Pelvic inflammatory disease is an infectious disease of the genital tract and reproductive system in women. It happens when the causative organism, mostly bacteria spread from the vagina upwards to the uterus, fallopian tubes or ovaries. It may occur naturally or it can be sexually transmitted. PID develops mostly in sexually active women in their reproductive age.
Apart from the discomforts it causes, PID is the leading cause of infertility for women in many countries. The severity of signs and symptoms may vary. Some women don’t experience any signs or symptoms. So, it gets diagnosed accidentally as a part of infertility treatment. Some cases can be showed up asking treatment for only a dull & chronic pelvic pain. At times, symptoms are confused with appendicitis, ectopic pregnancy, or ovarian cysts. It can be diagnosed through pelvic ultrasound or laparoscopy. Treatment is done with antibiotics and antimicrobial agents. More than one cycle of treatment will be needed to clear PID completely in most cases.
Signs & symptoms
Some women will not have any symptom at all. Signs and symptoms can be mild or severe. They include:
- Pain in the lower abdomen and hip
- Abnormal or heavy vaginal discharge with unpleasant smell
- Abnormal uterine bleeding, especially during or after intercourse
- Pain during intercourse
- Fever, sometimes with chills
- Painful, frequent or difficult urination
Causes
Most common cause is infection from a bacterium like Gonorrhoea or Chlamydia
Risk factors
Sexually active, younger than 25 years old
Multiple sexual partners
Sexual relationship with a person who has more than one sex partner
Unsafe sex with direct contact
Regular use of douche, that alters the balance of good and harmful bacteria in the vagina
History of pelvic inflammatory disease or a sexually transmitted infection
Insertion of an intrauterine device (IUD).
Pathophysiology
Most cases of PID occur in 2 stages. One is acquisition of a vaginal infection. This infection is often sexually transmitted and may be asymptomatic. Second is direct ascent of germs from the vagina or cervix to the upper genital tract, with infection of more organs.
The mechanism of this ascend is unclear. Studies suggest that multiple factors are involved. Cervical mucus is a functional barrier against this spread, but the efficacy of this barrier may be lessened by vaginal inflammation or hormonal changes that occur during ovulation and menstruation. Antibiotic treatment of infections can alter the balance of endogenous flora in the lower genital tract. Opening of the cervix during menstruation, along with retrograde menstrual flow, may also help the ascent of microorganisms. Bacteria may also be carried along with sperm into the uterus and fallopian tubes.
In the upper genital tract, infection of the fallopian tubes initially affects the mucosa, but inflammation can quickly become transmural. This inflammation, can be more severe with subsequent infections. Inflammation may extend to uninfected parametrial structures, including the bowel. Infection may extend via spillage of purulent materials from the fallopian tubes or via lymphatic spread beyond the pelvis to produce acute peritonitis.
No single test can accurately diagnose pelvic inflammatory disease. Instead, a any of the following methods will be used:
- medical history including sexual habits
- Signs and symptoms
- A pelvic examination
- Blood and urine tests
- Ultrasound
- Vaginal swab tests or pap smear tests
- Laparoscopy.
- Endometrial biopsy.
Treatments
Proper medication can heal the infection. But any scar or such damage to the reproductive tract due to PID can’t be reversed. Treatment for PID most often includes:
- Antibiotics.
- Treatment for partner is also important as it can be sexually transmitted.
- Temporary abstinence.
- Surgery is rarely needed, such as in cases of a ruptured abscess.
Prognosis
Prognosis is good in acute cases, but approximately 25% of patients diagnosed with acute PID develop long-term complications. Tubal factor infertility occurs in some women after one episode of PID.
Complications
Scar tissue and pockets of infected fluid (abscesses) developed in the reproductive tract. There are chances of permanent damage to the reproductive organs.
Complications from this damage might include:
- Ectopic pregnancy.
- Infertility.
- Chronic pelvic pain.
- Tubal or ovarian abscess
Disease & Ayurveda
Diseases of female genital tract are described under the heading Yonirogas. Manifested cases of PID can be compared with features described under Paripluta yoniroga.
Nidana
Holding of sneezing and belching during coitus (by woman with Pitta constitution or Pitta dominance
Purvaaroopa
Not mentioned
Samprapti
When a woman with Pitta dominance indulges in coitus holding the urge for sneezing and belching, the Vaata along with Pitta get vitiated, reach her vagina and produce the disease.
Lakshana
Swelling/inflammation in the vagina
Tenderness in vagina
Painful bleeding with yellow or bluish tinged discharge
Severe pain in the hip, inguinal area, and lower back
Fever
Divisions
Not mentioned
Prognosis
Kashtasadhya
Chikithsa
Ayurvedic treatment of Paripluta is managing the imbalanced Pitta and Vaata considering not to vitiate Kapha. Therapies are needed to reduce inflammation and to bring normalcy of all the three doshas locally and in the whole body. Wholesome diet and regimens along with proper dinacharya & ritucharya are also advised for complete cure.
Samana
After proper aamapaachana & agnideepana, santarpana (nutritive diet) is advised. Lepanam with sothahara dravyas
Parisheka with thriphala/naalpamara kwatha
Swedanam
Yonipichu – tampoons with medicated oils
Sodhana
Virechana
Kashayavasti
Snehavasti
Uttaravasti
Commonly used medicines
Varanadi kashayam
Guggulupanchapalachoornam
Kanchanaraguggulu
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Practice safe sex. Use protective measures/physical barriers.
Use safe methods of contraception.
Get regular screening tests if you are prone to PID
Avoid douche.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil, cow’s ghee
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from extreme climate changes.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Maintain proper personal hygiene, especially private parts.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843151/
https://pubmed.ncbi.nlm.nih.gov/12179634/
*These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake. Ayurveda Supplement with GMP Certification from India.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
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