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Various pains below the lower back in women can be a sign of many diseases: from minor to deadly. Sometimes women feel a nagging pain in the lower back with sudden movements. Lower back pain is common during menstruation. But such symptoms are usually short-lived. But chronic pain in the lumbar spine already indicates some obvious illness. It is important to identify the characteristic symptoms of dangerous or harmless diseases and, in any unclear situation, visit a local physician.

Causes

What could be the causes of lower back pain in women? There are many different ailments. Constant pain in the lumbar region in women is a bad sign. After all, lumbar pain of this type usually does not bode well.

Increased load

Some nagging lower back pain in women is caused by unusual physical activity. If a girl was almost unfamiliar with sports disciplines and put a sudden increased load on her back, there is a high chance of muscle strain. If aching pain in the lower back does not stop for 3-4 days, you need to visit a doctor. After all, under load, not only muscles, but also intervertebral discs can be damaged, and this is a serious reason.

A common cause of lower back pain in women is the progression of pathological processes in the spinal column under the influence of a sharply increased load.

• We recommend reading: what to do if you break your back

Osteochondrosis and intervertebral hernia

The cause of pain in the lower back in women can be osteochondrosis. With this pathology, a change in the structure of the intervertebral discs and destruction of cartilage tissue occurs. The previously elastic disc becomes rigid and loses its shock-absorbing properties.

If a woman has lower back pain that does not stop for several days and worsens when lifting heavy objects or sudden movements, there is a high probability of osteochondrosis.

• Be sure to read: lower back pain after lifting weights

The next stage of pathological changes is compression of the intervertebral discs, during which they protrude. Because of this, the spinal nerves are compressed, blood circulation and coordination of movements are disrupted, and the pain intensifies.

The final stage of osteochondrosis is the appearance of intervertebral hernias. This pathology is another reason why lower back pain occurs in women. As a rule, pain in the lumbar region is very pronounced, radiating to the limbs and other areas of the back. In this condition, the spine can ache in almost any position of the body (except lying down).

Gynecological diseases

Gynecological diseases very often cause pain below the lower back in women. Both the lower back and the sides may become sore.

There are such diseases:

• Tumor formations (cysts) in the ovaries;
• Pathologies of the uterus;
• Varicose veins of the organs surrounding the pelvic floor;
• Benign formation in the inner wall of the uterus;
• Rupture of ovarian tissue.

It is for these reasons that women often experience lower back strain. Unpleasant sensations, loss of strength, irritability and other symptoms occur. However, there can be many truly dangerous consequences: problems with having children, disruption of menstrual cycles.

Kidney diseases

If there is pain in the lower back on the right or left, or even girdle pain in the lower back, there is a high probability of renal pathologies, one of which is pyelonephritis. With an exacerbation of such an infectious disease, inflammation of the kidney (one or two) occurs. Lower back pain on the right is not the only symptom of this pathology. A person feels a number of negative manifestations:

• Increased body temperature;
• Increased sweating;
• Migraine;
• Dysfunction of the genitourinary system;
• Loss of appetite;
• Exudative discharge.

Pregnancy

Many women who decide to have children and become pregnant often experience lower back pain. Low back pain associated with physiological changes in the structure of the hip girdle is absolutely normal and does not require treatment. Aching pain in the lower back occurs due to a sharp increase in body weight and the fetus is localized in the lumbar region. In the last months of pregnancy, both the lower back and lower abdomen may hurt. Such symptoms are not uncommon, but if you wish, you can discuss the problem with your doctor.

Endometriosis

Another cause of lower back pain in women is excessive epithelial coverage. With this disease, the upper skin layer of the uterus covers the excess area of ​​the pelvic organs. Endometriosis not only provokes pain in the lower back, the pathology can lead to serious consequences. If treatment is untimely or the disease is ignored, reproductive function is impaired. And back pain below the waist can result in infertility.

Period

If a woman’s lower back hurts, her period may have begun. This phenomenon repeats regularly, so the girls know what to expect. Pain in the lower back on the right, pain in the lower back on the left and lower abdomen occur as a result of contractions of the uterus and a sharp increase in body weight from stagnation of water in the body.

If the lower back hurts in women precisely because of menstruation, you can take diuretics. This treatment will help remove excess water from the body and alleviate the condition.

