Why do adhesions appear in the pelvis. What is the adhesion process? Adhesions after stomach surgery

Modern classification fertility disorders in a separate group makes infertility due to the tubal-peritoneal factor, that is, infertility that occurs due to impaired patency of the fallopian tubes. critical role at the same time, adhesive processes of the small pelvis play. Adhesions are strands or films of dense connective tissue, which, by “gluing” organs together, change their anatomical position. Thus, there are bends or sealing of the fallopian tubes, displacement of the ovaries and other conditions that interfere with the normal fertilization of the egg.

Reasons for the formation of adhesions

The formation of adhesions is based on the reaction of the peritoneum - a special membrane that isolates internal organs. Complex biochemical processes that occur when it is irritated and lead to the formation of connective tissue strands that firmly solder adjacent anatomical structures. There are many factors that cause such changes: infectious and inflammatory process, mechanical or chemical effects, autoimmune damage. Simply put, the formation of pelvic adhesions is facilitated by acute and chronic inflammation of the uterine appendages, surgical interventions, endometriosis - any processes, one way or another, affecting the peritoneum.

Soldering process.
Spikes are seen as thin films
between neighboring bodies

1. Adhesions are visible between the uterus and the abdominal wall
2. Uterus

Symptoms of adhesive disease

The manifestations of the adhesive process depend on how much their presence has changed the anatomy of the small pelvis. In some cases, adhesions are asymptomatic and do not cause problems for a woman, in others they have a significant impact on the quality of life and reproductive health. The most typical manifestations of adhesive disease include:

Pelvic pain syndrome. Depending on which structures are involved in the adhesive process, pain may have different localization, give to the rectum, genitals. Usually women describe them as "pain in the lower abdomen." The intensity and nature of the pain syndrome vary - from slight aching to quite pronounced.
Digestive disorders. Bloating, vomiting, constipation are often sure signs of partial or complete adhesive obstruction of the intestine. This is a formidable pathology that requires surgical treatment. Sometimes emergency.
Infertility. Adhesions, as we have already mentioned, are one of the main components of the tubal-peritoneal factor of infertility, which causes up to 40% of cases of female infertility.

The prevalence of adhesive disease is very high. According to domestic scientists, 75% of women with various gynecological problems have peritoneal adhesions.

Diagnostics

When a doctor conducts a study, he, of course, is not looking for adhesions, but for the causes of abdominal pain or fertility disorders. That's why diagnostic measures in different occasions differ significantly. If we talk about the diagnosis of adhesions as a cause of infertility, then the purpose of the study is primarily to assess

patency of the fallopian tubes. The most informative in this regard:

Hysterosalpingography is an x-ray study, during which the distribution of a contrast agent in the fallopian tubes is assessed. The method allows you to assess the condition of the mucous membrane of the tubes, to identify paratubal, that is, adhesions located around the tube.
Sonohysterography - ultrasound procedure tubes with pre-filling them with saline or contrast. The method has very good sensitivity in the study of patency, but adhesions are not visible to the doctor.
Laparoscopic chromopertubation is the introduction of optical equipment into the pelvic cavity through punctures in the abdominal wall and assessment of the patency of a contrast agent through the tube. This method is the most invasive, but also the most informative, especially for detecting peritubal adhesions, and is the "gold standard" of diagnosis.

There are diagnostic criteria by which we can talk about adhesions and with a standard ultrasound of the pelvic organs, therefore, this procedure is widely used in diagnosing the causes of pelvic pain, however, the patency of the fallopian tubes cannot be assessed in this way.

Treatment of pelvic adhesions

Spikes that do not cause concern should not be touched. Strictly speaking, it is necessary to treat, not adhesions, but the conditions associated with them: pelvic pain, intestinal obstruction, infertility. In the first case, it is possible to use conservative methods - medicines, physiotherapy, spa treatment. If we are talking about the treatment of infertility, then two fundamentally different approaches are possible:

Surgical treatment, which is carried out today, is mainly (but not always!), Laparoscopic access.

Assisted reproductive technologies, in particular, the IVF program.

It is impossible to say which of these approaches is more effective, since everything depends very much on the characteristics of the clinical case, the technique used and, especially, the skill of the specialist performing the procedure. To understand how different the medical approach can be, just look at the list of possible surgical procedures:

laparoscopic adhesiolysis - dissection of peritoneal adhesions;
salpingo-ovariolysis - dissection of adhesions between the tube and the ovary;
fimbriolysis - separation of fimbriae (fimbriae are fringe-like formations of the fallopian tube that meet the egg that has left the ovary and deliver it to the tunnel);
salpingostomy - removal of a part of the pipe where the patency was impaired and further plastic surgery;
salpingoectomy - removal of the fallopian tube.

