New approach of perineal pain with intracavitary ultrasound therapy

Dr. Arcangelo Garofalo (Carmagnola, Italy)

Received 26 july 2001

 
Painful pelvic syndromes with a musculo-fascial origin can be treated by classical rehabilitation techniques. Intra-vaginal ultrasound therapy seems to be a new relevant tool which is very helpful in the management of these pains.

CLINICAL APPROACH

Treat as soon as possible !

The physician has to search after painful area with its finger. If the patient doesn't feel the pain without pressure on the area (no spontaneous pain), the result will be better because the adhesions are less structured (less fibrous tissue) and it is possible to prevent alteration of central modulation of pain. 

Our method

In our protocol, we use a combined therapy of ultrasound and interference electrotherapy in tissular injured site and we make sure the probe applies both therapies on distal receptors where nociperception originates. Afterwards we apply stretching and we module the afferent nervous tracts with TENS currents. We replan the functional aspects with electrotherapy, bio feedback and kinesitherapy.

What kind of ultrasound?

We always seek for a mechanical effect, consequently we can use the pulsated form of ultrasounds which allows to reach more elevated tops of intensity with a modest thermic effect and a better acceptance of the therapy. The frequency is chosen on the basis of the micro-dimensions of the treated structures. We use a probe with a frequency of 3 MHz for small and superficial microstructures; a probe with a frequency of 1 MHz for bigger and deeper structures. The used power is from 1 to 3 Watts. The bundle of ultrasonic energy must never cross the gonads because nowadays there are no study which shows the innocuity of such waves at this level.

TREATED PATHOLOGIES

Almost every pain :

1)cicatricial outcomes of endometriosis after surgical and/or pharmacological treatment 
2)pelvic adhesive disease
3)inflammatory pelvic varicocele
4)situations of chronic pelvic phlogosis 
5)venous stasis and interstitial stasis which are typical of cicatricial areas 
6)lesions owing to entrapment of peripherical nerves 
7)nociceptor hyperesthesia owing to chronic pain 
8)overload pathologies with tendinous and insertion pathology
9)less definite pathologies such as interstitial cystitis, urethral syndrome, urethrotrigonitis, vaginismus, proctalgia, perinealgia 
10)post-surgical inflammatory and adhesion pelvic pathologies


OUTCOMES

Pain to palpation, subjective pain, sexual life quality and degree of satisfaction show an average improvement of 77% at a follow up of 1-5 years.
200 treated patients : 85% women , 15% men; mean age : 45 (17-75)

ASSUMPTIONS OF ULTRASOUND THERAPY

It is a mechanical therapy which develops strengths of compression and decompression in an extremely selective way, above all on tissular interfaces. The aim of ultrasound is to obtain a good sliding of the tissues and to improve the microcirculation.

Ultrasound therapy produces :
1)microflows of interstitial fluids 
2) increased compliance of collagen 
3) reduction of adhesion and cicatricial reactions 
4) micromassage 
5) vasodilatation, acceleration of lymphatic flow, increase of topic metabolic process
6) increased speed of conduction on peripheral nerves, even if amplitude and length of action potential are unchanged; increase of pain threshold. The most susceptible fibers are the C ones.

ANATOMICOPATHOLOGIC ASSUMPTIONS

The pelvic organs and the myofascial structures are closely integrated both functionally and anatomically. 

This implies three different types of events: 

1) a recurrent organ pathology can produce a chronic phlogistic cicatricial reaction near the myofascial structures which can be lately the cause of the persistence of the pain. Vice versa the initial myofascial pathology can induce pathology in the contiguous organ

 2) in the presence of a myofascial pathology we can point out an organ symptomatology or vice versa 

3) the inadequate sliding owing to adhesions engenders a tissular ache and a functional insufficiency.

CONCLUSION

Ultrasound therapy should become a first line therapy for pain produced by cicatricial reactions, at fascial and/or muscular level. It should avoid many inefficient operations.


Dr. Arcangelo Garofalo
Via Gozzano n.16
10022 Carmagnola (To) Italy
Tel. 003911 9721433

P.S. I would like to exchange information and to discuss experience with everybody who uses ultrasound therapy in perineal pathologies. 

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