Bust size

Some girls with breast sizes 4-5 may experience pain in the lower back. Not only does the load on the thoracic region increase and osteochondrosis of the thoracic region may appear, but also the load on the lower back comes from the unnatural bend in the spine. In such a situation, the back hurts, mainly due to incorrect posture and stooping. By doing exercises to strengthen the extensor muscles along the spine and leading an active lifestyle, such back pain can be avoided.

Shoes

Another reason why lower back pain in women is prolonged wearing of shoes with too high heels. When walking, the pelvis goes up a little and an unusual bend appears in the lower back. The load increases and aching pain occurs in the lower back.

Try to avoid stiletto heels. The optimal heel height should be no more than 5 centimeters.

Climax

Some pain in the lower back on the right side is associated with a certain period in the life of every woman. During menopause, hormonal disruption occurs and blood circulation in the pelvic area is disrupted. As a result, the spine does not receive the required amount of nutrients. And, directly, the causes of pain are complications from vitamin deficiency (osteoporosis, etc.).

Excess weight

The female body contains more fat tissue than the male body. In old age, women who are prone to obesity can gain a lot of excess weight. In such a situation, the spine experiences a strong constant load.

Excess weight can cause lower back pain on the left, right or center. This happens because the maximum pressure is on the lower back.

Oncology diseases

Tumors of any kind, reaching a certain size, begin to create pressure on the nerve endings. As a result, pain may occur below the lower back on the left or right, depending on the location of the tumor. Whether the pathological formation is benign or malignant, treatment must be started immediately. Any tumor can sooner or later become deadly.

Hypothermia

Why else does pain occur in the lower back or abdomen? If you dress inappropriately for the weather or sit on cold surfaces, hypothermia may occur. Pain below the lower back on the right occurs if the girl has a cold in the organs surrounding the pelvic floor. However, it is possible to overcool the lumbosacral spine. Acute pain in the lower back on the right in women can be the cause of just such hypothermia.

What kind of pain is there?

Various reasons can cause pain in women. The nature of the pain may vary. In order to help the doctor make the correct diagnosis, it is necessary to be able to determine the properties of pain.

Here are the main types:

• Very pronounced pain that occurs suddenly and is localized at a specific point. For example, lower back pain on the left.
• Nagging pain in the lower back that occurs during monotonous processes in an uncomfortable body position. The appearance of such a symptom answers the question of why the lower back is pulled.
• Radiating pain. It is characterized by non-local manifestations. Such pain from the lower back, radiating to the legs and groin, indicates an intervertebral hernia of the lumbosacral region.

Radiating pain requires immediate medical attention. Such symptoms always signal danger.

Localized, sharp, aching pain in the lower back on the left or right is usually not serious, but you still need to see a doctor. There are some diseases with vague symptoms, and in such cases diagnostics are performed.

One of the most dangerous cases is lower back pain on the left, back or right, which does not stop even in a comfortable body position (lying down). Very often this is how cancerous tumors reveal themselves.

Diagnostics

If you have pain in the lower back on the right, left, or any other, the most correct solution would be to contact your local physician. After conducting an individual examination, prescribing tests and some procedures, the doctor determines the need to involve other specialists. If the disease is serious, the therapist prescribes a consultation with a neurologist, gynecologist, nephrologist, or oncologist. After conducting the necessary examinations, doctors make a conclusion and determine the disease.

There is a very low chance that the patient has metastases, but a biopsy is required, because every minute is important in this case.

Treatment

Any lower back pain in women has causes and treatment. It is important to correctly diagnose and determine the cause. Some diseases are difficult to treat, while others can be cured in a few weeks. Of course, each disease has its own treatment methods; complex therapy is often used. But for mild illnesses or even simple complications (during menstruation or pregnancy), folk remedies can be used.

After a complete diagnosis, when the doctor gives permission, you can use some painkillers of traditional medicine. Such medications are used for pain on the right side of the lower back, on the left side. In short, localization is not important.

Some recipes to combat pain in order to calmly look at the world around you:

• Tincture of elecampane root is effective against lower back pain in women. You need to take about 5 g of root and put it in a glass of boiling water. You can use a tablespoon several times a day.
• A tincture based on horsetail has analgesic properties. It is necessary to put about 20 g of roots in a volume of boiling water equal to two glasses. You can take 50 ml once an hour.
• A tincture based on celery root also has an analgesic effect. Take celery root (35g) and put it in a glass of plain water. The tincture takes several hours to prepare. Then you can take a small glass (70g) several times a day.
• Tincture based on dry raspberry leaves. You need to take 2 glasses of boiled water and pour 70g of dried raspberry leaves over them. You can take it twice an hour for several days in a row.

