Pelvic pelvic pain (abbreviated PGP ) is a pregnancy discomfort that causes pain, instability and mobility limitations and works in one of three hip joints. PGP has a long history of recognition, mentioned by Hippocrates and later described in the medical literature by Snelling.
Caution seems to consist of pelvic articulation relaxation, becoming apparent suddenly after birth or gradually during pregnancy and allowing pelvic floor mobility to effectively impede movement and cause the most bizarre and alarming sensations.
Video Pelvic girdle pain
Classification
Before the 20th century, PGP specialists related to pregnancy use various terminology. It is now referred to as Pregnancy-related Pelvic Girdle Pain that may combine the following conditions:
- Diastasis from Symphysis Pubis (DSP)
- Symphysis pubis dysfunction (SPD)
- Joint Syndrome
- Pelvis Girdle Physical Relaxation
- Symptoms of Giving Pelvic Girdle Relaxation
- Pain Posterior Pain
- Pelvic Artropathy
- Public Saw Low/Moving Superior Slide/Slide Symphyseal
- Symphysiolysis
- Osteitis pubis (usually postpartum)
- Sacroiliitis
- One Sided Syndrome/Sided Sacroiliac Syndrome Two Sides
- Hypermobility
"The classification between hormonal and mechanical pelvic gel instability is no longer in use.For treatment and/or prognosis, it makes no difference whether complaints are initiated during pregnancy or after childbirth." Mens (2005)
Maps Pelvic girdle pain
Signs and symptoms
The combination of postural changes, growing babies, unstable pelvic joints under the influence of pregnancy hormones, and changes in the center of gravity can all add to different levels of pain or discomfort. In some cases it can come suddenly or after a fall, sudden thigh abduction (opening too wide too fast) or stretching joints.
PGP can begin as early as the first trimester of pregnancy. Pain usually feels low above the symphyseal joint, and this area may be very soft to the touch. Pain can also be felt in the hips, groin and lower abdomen and can radiate down the inner thighs. Women who suffer from PGP may start waddling or shuffling, and may be aware of the clicks heard from the pelvis. PGP can progress slowly during pregnancy, gradually getting worse as the pregnancy progresses.
During pregnancy and postpartum, the symphyseal gap may be felt moving or straining while walking, climbing stairs or turning in bed; this activity can be difficult or even impossible. The pain can remain static, for example, in one place like the front of the pelvis, producing a feeling of being kicked; in other cases it may start in one area and move to another area. It is possible that a woman may experience a combination of symptoms.
Any severe congestion activity has the potential to exacerbate an unstable pelvis, producing symptoms that can limit a woman's ability to perform many daily activities. She may experience pain involving movements such as dressing, getting in and out of the tub, rolling over in bed, climbing stairs or sexual activity. Pain can also be present when lifting, carrying, pushing or pulling.
The symptoms (and severity) experienced by women with PGP vary, but include:
- Present swelling and/or inflammation over the joint.
- Difficulty raising feet.
- Pulls pull feet.
- Inability to stand on one leg.
- Inability to transfer weight through the pelvis and legs.
- Pain in the hip and/or restriction of hip movements.
- Nerve pain that is lowered to the foot.
- May be associated with bladder and/or bowel dysfunction.
- The pubic symphysis feeling gives way.
- Stooped back while standing.
- Malalignment of the hip joint and/or back.
- The struggle to sit or stand.
- Pain can also radiate into the inner thighs.
- Swinging or walking style stumbles.
- The clicking sound comes from the pelvis. Severity
- The hip joint is unevenly moving.
- Changes in muscle activity in the pelvis, hip, abdomen, back and pelvic floor.
- History of pelvic trauma.
- The baby's position of changing loading emphasizes the pelvic and joint ligaments.
- Heavy work.
- Previous lower back pain.
- Early pelvic girdle pain during pregnancy.
- Hypermobility, the genetic ability to stretch the joint beyond the normal range.
- Occurrence during pregnancy or birth causing injury or strain on the hip joint or fibrocartilage rupture.
- The occurrence of PGP is associated with multiple pregnancies, first pregnancy and higher age in the first pregnancy.
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- European Guidelines on the Diagnosis and Treatment of Pelvic Pelvic Pain (pdf)
- Guides for Pregnancy Professional Health Related to Pelvic Girdle (pdf)
- A Guide for Mom and Mother to Get Pregnancy Related to Corset Pain (pdf)
- Historical perspective on pregnancy related to low back hip pain
- Diagnosis and Treatment of PGP
The severity and instability of the pelvis can be measured on a three-level scale.
pelvic type 1: The pelvic ligaments support the pelvis sufficiently. Even when the muscles are used incorrectly, no complaints will occur when performing daily activities. This is the most common situation in people who never get pregnant, who have never had an accident, and who are not hypermobile.
