Pelvic disease

I have been experiencing pelvic pain on and off for a year or so. Recently, my menstrual flow has changed and I am experiencing abdominal bloating and occasional tenderness. My GP believes that I may have pelvic inflammatory disease and has advised me to have a swab and begin a course of antibiotics. I am awaiting the results of the swab but am reluctant to take antibiotics just in case. Can you give me some more information on PID and effective alternative treatments. RS, Portsmouth....

Pelvic inflammatory disease (PID), or slapingitis, is a catch all term for a group of bacterial diseases of the uterus, fallopian tubes and ovaries. In addition to these, the bacteria that cause PID can also infect the vagina, throat and rectum. Men and women can both be affected equally

by these bacteria and, left unchecked, infected sexual partners can become part of a vicious cycle of continual re infection. The genitourinary tracts and reproductive organs of both men and women can be damaged by the bacteria which cause PID.

In women, PID is a major cause of fertility and reproductive illness, accounting for the majority of cases of acquired infertility and substantially increasing the risk of subsequent ectopic pregnancy (JAMA, 1988; 259: 1823-7; Am J Epidemiol, 1991; 133: 839-49). Other side effects of PID include abscesses of the ovaries and fallopian tubes and pelvic adhesions, often leading to dyspareunia (painful intercourse) and chronic pelvic pain. If a woman becomes pregnant with untreated PID, her chances of giving birth to a live baby fall dramatically with the severity of her condition from 90 per cent with a woman who has a mild form of the disease to 57 per cent for those with severe disease (Am J Ob Gyn, 1998; 178: 977-98). A woman with recurring PID is eight times less likely to achieve a live birth, compared with a woman with a single mild episode of PID.

PID is usually brought on through sexual contact, but this is not the only route through which bacteria find their way into the normally sterile uterus.

The bacteria contamination may, in fact, happen during gynaecological procedures involving dilating the cervix and/or inserting instruments into the uterus. These can include abortion, D&C, tubal ligation, gynaecological examinations and insertion of an IUD. The risk of contracting an infection is also thought to be greater in the first few weeks after birth, when the cervix is still open. Bacteria can also be transferred from the gastrointestinal tract into the vagina from faeces either through poor hygiene or anal intercourse.

PID appears to be mostly a young woman's disease. Sexually active adolescent girls aged 15 to 19 are more likely to be hospitalised with PID than adult women aged 25 to 29 (Ob Gyn, 1995; 86: 764-9; Morb Mortal Wkly Rep, 1991; 40: 1-25). It is not totally clear why this should be the case, except that younger girls may be more likely to have multiple sexual partners, less likely to take precautions such as using a condom, or less inclined to seek a medical diagnosis when vague symptoms begin to appear.

While PID can be caused by any number of sexually transmitted diseases, including gonorrhoea and myoplasma, two factors seem to contribute more than anything to its development: chlamydial infection and delay in seeking treatment (Sexually Trans Dis, 1998; 25: 378-85). In one study, 48 per cent of women with PID had delayed going to the clinic by one week and one third had delayed by more than one week (Sexually Trans Dis, 1997; 24: 443-8).

PID usually starts as an infection of the cervix that, for whatever reason (and there are a variety of them), spreads upward into the uterus, the fallopian tubes, the ovaries and into the abdominal cavity.

The most common symptoms in extreme cases are severe pelvic pain, which is usually noticeable with exercise or sexual intercourse, temperatures of 100.4 degrees F or more, chills, abnormal vaginal discharge and/or bleeding, fatigue, abdominal or back pain and just a general aching feeling all over. For many women acute symptoms never appear.

Many things aid in spreading the bacteria that cause PID. Frequent douching has been found to be a contributing factor. Research also draws a connecting line from PID to IUD use, specifically the now defunct Dalkon Shield. IUDs seem to aid in the spreading of pelvic infections of all varieties. The string attached to an IUD which hangs down into the vagina acts like a small ladder for bacteria to climb up and into the uterus.