VIDEO ON THE TOPIC

Every woman has experienced lower back pain at least once in her life. Even a girl who seems absolutely healthy at first glance sometimes has pain or shooting pains in her lower back. There are many reasons why lower back pain occurs in women: from uncomfortable sitting in one position and walking in high heels to serious gynecological diseases. If the attack happened once, then there is no reason to worry, but if the problem does not go away for several days or weeks, then you should not delay going to the doctor.

What kind of pain occurs in the lower back in women?

Lumbago is an acute lumbar lumbago that occurs as a result of increased stress or after hypothermia.
Lumbodynia is a constant dull pain acquired as a result of sedentary work or from regular stress on the back.
Lumboischialgia - pain radiating to the leg, is the main symptom of a vertebral hernia. Requires immediate medical attention.

Causes of pathology

As soon as the summer season opens, women rush to their gardens: weed, dig, plant. All these procedures involve frequent bending. Obviously, by the end of the day, a tired summer resident will complain of lower back pain. This happens because unprepared muscles have been subjected to sudden and excessive stress. Both athletes who train mercilessly before competitions and newcomers to the gym suffer the same lumbar pain.

But the lower back can bother you not only after vigorous physical activity, but also with a sedentary lifestyle and sedentary work. All this is aggravated by the incorrect posture in which office employees can sit for hours. The cause may also be a mattress that is too soft: in this case, the body takes an unnatural position during sleep, the spine is bent, and the muscles suffer.

If you lift weights incorrectly and unevenly distribute the load in your hands (for example, heavy bags), you may feel pain in the lower back. Women with small children, who are forced to carry the baby in their arms throughout the day, often experience back pain for this very reason.

Gynecological problems

In gynecology, a special place is given to lower back pain, as it is a sign of many infectious diseases. During pregnancy, progesterone, produced in large quantities, weakens joints and ligaments, and the constantly growing fetus puts pressure on the muscles and organs of the pelvis, which causes pain below the lower back. Women in the first trimester have a high risk of natural termination of pregnancy or miscarriage. The first signs of what has happened are brown discharge and discomfort in the lumbar region. These same symptoms may also indicate other serious health problems, such as cervical cancer and sexually transmitted diseases. The endometrium is inflamed, the uterus has dropped or even prolapsed - these are just some of the many possible answers to the question “why does the lower back hurt in women?”

A disease such as endometriosis, characterized by the spread of endometrial tissue outside the uterus, leads to its dysfunction, in other words, to infertility. At the early stage of development of this pathology, there are practically no symptoms. That is why a single pain below the lower back in women is attributed to hormonal disorders or premenstrual syndrome, thereby allowing the disease to progress.

Why does the lower back pull? Causes

In women (and men too), pain of this kind may indicate simple fatigue. But most often it signals the development of a serious illness.

1. Renal colic. They are accompanied by acute and very severe pain in the lumbar region, but, as a rule, only on one side. A person suffers from intense pain. Before the onset of such powerful spasms, patients complain that their lower back is pulling. Women experience fever, discomfort in the perineal area, rapid heartbeat, urination and nausea.

2. Pyelonephritis. Going to the toilet becomes more frequent and painful, and lower back pain can be described as dull and aching.

3. Osteochondrosis and osteoarthrosis. These diseases are widespread among older people, and they are characterized by nagging pain on both sides of the lower back, which intensifies with any load. With sudden movements there is a risk of pinching the nerve, so you should be careful with bending and turning.

4. Gynecological pathologies. They are accompanied by nagging pain that intensifies during menstruation.

5. Spondyloarthropathy. Most often occurs in young people. The peculiarity of the disease is that all discomfort worsens at rest, and with any activity it decreases. The pain is shallow but widespread.

6. Malignant tumors. They cause severe, deep pain that does not go away for more than a day, even when changing position.

7. Tuberculosis and osteomyelitis of the spine. With these diseases, the lower back ache for a long time. If the pain does not go away, then after a day signs of poisoning of the body are observed.

There are many reasons why lower back pain occurs in women. In order to eliminate them, you need to see a doctor, get tested and undergo the required treatment.

