Frozen Pelvis: Description, Causes and Risk Factors
A condition in which the true pelvis is indurated throughout, especially by carcinoma.
Five major causes of the extensive pelvic disease lead to a frozen pelvis may include infection, surgery, benign growths, malignant growths, and radiation therapy. When evaluating a patient, it is important to determine which of these conditions exist.
- Infection. Adhesions and fibrosis secondary to infectious processes such as gonococcal salpingitis, tubo-ovarian abscess, a ruptured diverticulum, infected pelvic hematoma, and ruptured appendix can create anatomic abnormalities.
- Surgery. The type of surgery a patient has undergone may provide important clues to potential problems. For example, pelvic distortion that arises from a cesarean section and tubal reconstructive surgery differs considerably from that found in women who have undergone abdominal hysterectomy with preservation of one or both ovaries. Removal of a retained left ovary may require extensive dissection of the ureter and bowel.
- Benign and malignant growths. Uterine myomata, endometriosis, and adenomyosis are the most common benign growths that can lead to a frozen pelvis. Malignant growths of the adnexa, such as ovarian carcinoma, can necessitate en bloc resection of portions of the gastrointestinal tract along with the tumor. In contrast, carcinomas of the endometrium and cervix generally do not present with a frozen pelvis, although they occasionally require extensive or radical surgery.
- Radiation therapy. When a woman has undergone radiation, pelvic structures are commonly adherent to the uterus and each other, making hysterectomy a challenge. The intestinal and urinary tracts also must be handled with great care. Even a small degree of intraoperative trauma to these structures can lead to postoperative complications including fistula formation.
There are approximately 102 million women and girls living with frozen pelvis globally. Some researchers believe that genetic factors can predispose a woman to the frozen pelvis. Several studies are ongoing to isolate the 'frozen pelvis gene'. Generally accepted figures for the incidence of frozen pelvis are 12-15%. To illustrate how high that rate is, consider that the average person is acquainted with about 250 people. Therefore, statistically speaking, the average person knows 30-38 women with frozen pelvis! Not all of those women know they have it, because some women haven't been diagnosed, and others have no symptoms.
Symptoms may include:
- Severe menstrual cramps.
- Pelvic pain apart from menses.
- Painful intercourse or pain associated with sexual activity.
- Painful bowel movements.
- Menstrual diarrhea.
- Pain with exercise.
- Painful pelvic exams.
- Painful and frequent urination.
Diagnosing frozen pelvis takes time and is often a challenging. There are no simple tests to diagnose the condition. Performing a laparoscopy and taking biopsies of the tissue is the only sure way of diagnosing frozen pelvis. It is an expensive and invasive procedure that should only be done by a surgeon that is well-educated and experienced in diagnosing frozen pelvis. If you prefer not to have surgery to diagnose the condition, an experienced gynecologist can recognize symptoms that are common with endometriosis. Other than a general history and physical, your doctor may perform ultrasounds, MRI scans and vaginal exams. None of these tests can 100% confirm or rule out frozen pelvis. Unfortunately, the only way of finding out for sure is to have an invasive surgery.
Frozen pelvis is an advanced stage of endometriosis and may require ongoing treatment for fertility to return or to have relief from its debilitating symptoms. Surgery, hormone therapy and physical therapy can all help you get on your way to healing.
The endometrial cells that are causing your frozen pelvis react to hormones in a manner similar to your uterine lining. This means that the cells thicken and shed just like having a menstrual period inside of your body. Blood and endometrial cells can pool up, since they have nowhere to go, causing a lot of pain. Birth control pills can help the problem tissues shrink and cause fewer problems. The growth of the tissues can be controlled long-term in this manner. Anti-inflammatory medications help with pain. Exercise, stretching, and palpation of the affected area can help some of the adhesions break loose from your organs. Talk to your doctor about what options are best for your personal situation.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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