustion. Leucorrhea acrid, profuse, transparent, ropy, with burning worse daytime and after menses, relieved by washing in cold water .
Ambra grisea
Nymphomania, itching of pudendum, with soreness and swelling, menses too early, profuse, bluish leucorrhea . Worse at night. Discharge of blood between periods, at every little accident.
Ammonium muriaticum
Leucorrhea like white of an egg with pain about the navel,brown , slimy after every urination . menses too early ,dark and clotted , flow more at night .
Apis mellifica
Edema of labia, relived by cold water. Soreness and stinging pains , ovaritis, worse right ovary, menses suppressed with cerebral and head symptoms especially in young girls dysmenorrhoea with severe ovarian pains ,metrorrhagia profuse, with heavy abdomen, faintness, stinging pain, bearing down as if menses were to appear endometritis with stinging pains , great tenderness over abdomen and uterine region .
Arsenicum Album
Menses too profuse. Burning in ovarian region . leucorrhea , acrid , burning, offensive, thin. pain as from red-hot wires :worse least exertion cause great fatigue better in warm room , menorrhagia . Stitching pain extending to thighs .
Belladonna :
Congestion of genitals, dryness and heat of vagina, dragging pains in loins , menses hot and offensive bright red in colour , pain comes and goes suddenly, leuchorrea with colicky pain.
Borax
Leucorrhea like white of an egg , with sensation as if warm water flowing. Menses too soon, profuse with pain in abdomen and nausea , membranous dysmenorrhoea . sterility , pruritus vuluva.
Bovista
Menses too early and profuse diarrhea like symptoms during menses , leucorrhea acrid , thick tough, greenish follows menses , cannot bear tight clothing around the waist , trace of blood in between the menstruation cycle, soreness of pubes during the menses , parovrian cyst.
Bryonia
Stitching pain in the ovaries , very sensitive to touch ,pain in right ovary and extending to thighs menstrual irregularities , bleeding with great abdominal soreness and pelvic soreness.
Caladium
Pruritus vuluva and vagina , voluptuness, cramp like pain in uterus at night .
Cantharis
Expels retained placenta , moles , membranes ,puerperal metritis with inflammation of bladder , black swelling of vulva with irritation , constant discharge from uterus worse false step .burning pain in ovaries extremely sensitive , pain in coccyx lancinating and tearing.
Cimcifuga racemosa
Amenorrhea , pain in ovarian region, shoots upward and down anterior part of the thighs menses dark, coagulated , offensive , with backache, ovarian neuralgia ,pain across pelvis from hip to hip.
Fagopyrum
Pruritus vulva, with yellow leucorrhea , worse rest , burning pain in right ovary
Hamamelis
Ovarian congestion and neuralgia , menses dark and profuse with soreness and pain in back . metrorrhagia, occurring midway between menstrual periods . intermenstural pain , vagina very tender . profuse leuchorrhea , vulva itches , vaginusmus and ovaritirs with soreness all over the abdomen .
Kreosotum
Corrosive itching within vulva , burning ad swelling of labia , violent itching between labia and thighs, leucorrhoea , yellow , acrid, odor of green corn ,worse in between the periods . hemorrhages after coition ,menstrual flow intermits,pain worse after menses .
Lachesis
Inflammation of ovaries , left ovary pain full and swollen , indurated ,pain in sacrum especially on rising from sitting position . pains all are relived by menstrual flow.
Magnesium phosphoricum
Menstrual colic, menses too early , dark and stringy, swelling of external pats, ovarian neuralgia, vaginismus .
Medorrhinum
Ailments from suppressed gonorrhea , intense pruritus , menses offensive and dark, leucorrhea , acrid excoriating, fishy odor , ovarian pain worse on left side , or from ovary to ovary ,sterility , inter menstrual colic, metrorrhagia .
Palladium
Acute pelvic peritonitis , cutting pain in uterus better after stools , pain and swelling of right ovary , bearing down pain in the pelvis , better by rubbing . glairy leucorrhea.
Platina
Parts hypersensitive , ovaries sensitive and burn , menses early , profuse and dark with spasm and bearing down pains , vaginusmus , nymphomania , pruritus vulva.
Natrum Muriaticum
Leucorrhea acrid,watery.suppressed menses. Vagina dry. Menses irregular profuse .
Sepia
Leucorrhea yellow ,greenish ,with must itching.menses too late and scanty .irregular early and profuse. violent stitches upward in vagina, from the uterus to the umbilicus. Vagina painfull,especially during coition.
References
• Shaw’s textbook of gynecology by VG Padubidi and Shirish N Daftary
• Essentials of obstetrics’ and gynecology by Hacker and Moores
• Pelvic inflammatory disease NCBI by Jonathan DC Ross
• Homoeopathic materia medica by William boericke .
• Allens keynote H.C Allen