Problems with internal organs

Sometimes there is pain and burning in the lower back in women. Similar sensations can be caused by diseases of the gastrointestinal tract, kidneys, nerve endings, and spine. The cause of burning is most often urolithiasis. An unpleasant feeling is caused by sand and stones located in the ureters. When moving, they irritate the epithelium layer, it becomes inflamed. If these lumps are no more than 5 mm in diameter, they come out on their own and do not pose a strong danger, but if they are large, they can clog the outlet channels of the ureters, increase the pressure in the kidney and even cause its death. A rare, but still common case is when lumbar pain is caused by a stomach or intestinal ulcer.

Another cause of burning can be diseases of the pelvic organs (fibroids, endometritis). Symptoms indicating the presence of pathology do not appear, unfortunately, in the initial stages. Uterine fibroids cause dull pain in the lower back and abdomen.

Problems with the spine and peripheral nerves

Osteochondrosis and herniated discs cause a burning sensation in the lower back. This is explained by the fact that in these diseases the radicular nerves are affected. Overgrowth of bone tissue between the joints, disc deformation due to herniation puts pressure on the nerve processes, causing inflammation and loss of sensitivity.

Painful sensations when carrying a baby appear due to changes in the body and hormonal changes, as well as due to softening of joints, ligaments and muscles.

Treatment

It is not enough to know why women have lower back pain; one must also be able to eliminate such discomfort. If we are talking about sensations caused by physical factors, then you need to take a horizontal position on a flat surface and relax your body. The position can be any, the main thing is to feel that the pain subsides. An excellent way to relieve tension from the lumbar region is to lie on your back and raise your legs at a right angle to your body. No sudden movements! You should also get up slowly: first roll over on your side, then get on all fours. If the pain does not completely go away, you will have to take pills to relieve the attack.

To prevent pregnancy from being marred by lumbar burning, doctors recommend wearing a bandage, strengthening your back muscles, and monitoring your gait and weight gain.

An excellent solution to the problem is massage. It promotes relaxation, relieves muscle spasms, and improves blood circulation. To achieve greater effect, you can use special gels and ointments for rubbing.

Pregnant women should trust their body only to an experienced specialist who knows how to help and not harm.

If pain appears after an injury or fall, you should immediately call a doctor. For chronic lumbar burning sensations, you should undergo a full examination by contacting a gynecologist, orthopedist, cardiologist, infectious disease specialist, or urologist.

Traditional medicine can also give some good advice. So, to alleviate the condition, it is recommended to take a bath with mustard or hay dust, or make a compress from pre-heated sand. That is, therapy is based on heating the affected area. However, before using traditional methods, it is necessary to find out why women have lower back pain. For example, in almost 90% of cases, for pregnant women or those suffering from cancer, hot baths and heating are contraindicated.

Instead of a conclusion

Pain never occurs out of nowhere. At its first manifestations, it is necessary to contact a specialist. Then there is a chance to nip the disease in the bud, preventing it from developing.

Pelvic pain is a feeling of discomfort in the lower abdomen: below the navel, above and medial to the inguinal ligaments, behind the pubis and in the lumbosacral region. Chronic pelvic pain syndrome is a long-term (over 6 months), difficult to relieve pelvic pain, disorganizing the central mechanisms of regulation of the most important functions of the human body, changing the psyche and behavior of a person and disrupting his social adaptation.

SYNONYMS OF CHRONIC PELVIC PAIN

Pelvic pain syndrome, pelvic neurosis, autonomic pelvic ganglioneuritis, psychosomatic pelvic congestion.

EPIDEMIOLOGY OF PELVIC PAIN

According to WHO, every fifth person in the world suffers from chronic pain caused by diseases of various organs and systems. Over 60% of women annually seek help from an obstetrician-gynecologist specifically due to pelvic pain. Chronic pelvic pain is much more often a symptom of gynecological (73.1%) or extragenital diseases (21.9%) than of various types of mental disorders (1.1%). Just as rarely, it has an independent nosological or syndromic significance (1.5%).

CLASSIFICATION OF CHRONIC PELVIC PAIN

According to its manifestations, chronic pelvic pain can be divided as follows:

● pelvic pain itself - pain in the lower abdomen, groin areas, lower back, which worries the patient almost constantly and intensifies on certain days of the menstrual cycle, with hypothermia, prolonged static load, etc.;
● dysmenorrhea - painful menstruation;
● deep dyspareunia - painful sexual intercourse with deep penetration.

