Adhesions in the pelvis: the symptoms and treatment of adhesive disease
Adhesions in the pelvis — strands generated from proliferating connective tissue. The result is the coalescence (adhesion) and the displacement of internal organs, accompanied by severe pain. Adhesions disrupts the normal functioning of the organism is the cause of infertility.
The mechanism of the formation of adhesions in the pelvis
The internal cavity of the small pelvis and the parietal peritoneum covered with a shell, and the surface of the internal organs – visceral.
The main objective of these tissues is to ensure free movement of organs in relation to each other, it is produced by peritoneal fluid. Especially important is this feature when it comes to pregnancy, since the repeated increase of the uterus should not interfere with the work of the intestine and urinary tract. Additionally, the peritoneum protects the internal organs from infections and prevents the penetration, fat accumulates.
With the development in the pelvis the pathological process involved in tissue swelling, and on the visceral surface there is a RAID of fibrin. This substance has a sticky consistency, making the inflammation does not extend to adjacent organs.
Adhesions of pelvic organs (plastic pelvioperitonit), that is, adhesion (adhesion) of the visceral sections of the shell takes place in several stages:
|Phase||Stage duration||What is happening in the pelvis changes|
|Jet||The first 12 hours after start of inflammation or tissue damage||The development of an inflammatory liquid (exudate).|
|Exudative||1 – 3 days||Due to the increase in vascular permeability undifferentiated (immature) cells, exudate and blood protein fibrinogen, into the pelvic cavity.|
|Adhesive||Day 3||Fibrinogen is transformed into fibrin, forming a filamentous coating on the abdominal wall. Of immature cells formed fibroblasts that produce collagen, which is the basis of connective tissue.|
|Young bands loose consistency||7 – 14 days||Due to insufficient amounts of collagen are formed loose spikes, in which the formation of new blood vessels, nervous processes.|
|Mature dense spikes||From 14 days to one month||The previously formed strands are compacted due to the increase of collagen and thickening of blood vessels.|
Consider how women have formed adhesions in the pelvis:
- Resulting in inflammation exudate is distributed throughout the oviduct. After its penetration into the abdominal cavity begins to produce fibrin, which blocks the abdominal orifice of the fallopian tube. Further it leads to its sealed obliteration (complete blockage);
- The oviduct is closed, and the generated inflammatory fluid accumulates in the cavity. Exudate purulent character contributes to the formation of pyosalpinx, and serous — hydrosalpinx or sanjoanense. If you open the pipe hole from the side of the uterus, then perhaps the outpouring of pus in its cavity and then through the vagina to the outside;
- When purulent inflammation of the infection through the blood or fluid can penetrate into the ovaries, which leads to its melting and formation of Pilbara;
- The accumulation of inflammatory fluid tube and ovary deformed. Occurs desquamation (partial peeling) of the epithelium of the oviduct, it contributes to bonding the opposite sides and the formation of partitions. The result is a multi-saccular formation;
- In the absence of timely treatment of pyosalpinx and power first, stick together, and after heal. Capsule, located in the places of their bonding, melted, and appears purulent tubovarial formation;
- Pyosalpinx (hydrosalpinx), power and tubo-ovarian tumor may form strands in the pelvic cavity with its walls, the uterus, a healthy fallopian tube and the ovary, bladder and intestine, omentum. To get rid of adhesions of this nature is very difficult, since during the operation the attending physician must remove fluid and formed to dissect tissue, without affecting healthy organs and blood vessels.
Timely treatment is trapped in the fallopian tube infection can eliminate the inflammation until the early exudative phase, preventing adhesions in the pelvis.
A variety of factors, mechanical and inflammatory insults to provoke adhesions in the pelvis. Consider the main reasons of development of this pathology:
- Surgery. Postoperative adhesions are due to prolonged contact of internal tissues with air and tools, drying sheets of peritoneum. Therefore, the number formed by the strands depends on the extent of the operation, the chosen mode of access, introduction of drainage to output the inflammatory fluid and blood, establishing nets to strengthen the tissues of the peritoneum, etc. When re-surgery adhesions pelvis appear with probability 95%.
- Diseases accompanied by inflammation of the pelvic peritoneum (pelvioperitonit), uterus and appendages (parametritis, endometritis, salpingoophoritis). The impetus for their development are genital infections (chlamydia, ureaplasmosis,gonorrhea, etc.), surgical procedures (abortion, hysteroscopy, etc.), the establishment of IUDs, lack of or incorrect treatment of diseases of the small pelvis.
- Endometriosis, hyperplasia of the inner layer of the uterus beyond its limits. During menstruation, the endometrium secretes blood in the pelvic cavity than provokes a defensive reaction of the peritoneum, starting the mechanism of formation of bands.
- Heavy pregnancy and childbirth. Adhesive disease of small pelvis during these periods may occur after complications (cesarean section, infection of the uterus during childbirth, etc.).
- Hemorrhage inside the peritoneum and the pelvic cavity that occurs with ovarian apoplexy, mechanical damage,ectopic pregnancy, retrograde reflux of menstrual blood through the fallopian tubes.
