Adhesive disease: spikes in the small pelvis - Causes, symptoms and treatment. MF.

Adhesive disease ( morbus adhaesivus) is a condition characterized by the formation of adhesions in the abdominal cavity and pelvic organs - connective tissue strands.

Recently, the incidence of adhesions in gynecology has greatly increased.
This is due to many provocative factors in the modern world.

Causes and mechanism of adhesions in the small pelvis

The most common causes contributing to the onset of the adhesion process in the small pelvis are the following: 1) pelvic inflammatory disease .These include infections of the uterus, appendages and pelvic peritoneum: endometritis( inflammation of the uterine cavity), metroendometritis( inflammation of the mucous membrane and muscular membrane of the uterus), parametrization( spread of infection to the space outside the uterus), salpingoophoritis( inflammation of the uterine appendages), pelvic peritonitisperitoneals).

Predisposing factors for the development of these infectious diseases are: prolonged wearing of the intrauterine device;scraping of the uterine cavity, in particular, abortion;infections, sexually transmitted diseases( chlamydia, ureaplasmosis, trichomoniasis, mycoplasmosis, gonorrhea).

The mechanism of the adhesion is the following: when inflammation occurs in the small pelvis, inflamed tissues become edematous, a fibrin raid appears on the peritoneum. Fibrin, as it were, glues together the underlying tissues. As a result, there is an obstacle to the further spread of the inflammatory process. After an inflammatory disease, the glued tissue surfaces form a fusion between each other. Bracing - this is the spikes, they perform a protective function - they limit the inflammatory process.

When the infection gets into the fallopian tubes, inflammatory exudate does not always form. Abortion of acute inflammation of the mucous membrane of the tubes may occur before it passes into the stage of exudation. In many patients, the exudate formed in the acute stage of the disease resolves. Only in a small part of patients acute inflammatory process in the fallopian tubes leads to the spread of inflammatory serous or purulent exudate throughout the tube. Exudate, poured through the abdominal opening of the tube into the abdominal cavity, can cause a response - loss of fibrin, sealing the abdominal opening, which eventually hermetically obliterated. The fallopian tube is transformed into a closed cavity. With the development of a purulent process, it forms a pyosalpinx. If the uterine opening of the tube remains open, it is possible to pour the exudate into the uterine cavity and then through the vagina to the outside. From the fallopian tubes with exudate and hematogenous way bacteria can penetrate into the ovary and cause its purulent melting( pyovar).

Both the fallopian tube and the ovary increase in size as the inflammatory exudate accumulates, the tube acquiring a retort-like shape and the ovary acquiring a spherical shape. In the mucous membrane of the tube there are areas of desquamation of the epithelium and gluing of opposite surfaces with the formation of partitions. As a result, a multicameral saccular formation is formed, filled in some cases with serous exudate - hydrosalpinx, in others - purulent exudate - pyosalpinx. When gluing, and then joining the pyosalpinx and pyovar in the junctions, melting of the capsules may occur.

The white membrane of the ovary and the walls of the fallopian tube, as hyaluronic acid is deposited in them and fibrous tissue proliferates, becomes dense, impermeable capsules. These inflammatory formations( hydrosalpinx, pyosalpinx, pyovar, purulent tubo-ovarian tumors) are usually fused to the walls of the pelvis, with the uterus, fallopian tube, ovary of the opposite side, with omentum, bladder and guts. The formation of capsules impervious to microbes and extensive adhesions in the acute stage plays a protective role, preventing the spread of infection. Later, after the death of the pathogens of the inflammatory process, these impermeable capsules delay the resolution of the accumulated serous or purulent exudate.

The location of the pelvic organs with inflammatory saccular formations changes significantly, and the function of the neighboring organs( rectum, bladder) and, of course, the genital function is also disturbed.

2) inflammatory diseases of the abdominal cavity, for example, appendicitis;

3) mechanical damage to the pelvic organs and abdominal cavity( injuries, surgical interventions).Spikes develop with a hemorrhage into the abdominal cavity, especially when the blood is infected with blood. In gynecology, the cause of the formation of adhesions is bleeding in the ectopic pregnancy and with ovarian apoplexy. The importance of peritoneal injury, cooling or overheating of the peritoneum in the development of adhesions has been experimentally proven.

The presence of foreign bodies( napkins, drains) in the abdominal cavity during surgery is also accompanied by the formation of adhesions.;

4) hemorrhages in the abdominal cavity( ectopic pregnancy, ovarian apoplexy, etc.);

5) endometriosis is a disease characterized by proliferation of endometrioid tissue outside the endometrium - the inner layer of the uterus.

The inflammatory process in the abdominal cavity and small pelvis does not always lead to the formation of adhesions. If treatment is started on time and done correctly, the likelihood of adhesions is reduced. Spikes are formed when the acute process passes into the chronic process and the healing process is stretched in time.