ETIOLOGY OF PELVIC PAIN

The main causes of pain in the lower abdomen:

● gynecological diseases;
● chronic inflammatory diseases of the internal genital organs;
● adhesions as a consequence of a previous inflammatory disease of the genital organs;
● external genital endometriosis;
● internal endometriosis of the uterine body;
● Allen–Masters syndrome;
● genital tuberculosis;
● uterine fibroids;
● BC and malignant ovarian tumors;
● malignant neoplasms of the body and cervix;
● primary algomenorrhea;
● “middle” pain (“Mittelschmerz”);
● abnormal development of the genital organs with impaired outflow of menstrual blood;
● atresia of the cervical canal;
● use of IUD;
● serosocele and adhesions after gynecological operations;
● residual ovarian syndrome;
● gastrointestinal diseases;
● chronic colitis, irritable bowel syndrome, ulcerative colitis;
● diseases of the musculoskeletal system;
● osteochondrosis of the spine;
● Schmorl's hernia;
● coccydynia, arthrosis of the sacrococcygeal joint;
● primary tumors of the pelvic bones;
● metastases to the pelvic bones and spine;
● tuberculosis of the musculoskeletal system;
● symphysiolysis, symphysiopathies;
● retroperitoneal neoplasms, including retroperitoneal ganglioneuroma;
● diseases of the peripheral nervous system;
● plexitis, including solaritis and solaropathy;
● appendicular-genital syndrome;
● proctitis;
● adhesive disease;
● diseases of the urinary system;
● chronic cystitis;
● urolithiasis;
● pelvic dystopia of the kidney, nephroptosis;
● vascular diseases;
● varicose veins of the small pelvis;
● mental illness;
● abdominal seizures of epilepsy;
● depressive syndrome, including schizophrenia;
● “inorganic” pain not associated with mental illness;
● psychogenic pain;
● abdominal form of spasmophilia;
● abdominalgia in patients with hyperventilation syndrome;
● pain for no apparent reason.

MECHANISM OF DEVELOPMENT OF CHRONIC PELVIC PAIN

The main reasons for the formation of chronic pelvic pain syndrome in various gynecological diseases should be considered disorders of regional and intraorgan hemodynamics, impaired tissue respiration with excessive formation of cellular metabolic products, inflammatory, dystrophic and functional changes in the peripheral nervous system of the internal genital organs and autonomic sympathetic ganglia. It is obvious that stabilization and aggravation of pain, i.e. in fact, the formation of pelvic pain syndrome occurs through the interaction of various factors, among which the type of development of a woman’s personality, features of her lifestyle, level of intelligence, etc. are of no small importance.

Pain syndrome, which, as a rule, does not form immediately, but after some (sometimes quite a long) time from the onset of the action of certain damaging factors, apparently goes through certain stages of development. The first stage is called the organ stage, and is characterized by the appearance of local pain in the pelvic area and lower abdomen. Often the pain is combined with dysfunction of the genitals and adjacent organs. These phenomena largely depend on circulatory disorders (hyperemia, blood stagnation, etc.).

The second (superorgan) stage is characterized by the appearance of repercussion (referred) pain in the upper abdomen. In a number of observations, pain sensations finally move to the upper abdomen. Thus, a secondary focus of irritation occurs in one of the paravertebral nodes. When the visible connection between the pain syndrome and the genital apparatus disappears, it is usually very difficult to explain these pains, and this often leads to diagnostic errors.

The third (multisystem) stage of the disease is characterized by the spread of trophic disorders in an ascending direction, with wide involvement of various parts of the nervous system in the pathological process. In this case, as a rule, disturbances of menstrual, secretory and sexual functions, intestinal disorders, and metabolic changes occur. Pelvic pain becomes more intense, making it extremely difficult or almost impossible to diagnose the disease. At this stage, the pathological process acquires a multisystem character, and its nosological specificity finally disappears.

CLINICAL CHARACTERISTICS OF CHRONIC PELVIC PAIN

Pain in the lower abdomen, on the one hand, can be a symptom of any gynecological, somatic or mental disease, on the other hand, it can have a completely independent, nosological significance, and be the most important component of pelvic pain syndrome.

With chronic pelvic pain syndrome of almost any origin, women, as a rule, complain of increased irritability, sleep disturbances, decreased performance, loss of interest in the outside world (“the patient goes into pain”), depressed mood, up to the development of depressive and hypochondriacal reactions, which, in turn, aggravate the pathological pain response. A kind of “vicious circle” is formed: pain - social maladaptation - psycho-emotional disorders - pain. Chronic pain, as a rule, occurs in people of a certain type: hypochondriacal, anxious, suspicious.