If you do have an IUD, your doctor probably advises you to have it replaced every three to five years to help prevent PID. However, each time an IUD is replaced there is not only an increased risk of uterine perforation, but also an increased risk of PID due to the fact that it can take from one to six weeks for the cervical opening to shrink back to its normal size after the procedure.

In addition, the risk of getting an infection is higher during or immediately after your menstrual period. Bleeding seems to make it easier for bacteria to spread upward into the uterus and menstrual blood enhances bacterial growth.

Medicine has very little to offer women with PID other than antibiotics or surgery. Treatment can be complicated by the fact that more than one type of bacteria may be present.

In recurring acute cases, antibiotic use may be of benefit as a first step (some chlamydial infections will respond well to tetracyclines and erythromycin).

Unfortunately, because chlamydia lives within human cells, it may be difficult to entirely eradicate the organism with antibiotics alone. So, women who are experiencing a single mild to moderate first bout of PID may wish to take less aggressive steps.

To clear up a case of PID, practitioners (both alternative and conventional) will generally recommend complete bed rest, probably for a week or two. You will also be advised to refrain from sex to reduce irritation in the pelvic cavity.

An alternative practitioner will approach PID as he would any other bacterial infection anywhere else in the body by prescribing herbs and other treatments which help the body fight off infection naturally. Herbalist Kitty Campion has assisted many women in healing both chronic and acute PID with great success. She cautions that the natural route requires much dedication and persistence as well as considerable courage as the pain can often be quite extreme.

'During acute attacks, I always recommend fasting on apple or carrot juice with plenty of potassium broth (a clear broth made from 1/4 thick potato peelings, 1/4 carrot peelings, 1/4 onions and garlic celery and 1/4 greens all preferably organic simmered on a low heat for one to two hours and taken in a mug with two desertspoons of yeast extract) for as long as the attack lasts, ensuring the colon is functioning extremely well. Hot and ice cold abdominal packs applied alternatively as long as the pain lasts are also helpful.

'All forms of hydrotherapy, including Turkish baths, cold plunges, sauna and cold showers help to get general circulation moving and should be taken at least twice a week. Alternative morning and evening hot and cold sitz baths (shallow baths which come up only as far as your hips) with lavender oil added are also extremely helpful.'

You might also consider taking natural antibiotics. Kitty Campion recommends up to 360 drops of echinacea tincture daily during acute attacks.

Echinacea has repeatedly shown to be an effective herbal antibiotic with few side effects even at very high doses (Econ Med Plant Res, 1991; 5: 253-21; Can Pharm J, 1991; 124: 512-6; Arzneim Forsch, 1985; 35: 1069-75).

Garlic should be taken liberally in all its forms and has much scientific literature to back up its use as an anti bacterial agent (Phytother Res, 1993; 7: 278-80; Phytother Res, 1991; 5: 154-8; Planta Med, 1992; 58: 417-23; Med Hypothesis, 1983; 12: 227-37).

Goldenseal has also been shown to be effective against a wide range of bacteria, including chlamydia (Antibiotics, 1976; 3: 577-84; Sabouraudia, 1982; 20: 79-81).

Besides a wholefood diet, daily supplements of antioxidants and essential fatty acids will help to take the strain off your immune system.

The homoeopathic remedy Folliculinum, a potentised form of oestrogen, has no provings to date, but practitioner experience suggests that it may be useful in cases of PID (Am Hom, 1997; 3: 80-4). It is generally taken in single doses of 30C in acute cases.

Other measures you can take include reducing the number of sexual partners you have. Always use a condom even if you are on the Pill, and get tested for STDs every six months if you are in a high risk category.

If you smoke, it's time to stop since smokers are at greater risk from PID. You should change tampons and pads frequently when you menstruate and always wipe from front to back after a bowel movement to keep bacteria from the faeces from entering the vagina.