The most common cause of of the adhesive disease is inflammation of the appendix( appendix) and appendectomy( about 43%), followed by diseases and operations on the pelvic organs and operations for intestinal obstruction( about 30%).

Symptoms of the presence of adhesions in the small pelvis

The severity of the symptomatology in a commissural disease depends entirely on the degree of spreading of adhesions in the pelvic space. There are variants from asymptomatic course to a pronounced clinical picture. There are three main clinical forms of the disease:

1) acute. Patients with this form of the disease have fairly pronounced complaints, gradually pain pain develops, vomiting, nausea, temperature rises, heart rate increases. Examination of the abdomen( pressure) causes severe soreness. There is an obstruction of the intestine. After that, the patient's condition deteriorates sharply: pressure drops sharply, the amount of urine released decreases, there is weakness, drowsiness. Violated water-salt and protein metabolism in the body. The condition of patients with an acute form of commissural disease is estimated as extremely severe;

2) Intermittent form: pains occur periodically, may disturb intestinal disorders - constipation, diarrhea.

3) a chronic form - is characterized by a hidden clinical picture: the clinic is absent, or there are occasional painful pains in the lower abdomen, constipation. It is the chronic form of adhesive disease that most often occurs in gynecological practice. Quite often it is a manifestation of endometriosis and hidden infections, of which neither the patient nor the gynecologist is aware. Adhesive process causes obstruction of the fallopian tubes, which leads to infertility. It is with this complaint, the inability to become pregnant within a year of a patient and turn to a gynecologist with an asymptomatic course of a chronic form of a commissural disease.

If a pain attack occurs and signs of intoxication( vomiting, nausea and fever), the patient should urgently consult a gynecologist. If complaints have a pronounced character - you need to call an ambulance. If you start from the symptoms, then the adhesion can be confused with many diseases, ranging from acute surgical pathology( appendicitis, intestinal obstruction, ectopic pregnancy), and ending with banal poisoning.

Self-medication in this case is unacceptable-only competent consultation of a specialist will help to protect yourself from unpleasant consequences.

Diagnosis of adhesive disease

Diagnosis of adhesive process in the small pelvis is not so simple, it can be suspected by a gynecologist at the first examination in the presence of characteristic complaints and anamnesis( surgical interventions in the past).With vaginal examination, the pelvic organs are immobile, or slightly mobile in the study. With a pronounced adhesion process, the examination on the armchair causes painful sensations. However, a reliable diagnosis can be made only after a series of tests and studies:

- A smear on the flora of the vagina;

- PCR - diagnosis - examination for urogenital infections;

- ultrasound of the pelvic organs;

- MRI - magnetic resonance tomography of pelvic organs - performed after a preliminary ultrasound of the pelvic organs. Noninvasive instrumental research method, which has high informativeness;

- Diagnostic laparoscopy is an operational, but the most reliable method of diagnosis. Two small incisions are made on the abdominal wall. In the abdominal cavity air is pumped. A laparoscope is inserted into one incision( a thin tube with the camera block at the end, through which the image is transferred to the monitor screen).In another incision, a manipulator is inserted, with the help of the doctor, the doctor examines the organs, displaces them, examines them in detail. This allows us to make an accurate diagnosis with full confidence.

Depending on the laparoscopic picture, 3 stages of spreading of adhesive disease are distinguished:
1st stage-spikes located only near the fallopian tube, ovary or other area, but do not interfere with the capture of the egg;
2nd stage-spikes located between the fallopian tube and the ovary or between these organs and interfere with the capture of the oocyte;
The third stage is the overturning of the fallopian tube, blockage of the uterine tube with spikes, which makes it absolutely impossible to capture the egg.

Obstruction of the fallopian tubes according to hysterosalpingography( a contrast agent is injected into the uterus, radiographic images are taken), gynecological examination and ultrasound examination with a high degree of reliability indicates the presence of an adhesive process, but the patency of the fallopian tubes does not exclude the presence of adhesions that seriously impede the onset of pregnancy. Conventional ultrasound can not reliably detect the presence of small pelvic adhesions.

Thus, it is the definition of the stage of spreading the adhesive process that is fundamental for determining the tactics of treatment. In many cases, patients may be observed and examined for years for a gynecologist with an unclear diagnosis, but it is laparoscopy that not only allows an accurate diagnosis, but also an effective treatment of adhesions.

Treatment of adhesive disease

Treatment of adhesive disease entirely depends on the severity of the disease, it can be both conservative and surgical. Immediately make a reservation that when acute and intermittent form of the disease, surgical treatment - laparoscopy, is the only method of treatment due to high efficiency and rapid effect. Very often, surgical treatment is combined with conservative treatment for greater effect.