DIFFERENTIAL DIAGNOSTIC MEASURES FOR LOWER ABDOMINAL PAIN

ANAMNESIS

A well-collected medical history is of key importance for the differential diagnostic search for the causes of pain in the lower abdomen in women. The history of the present disease, family and social history, as well as detailed information (including data from medical documents) about the state of the main systems of the woman’s body allow us to assume the most likely genesis of the pain syndrome and, based on this, develop an individual examination plan for the patient.

The woman's main complaints should be recorded with particular care. At the same time, complaints, as a rule, are quite varied. Often the patient is not able to accurately indicate the location of the pain, noting a fairly large area: from the hypo to the epigastric region. However, specifying the topography of pain is of fundamental importance.

Pain localized in the midline of the abdomen slightly above the symphysis pubis or directly behind it, are mainly characteristic of chronic inflammatory diseases and tumors of the uterus, bladder, rectum, as well as internal endometriosis of stages II–III of spread. Much less often, such pain occurs with anomalies of the uterus, symphysiolysis, unrecognized umbilical hernias or postoperative hernias of the white line of the abdomen.

Pelvic pain in the right and left iliac regions It is often the main and sometimes the only symptom of chronic inflammation of the uterine appendages, external genital endometriosis, traumatic damage to the broad ligaments of the uterus (Allen-Masters syndrome), benign and malignant tumors of the internal genital organs.

Pain, predominantly projected to the lower quadrants of the abdomen on the right or left, observed in functional or organic diseases of the gastrointestinal tract (nonspecific colitis, irritable bowel syndrome, diverticulosis and diverticulitis, Crohn's disease, atony of the cecum, neoplasms), organs of the urinary system (hydroureteronephrosis, ureterolithiasis, chronic ureteritis, etc.), as well as in cases of retroperitoneal damage lymph nodes (lymphosarcoma, visceral form of lymphogranulomatosis) and diseases of the spleen (chronic myeloid leukemia). In general, to simplify the diagnostic search, we can conditionally assume that pelvic pain localized below the line connecting the iliac spines and the navel, as a rule, indicates diseases of the internal genital organs, and above this line - damage to the intestines, kidneys, etc.

Chronic pelvic pain with an epicenter in the lumbosacral region most often associated with acquired skeletal diseases of traumatic, inflammatory, degenerative or tumor origin. Somewhat less often - with congenital anomalies of its development (nonfusion of the vertebral arch, spondylolysis, lumbarization, sacralization, etc.). Pain of similar localization is often observed with dysmenorrhea, including that caused by genital endometriosis. Pain can also occur with so-called sexual neurasthenia, which is often caused by congestive hyperemia of the pelvic organs, for example, under the influence of long-term masturbation or interrupted sexual intercourse (irritation of the visceral nerves). However, unilateral pain in the sacrum in the vast majority of cases argues against its genital origin.

Among the variety of extragenital causes of chronic pain in the lumbosacral region, one cannot fail to mention renal diseases (chronic pyelonephritis, hydronephrosis, nephroptosis), ureteral strictures of traumatic, inflammatory or tumor origin, as well as congenital or acquired diseases of the sigmoid and rectum (sigmatosis, megasigma, enlargement of the rectum, hemorrhoids, etc.).

Pain in the coccyx area- coccydynia is more often a consequence of traumatic damage to the coccyx itself (periostitis, arthritis of the sacrococcygeal joint, ankylosis of the joint, dislocation of the coccyx), less often it is of a reflected nature. In the latter case, coccydynia may be a symptom of parametritis, retrocervical endometriosis or endometriosis of the uterosacral ligaments. Severe pain in the coccyx area is often noted in advanced forms of rectal and cervical cancer.

When conducting a differential diagnostic search, it is also necessary to take into account factors that provoke aggravation of pain symptoms.

In case of diseases of the musculoskeletal system, these are most often static or dynamic physical activity; in case of damage to the urinary system - hypothermia or errors in diet (salty spicy foods, etc.). The last factor is considered decisive in diseases of the gastrointestinal tract.

The appearance or intensification of pain in the second phase of the menstrual cycle, usually 3-7 days before the expected menstruation, traditionally associated with genital endometriosis. Worsening pain symptoms in the second phase of the menstrual cycle can also be one of the most striking clinical manifestations of PMS or pelvic varicose veins. In the latter case, the intensity of pelvic pain depends not only on the day of the menstrual cycle, but also on the time of day: increasing in the evening, it gradually decreases or completely stops after a relatively long rest in a horizontal position.