- Inflammatory processes in the abdominal organs that have indirect (appendicitis).
The above reasons are not always lead to formation of adhesions in women. The risk of their occurrence is reduced to zero, if the inflammatory processes are treated on time and adequately complied with all recommendations of the doctor.
Signs of the formation of adhesions in the pelvis
The symptoms and treatment of adhesions depend on the stage of development of this pathology. Adhesive disease of the pelvis occurs in three forms:
- The acute phase is characterized by increasing pain, nausea, vomiting, palpitations, increased body temperature. Clicking on the stomach is accompanied by sharp pain. Appears bowel obstruction, which involves a violation of protein and water-salt exchange. The patient’s condition is assessed as extremely severe and requires surgical intervention.
- Intermittent stage, which is characterized by periodic aching pain in adhesions in the pelvic area, bowel disorders (constipation alternate with diarrhea).
- When adhesive process chronic clinical picture is missing entirely, or sometimes in the groin area appear aching pain, constipation.
This disease is accompanied by a number of complications:
- Chronic pelvic pain caused by tension of the adhesions of the displacement bodies. It is exacerbated during sexual intercourse, bowel movements, sports, the overflow of the bladder.
- Intestinal obstruction arising because of his being crushed by spikes. As a result of disrupted the release of gases and feces.
- Problems with gestation. The cords can disrupt normal blood flow in the uterus and its connection with the Central nervous system that can cause premature birth or spontaneous abortion.
- Infertility. Bands in the fallopian tubes result of their deformation and obstruction, breaking the circulation in the ovaries, which does not allow the follicle to Mature. As a result, the pregnancy does not occur at all or develops outside the uterus, as the egg is fertilized not in the right place.
Signs of adhesions are other diseases, such as appendicitis, ectopic pregnancy, pelvic ganglioneuroma. To diagnose the exact cause you need to see a specialist.
Diagnosis of adhesions
The diagnosis of this disease at the initial examination on the gynecological chair difficult. If the doctor has identified the symptoms as sore adhesions in the pelvis, it specifies what tests need to go further:
- smear on the flora;
- bacterial inoculation;
- tests for the detection of genital infections;
- Pelvic ultrasound;
- check the patency of the fallopian tubes – hysterosalpingography;
- laparoscopy — surgical method to accurately determine the presence of adhesions, the number of them.
According laparoscopy to determine the stage of development of the disease and choose a way to treat adhesions:
- I degree – educated bands around the fallopian tube, ovary or other area, do not prevent the release of an egg. In this case affected only one side of the bodies (right or left of the uterus).
- Grade II – localized adhesions between the ovary and the fallopian tube, or connect them with other bodies, making it difficult to capture the egg.
- III degree – strands cork and twist the fallopian tube, fertilization of the egg impossible.
Treatment of connective-tissue strands in the pelvis
Treatment of adhesions in the pelvis can be surgical and conservative. The choice of method of treatment depends on the cause of disease and the degree of its development.
Getting rid of adhesions in acute and intermittent forms of the disease is possible only through surgical intervention (laparoscopy). To strengthen the effect of additional prescribed medications.
Cure chronic adhesive process using only conservative method.
Before treatment is necessary to eliminate the reason for the formation of connective tissue cords:
- when urogenital infections and is prescribed a course of antibiotics, antimicrobial and anti-inflammatory drugs (candles, tablets, ointments, etc.);
- to eliminate endometriosis using hormonal agents.
At the initial stage of formation of adhesions and chronic form of disease, are appointed by fibrinolytic drugs:
- Trypsin, Streptokinase, Chymotrypsin injection;
- Longidasa — the spark and injection;
- Electrophoresis with lydasum assigned in the absence of acute infectious processes.
- Therapeutic effect on adhesions have hirudotherapy, massage, vagina tampons with Vishnevsky ointment.
- For getting rid of the pain using a good antispasmodic.
- With the ineffectiveness of drug therapy in acute for to get rid of adhesions in the pelvis can only be surgically removed.
- Idealizes — dissection of adhesions, which connect the pelvic organs to each other and with the abdominal tissue. Performed laparoscopically, with welded body can be detached with a laser (laser), water jet (equidistance), electrocautery (electrosurgery).
Rehabilitation after surgery
After surgery to prevent re-formation of adhesions in the abdominal cavity impose a special barrier fluid (dextran, mineral oil and other means with glucocorticoids), fallopian tubes and ovaries are wrapped in a polymer film. Required additional administration of anticoagulants and antiplatelet agents (Chimes, Heparin, Trental), a blood-thinning.
When adhesive process between the walls of the small pelvis and organs are connective tissue bands. This disrupts the functioning of the organism is the cause of female infertility. Symptoms plastic pelvioperitonit have an ectopic pregnancy, appendicitis and other pathologies. Therefore, for an accurate diagnosis you need to see a specialist. Timely treatment will allow to get rid of the adhesions without possible complications.