1. Back Pain:
Gynecologic Causes
BY
Hieder A`ala
601
MUST UNIVERSITY

2. What is backache ?
Is stiffness and/or
pain in the back

3. 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.

4. Epidemiology
 The second common
complaint after headache
 30-90 % in pregnancy.

5. Epidemiology cont…
Rarely due to any
serious disease.
Sometimes a clear
cause but mostly
no cause can be
elicited.

6. Causes of BaP in
Women
A. Obstetric (pregnancy associated BaP).
B. Gynecologic.
C. Others:
 Ligaments.
 Muscular.
 Bones and joints.
 Referred (renal, rectal).
 Psychological.
 Metabolic.

7. Gynaecologic Causes
 Prolapse (uterine).
 RVF.
 Ch. Cervicitis.
 Tumours.
 Endometriosis.
 Pelvic congestain.
 PMTS.
 Ut. Contractrains (polyp).
 IUD
 Osteoporosis

8. Diagnosis (Milestones)
backache caused by a gynecologic
lesion:
Always diffuse.
Midline OR bilat.
Sacral, lumbo sacral and never high
than L4 (LBP).
backache which can be pointed
with a finger tip ± local tenderness
not due to intrapelvic lesion.

9. Role Of Gynaecologist
1. 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).

10. Correction Of Posture
Advices:
Stand up straight (smart).
Drop your shoulders and relax
your knees when standing.

11. Correction Of Posture
cont..
Sit well back into your chair, legs
slightly apart with both feet flat on
the ground.

12. Correction Of Posture
cont..
In front of a
computer screen:
Sit up straight
Keep your feet
slightly raised off the
floor on a footstool or
other low object.

13. Correction Of Posture
cont..
Always bend from your
knees and lift objects
and children from a
crouching position to
minimize the stress on
your back.

14. Correction Of Posture
cont..
Maintain your weight within the given
parameters of weight gain.
Avoid standing for long periods of
time.

15. SPINAL EXERCISES

16. EXERCISES
. Simple exercises
(curative).
.Activity not bed rest.

17. 1. WAIST ROTATION

18. 2. HIP ROTATION

19. 3. SPINAL STRETCH-
SIDE TO SIDE

20. 4. SPINAL STRETCH-
FORWARD AND BACK

21. 5. TORSO-TWIST

22. 6. PELVIC ROCK

23. Alternative & Complementary
Medicine(CAM)
Acupuncture and acupressure.
Herbs (wheat oil……).
Aromatherapy (essential oils added
to bath water).
Massage and manual therapies
(Chiropractic care).

24. Alternative & Complementary
Medicine cont….
Hypnosis, music therapy, yoga as
well as breathing exercises.
TENS & PENS.
Cupping.

25. Acupuncture &
backache
In early
pregnancy is
not advised
because can
promote
abortion

26. TENS & PENS
TENS: transcutaneous
electric N. stim.
PENS: percutaneous
electric N. stim.
PENS is more effective
than TENS because it
combines advantages of
TENS + elect. Acupuncture.

27. Chiropractic
"Chiropractic “comes from the
Greek word Chiropraktikos,
meaning "effective treatment by
hand”
"Science based on the theory
that health and disease are life
processes related to the function
of the nervous system.

28. Gynecological Role
cont….
Referral to:
Physiotherapist.
Osteopath.
when serious problem is
suspected

29. 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.

30. Psychological
In majority
No gross lesion.
Patient is handed
from physician to
Gynecolog. to
orthopedic to
surgeon.
Anxiety neurosis
sequalae.

31. 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.

32. Myths & Back Pain.
Lifting heavy objects E
L Scauses back pain.
FA
SE
Bed rest is the best way to cure a bad back.
FAL
X-rays, cat scans and MRI can always
identify the cause of back pain.
AL SE
F
Most back pain will eventually need surgery.
AL SE
F