New or worsening pelvic pain during menstruation- dysmenorrhea is most typical for gynecological diseases, in particular for adenomyosis, primary algodysmenorrhea, abnormalities of the position and development of the uterus, chronic endometritis.

Increase in pain symptoms in the early follicular phase of the menstrual cycle most typical for exacerbation of chronic inflammation of the uterine appendages. As a rule, in parallel with increased pelvic pain, symptoms appear that indicate activation of the inflammatory process (increased body temperature, leucorrhoea, etc.).

Among gynecological diseases accompanied by pain, a special place is occupied by the so-called intermenstrual pain syndrome, or midline pain syndrome. With this syndrome, pain of varying intensity and duration occurs periodically (usually monthly) on the 13th–15th day of the menstrual cycle and is accompanied by severe psychovegetative disorders. Often, intermenstrual pain syndrome is associated with various gynecological diseases (chronic inflammation of the uterus and its appendages, genital endometriosis, functional ovarian cysts, varicose veins of the small pelvis), i.e. has a specific organic basis. However, the debut of pain symptoms and its subsequent stabilization are usually preceded by a variety of stressful situations: from banal hypothermia to severe mental trauma.

Another type, and in some cases an integral component of chronic pelvic pain syndrome, is dyspareunia. Most often, this symptom is observed in patients with external genital endometriosis when heterotopias are located on the uterosacral ligaments or in the retrocervical space. Somewhat less frequently, dyspareunia is detected in cases of fixed retrodeviation of the uterus, chronic salpingoophoritis, and adhesions in the pelvis of almost any origin.

It is necessary to clarify not only the factors that provoke increased pelvic pain, but also to carefully evaluate the effectiveness of previous treatment. Progestogen drugs significantly reduce pelvic pain in genital endometriosis, primary algodismenorrhea, and PMS. Limiting static load can be effective not only for diseases of the musculoskeletal system, but also for varicose veins of the small pelvis, traumatic damage to the broad ligaments of the uterus (Allen-Masters syndrome), and incompetence of the pelvic floor muscles. The use of a course of physiotherapeutic treatment (diadynamic, fluctuating, sinusoidally modulated currents) is most effective in patients with symptoms of chronic pelvic pain of inflammatory origin, including those with concomitant adhesions and hemodynamic disturbances in the pelvic vessels. However, with classic chronic pelvic pain syndrome, physiotherapeutic procedures often have the opposite effect, aggravating the initial pain symptoms.

In everyday practice, when examining this group of patients, visual analogue scales are most widely used, allowing, by comparison, to study the dynamics of a pain symptom in a certain time interval or during any treatment. They also use specially designed questionnaires, with which you can get an idea not only of the intensity of pelvic pain, but also of the degree of subjectivity in its assessment.

PHYSICAL INVESTIGATION

Typically, a physical examination begins with examination and superficial palpation of the abdomen, focusing on the appearance of pain associated with abdominal hyperesthesia. It may depend on various reasons, in particular on organic changes in the skin itself or in the deeper layers of the anterior abdominal wall (neurolipomas, desmoid tumors of the abdominal wall, muscle ruptures, etc.). The easiest way to detect increased sensitivity is by pinching the skin. To study hyperesthesia of the deep layers, you can use the following technique: the doctor places his hand flat on the corresponding area of ​​the abdominal wall, after which he applies light, usually almost painless pressure. Then the patient is asked to quickly raise the upper half of the body. With the contraction of the abdominal muscles occurring at this moment, light hand pressure can cause severe pain.

To exclude unrecognized inguinal, umbilical or epigastric hernias, the patient is examined both in a standing and lying position. When coughing and straining, you can usually determine the expansion of the hernial orifice or identify increased sensitivity when palpating the corresponding areas of the anterior abdominal wall. The use of special methods of gynecological examination (examination of the external genitalia, examination of the cervix and vagina using speculum, bimanual vaginal and/or rectovaginal examination) allows us to distinguish two main groups of patients.

The first of them consists of women who, already at this stage of examination, can be diagnosed with various gynecological diseases that can, alone or in combination, lead to the emergence and progression of chronic pelvic pain syndrome with the subsequent impact of the algogenic focus on the mental and somatic sphere.

The second group includes patients in whom visually detectable or palpable pathological changes in the external and internal genital organs are absent altogether or are so mild that they are not considered as a cause of chronic pelvic pain. The absence of mental disorders or any extragenital diseases in these women that occur with severe pain symptoms suggests the development of a unique condition in which pain acquires a nosological meaning, i.e. In fact, it becomes a disease itself.