Pelvic type 2: Ligaments alone do not support joints enough. The use of coordinated muscles around the joints will compensate for the weakness of the ligaments. In the event that the muscles around the joint do not work, the patient will experience pain and weakness while performing daily activities. This type often occurs after childbirth weighing 3000 grams or more, in case of hypermobility, and sometimes after an accident involving the pelvis. Type 2 is the most common form of pelvic instability. Treatment is based on learning how to use the muscles around the pelvis more efficiently.
pelvic type 3: Ligaments do not support joints enough. This is a serious situation where the muscles around the joint are unable to compensate for the weakness of the ligaments. This type of pelvic instability usually occurs only after an accident, or sometimes after a (minor) accident in combination with childbirth. Sometimes small accidents that occur long before childbirth are forgotten so pelvic instability is only caused by labor. Although the differences between Type 2 and 3 are often difficult to determine, if there is any doubt, an exercise program can help the patient. However, if Type 3 has been diagnosed then invasive treatment is the only option: in this case the pelvis is screwed together. (Mens 2005)
PGP in pregnancy greatly disrupts participation in society and activities of daily life; average sick leave due to posterior pelvic pain during pregnancy is 7 to 12 weeks.
In some cases, women with PGP may also experience emotional problems such as anxiety over the cause of pain, irritability, anger, lack of confidence, frustration and depression; he is three times more likely to suffer from symptoms of postpartum depression. Other psychosocial risk factors associated with women with PGP include higher stress levels, lower job satisfaction and worse relationships with partners.
Cause
Sometimes there is no clear explanation for the causes of PGP but there is usually a combination of factors such as:
Mechanism
Pelvic Girdle Pain (PGP) related pregnancies can be specific (trauma or injury to the hip joint or genetic connective tissue disease) and non-specific. PGP disorders are complex and multi-factorial and may also be represented by a series of sub-groups caused by pain varying from the peripheral or central nervous system, muscle weakness/stiffness, neglect of tendinous/ligament injury to males-Adopting mechanics body.
Pregnancy initiates physiological changes through the pattern of hormone secretion and signal transduction thereby initiating soft tissue remodeling, cartilage and ligaments. Over time, the ligaments can be stretched by excessive injury or tension and in turn can lead to PGP.
Anatomy
The pelvis is the largest bone portion of the skeleton and contains three joints: the symphysis pubis, and the two sacroiliac joints. The highly durable ligament tissue surrounding these joints gives them tremendous strength.
The pubic symphysis has fibrocartilage joints that may contain fluid and avascular cavities; This is supported by superior ligaments and arcuate. Sacroiliac joints are synovial, but their movement is restricted throughout life and they are progressively obliterated by adhesions. The nature of the bony pelvic ring with three joints determines that no single joint can move independently of the other two.
Relaxed hormones
Relaxin is a hormone produced primarily by the ovarian and breast corpus luteum, in pregnant and non-pregnant women. During pregnancy it is also produced by placenta, chorion, and decidua. The body produces relaxin during menstruation that rises to the top within about 14 days of ovulation and then decreases. In the pregnancy cycle, rather than subsided, relaxin secretion continues to increase during the first trimester and then again in the last weeks. During pregnancy, relaxin has various effects, including the production and remodeling of collagen, thereby increasing the elasticity of muscles, tendons, ligaments and birth canal tissue in the view of labor.
Although major cellular action in pregnancy is rejuvenating collagen with biosynthesis (thus facilitating connective tissue changes) does not seem to cause musculoskeletal problems. European studies have determined that relaxin levels are not a predictor of PGP during pregnancy.
Style changes
Pregnant women have different "ways of walking" patterns. This step extends during pregnancy because of weight gain and posture changes. Longer and shorter footsteps with PGP. Sometimes the foot may rotate inward because of hip rotation when the hip joint is unstable. On average, a woman's legs can grow half the size or more during pregnancy. Pregnancy hormones are released to adjust body changes also remodel the ligaments in the legs. In addition, pregnancy weight gain, fluid retention and weight gain decrease the curvature, increasing the length and width of the legs. There is an increased load on the lateral side of the legs and hind legs. This change is also responsible for musculoskeletal complaints of leg pain in pregnant women.
During movement walking, upward movement of the pelvis, one side and then the other, is required to let the foot follow. The faster or longer each step, the hip will adjust. Flexibility inside the knee, ankle and hip is stabilized by the pelvis. Normal gait tends to minimize the displacement of the center of gravity whereas abnormal walking force through pelvic instability tends to strengthen displacement. During pregnancy there may be an increase in the demand placed on the abductor's hips, hip extensors, and ankle flexor flexors when walking. To avoid the pain of the load-bearing structure, very short strokes and weakness occur on the injured side (s), this is called Antalgic Gait.
Treatment
A number of treatments have some evidence for benefits including an exercise program. Paracetamol (acetaminophen) has not been found to be effective but safe. NSAIDs are sometimes effective but should not be used after 30 weeks of pregnancy. There is temporary evidence for acupuncture.
Some trauma of the hip joint will not respond to conservative type treatment and orthopedic surgery may be the only option to stabilize the joint.
Prognosis and epidemiology
For most women, PGP resolves within a few weeks after delivery but for some women can persist for many years thereby reducing tolerance for load-bearing activities. PGP may take from 11 weeks, 6 months or even up to 2 years postpartum to subside. However, some studies support that the average time to complete recovery is 6.25 years, and the more severe the case, the longer the recovery period.
Overall, about 45% of all pregnant women and 25% of all postpartum women suffer from PGP. During pregnancy, serious pain occurs in about 25%, and severe disability in about 8% of patients. After pregnancy, the serious problem is about 7%. There is no correlation between age, culture, nationality and number of pregnancies that determine a higher incidence of PGP.
If a woman experiences PGP during one pregnancy, she is more likely to experience it in subsequent pregnancies; but the severity can not be determined.
References
External links
Source of the article : Wikipedia
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