With the chronic form of a commissural disease, only extremely conservative treatment is possible. It is necessary to identify the cause of the development of adhesions. If any urogenital infection( say chlamydia) is detected, then first of all the treatment should be aimed at eliminating the underlying disease in order to prevent further spreading of the adhesive process. For this purpose, the drugs of choice are antibiotics and anti-inflammatory drugs( NSAIDs, corticosteroids).If the cause of adhesions is endometriosis, then hormonal treatment, anti-inflammatory drugs, desensitizing and symptomatic therapy are prescribed.

Non-specific therapy is widely used - fermentotherapy - fibrinolytic drugs that dissolve fibrin( longidase, trypsin, chymotrypsin), these are quite effective drugs that dissolve small adhesions. In the absence of an acute infectious process, physiotherapy is used - internal laser therapy and external magnetic-laser therapy.

This treatment is not a panacea for the chronic form of adhesions. Conservative treatment is most effective at the first stage of the disease.

In case of ineffectiveness of all listed methods and with further spreading of adhesions, a diagnostic and diagnostic laparoscopy is indicated. As a rule, the surgeon-gynecologist diagnoses the adhesion sickness already on the operating table and simultaneously performs the operation - dissecting and removing the adhesions.3 variants of laparoscopy are possible:
-spikes are cut through the laser-laser therapy;
-spikes are cut using water under pressure - aquadisection;
-spikes are dissected with the help of an electroknife - electrosurgery.

The choice in favor of this or that method of treatment is determined by the doctor during laparoscopy, depending on the location of the adhesions and the prevalence of the process. During the operation, the surgeon also conducts conservative treatment with the goal of preventing the adhesive process: barrier liquids( dextran, povilin, etc.) are introduced, and polymer absorbable films are applied to the fallopian tubes and ovaries.

Factors Affecting Treatment of Adhesive Disease

With the established diagnosis of "Adhesive disease" it is necessary to adhere to certain canons and rules in order to avoid repeated relapses of the disease:

- visit to the gynecologist every six months;
- a rational diet - there are small portions with small breaks between meals - about 5 times a day;Avoid products that cause increased gas production;
- physiotherapy procedures are very useful for a speedy recovery, therefore it is recommended to visit the physiotherapist regularly - electrophoresis with medicinal products, therapeutic massage and physical culture can be performed);
- if you have a painful attack, you can use antispasmodics( no-spa, papaverine). If the seizures do not go away, you need to go to the gynecologist and not self-medicate yourself.

After the treatment - after surgery or conservative treatment - the patients are shown physical rest for 3-6 months, dynamic observation of the gynecologist. In the first 2-3 months, you must adhere to the above rational diet. Quick healing is also facilitated by physical therapy and physiotherapy procedures. With the implementation of all rehabilitation measures, the outlook is favorable.

Folk remedies for adhesions in the small pelvis

Traditional medicine is also used for a commissural disease as a symptomatic treatment. However, it should be borne in mind that all folk remedies are effective only when it comes to single spikes, otherwise herbal tinctures are not helpers and the condition can only worsen from prolonged "leavening" on the grass. It is very useful to use herbal tinctures in the rehabilitation period and as an additional means to the basic treatment. For this purpose, St. John's wort is used in dried and crushed form. A tablespoon of St. John's wort is poured a glass of boiling water, boiled for 15 minutes, filtered and take a decoction of 1/4 cup 3 times a day.

Complications of adhesive disease

Adhesive disease is a very formidable disease to look at it through fingers. There are cases when the disease is quite favorable, without letting itself know, but under adverse circumstances the adhesion process is rapidly spreading and in the absence of a competent approach and treatment there are very serious complications such as: infertility, menstrual irregularities, uterine bending( displacement)intestinal obstruction, obstruction of the fallopian tubes, ectopic pregnancy, not to mention the acute form of the disease, which can lead to very adverse effects on life.

Prophylaxis of an adhesion disease

Prevention of a commissural disease includes: regular observation by a gynecologist, gynecological massage, timely treatment of urogenital infections, natural family planning: protection from unwanted pregnancy, abortion, birth through natural birth canals, regular sex life.

Questions and answers on Spikes in the small pelvis.

1. On ultrasound found spikes in a small pelvis. Can I get pregnant?

2. How likely is the onset of pregnancy after laparoscopy?

3. Can there be adhesions after cesarean section?

4. Can adhesions dissolve after physiotherapy?

5. Can I put a spiral on spikes?

6. Can there be pain during sex, if there are spikes?

7. I have a bend in the uterus. Does this mean that I have spikes?

8. Which sexual infections most often lead to the formation of adhesions and infertility?

9. I always have a lower abdomen pulling. The doctor says that I have spikes. But on ultrasound did not find anything. What to do?