However, this assumption requires mandatory clinical laboratory, instrumental and, in some cases, pathomorphological confirmation.

LABORATORY AND INSTRUMENTAL RESEARCH METHODS

To clarify or verify the genesis of chronic pelvic pain, a complex of clinical laboratory and hardware and instrumental research methods is used, the mandatory components of which are considered to be:

• laboratory testing for herpetic infection, which is more associated with the development of pelvic ganglioneuritis;
• Ultrasound of the pelvic organs (screening to exclude organic diseases of the internal genital organs and urinary system);
• X-ray examination of the lumbosacral spine and pelvic bones;
• absorption densitometry to exclude osteoporosis;
• X-ray (irrigoscopy) or endoscopic (sigmoidoscopy, colonoscopy, cystoscopy) examination of the gastrointestinal tract and bladder;
• laparoscopy.

It is necessary to highlight laparoscopy, emphasizing the validity and feasibility of its implementation for all women suffering from chronic pelvic pain. The reason for this exclusivity is that laparoscopy is considered a necessary step in the diagnosis of peritoneal endometriosis, Allen-Masters syndrome, chronic inflammation of the uterine appendages, adhesions in the abdominal and pelvic cavity, varicose veins of the small pelvis, i.e. those diseases that, according to statistical studies, occupy leading positions in the structure of causes of chronic pelvic pain.

Currently, laparoscopy allows us to identify all the main causes of pain in the pelvis. If the cause of chronic pelvic pain still cannot be identified (in approximately 1.5% of cases), then in relation to such situations, the International Statistical Classification of Diseases, Injuries and Causes of Death (WHO, Geneva, 1997) provides for the classification “pain without visible reasons”, which gives grounds for symptomatic therapy.

TREATMENT OF CHRONIC PELVIC PAIN

The main treatment methods are presented in Table 1

Treatment of patients with chronic pelvic pain requires an integrated approach. Typically, the duration of the pain history is proportional to the number of methods and treatments tried, as well as the patient’s nihilism towards medicine in general and specific doctors in particular. In this regard, it is necessary to involve specialists of various profiles in drawing up a plan for examining and treating the patient: a therapist, a urologist, a neurologist, a physiotherapist and, possibly, a neuropsychiatrist. Collegiality reduces the likelihood of confrontation between the patient and the doctor, and therefore increases the chances of treatment success.

In general, treatment of chronic pelvic pain syndrome should be based on the following basic principles:

• it is necessary to help the patient understand the cause of the pain and, if possible, specify the factors that lead to exacerbation;
• It is better to reduce to a rational minimum the number of pharmacological agents used, eliminating unnecessary and ineffective ones. In this case, it is necessary to simplify treatment regimens as much as possible, gradually reducing the doses of drugs to a value where a pronounced beneficial effect can be achieved with minimal side effects;
• It is necessary to use methods of restorative therapy as early as possible and more widely, aimed at correcting personal factors that interfere with the elimination of pain, increasing the functional capabilities of the female body, and improving the quality of life.

Table 1: Basic principles and methods of treatment for chronic pelvic pain

• What diseases cause gynecological pain?
• Which doctors should I contact if gynecological pain occurs?

Gynecological pain

Gynecological pain can be of different types. First of all, gynecological pain can be acute or chronic.

What diseases cause gynecological pain:

Acute gynecological pain is sudden, severe pain that lasts several hours or days. Acute pain may be accompanied by fever, nausea, vomiting, intestinal problems, severe weakness and malaise. In cases of acute pain, especially in combination with the complaints described above, it is necessary to urgently consult a gynecologist. Acute pain manifests itself in almost any inflammatory disease of the uterus and appendages, ectopic pregnancy, torsion or rupture of an ovarian cyst, as well as a number of other conditions that require immediate help.

If you have been having pain in your lower abdomen for a long time and you suspect that the pain is of a female nature, then you need to see a gynecologist as soon as possible. Gynecological clinic in Moscow located on the street. Myasnitskaya will accept you with any disease and help solve any women's problems.

The main causes of gynecological pain:

Endometriosis.

Features of the anatomical structure of the genital organs, hormonal imbalances.
- Vulvodynia (pain in the perineum and vaginal opening).
- Chronic inflammation of the genital organs.
- Formations (benign and malignant) of the uterus and ovaries.
- Prolapse of the uterus and vaginal walls (pelvic organ prolapse).