It is clear that each of the listed methods has its own indications, which are determined during the diagnosis. Some surgeries are quite effective in helping to overcome infertility, while others serve as preparation for assisted reproductive technology (ART).

In vitro fertilization is recommended by many specialists for severe adhesions, when surgery futile. However, there are a number scientific works, who recommend not wasting time on plastic pipes and immediately starting the IVF program. There are no strict recommendations in this regard, so the choice of a method for overcoming infertility remains with the attending physician.

The clinic IDK "Mother and Child" adheres to a balanced approach when choosing medical measures. Our specialists have been working in the field of ART since 1992, and when choosing a treatment method, they start from the rich practical experience, detailed diagnostic data and protocols with high level evidence.

Adhesions of the small pelvis are dense film formations that stick the organs together. The emergence of this process has been studied for more than 100 years, but as such, there are still no exact results about the causes of their occurrence and methods of prevention.

What are spikes for?

Many scientists and physicians tend to assume that pelvic adhesions are formed not so easily - they are designed to protect the whole body from inflammation that has arisen. That's why adhesive process is a threat only when it has complications. If such is not

observed, and they do not require treatment. But this fact still requires considerable evidence.

The mechanism of formation of this pathology?

If it is simpler, then the main reason for the appearance of symptoms of pelvic adhesions is as follows: the entire space between the organs fills abdominal fluid, which is produced by the peritoneum (thin tissue covering the cavity from the inside). When inflammation of the organs (especially the genitals) occurs or an operation is performed on them, the release of this fluid increases dramatically. In addition, it acquires a very viscous and sticky texture. It is this thick liquid that is the adhesions that stick together nearby organs and tissues.

Factors provoking the formation of pelvic adhesions

Diseases inflammatory nature pelvic organs. It can be various infections appendages, peritoneum or uterus: parametritis, endometritis, metroendometritis, salpingo-oophoritis, etc.
Any surgical intervention on the uterine cavity: diagnostic curettage, installation of an intrauterine device, abortions, etc.
Sexual infections: mycoplasmosis, ureaplasmosis, gonorrhea, chlamydia, trichomoniasis.
Inflammation of the abdominal organs.
injury or others mechanical damage pelvic organs and peritoneum.
Bleeding due to ovarian apoplexy or ectopic pregnancy.
Overheating or cooling of the abdominal cavity.
Endometriosis disease.

Signs indicating the adhesive process

Symptoms of pelvic adhesions, or rather, their strength, largely depends on the spread and neglect of the disease. There are three forms of adhesive process:

Acute. Signs of its manifestation are as follows: pain, fever, nausea (sometimes vomiting), palpitations. Bowel obstruction may occur. On palpation of the abdomen, the patient feels sharp pain. After a while, her condition can deteriorate sharply - there is severe drowsiness, weakness. The pressure begins to fall, the amount of urine decreases, the water-salt metabolism in the body is disturbed. Required urgent help in the form of surgery.
Intermittent - appearance periodic pain and intestinal upset.
symptoms of chronic pelvic adhesions - Clinical signs either absent altogether, or occasionally there are aching pains in the abdomen and constipation. In gynecology, this form is most common. Basically, it manifests itself in the form of endometriosis and many infections that the patient does not even suspect. Chronic manifestation This disease can cause the formation of adhesions of the fallopian tubes, which lead to infertility in women.

Is it possible to confuse the adhesive process with another disease?

Yes, you can. The manifestation of the same symptoms as those of pelvic adhesions (abdominal pain, vomiting, nausea and fever) is characteristic of many diseases - from inflammation of appendicitis, ectopic pregnancy, and ending with simple poisoning or a viral infection.

What are the consequences of the adhesive process?

Pelvic adhesions can spread in almost all directions, forming something like a chain of interconnected tissues and ligaments. Moreover, the most weakened and diseased organs are most often affected. As a result of the appearance of adhesions, the axis of their movement decreases. The area of the adhesive process begins to increase, thereby more and more to reduce the mobility of organs. Because of this, blood circulation going to them can be disturbed. If we talk about the complications that give pelvic adhesions in the form of diseases, then there are many of them:

infertility;
bending of the uterus;
violation of the cycle of menstruation;
obstruction of the intestines and fallopian tubes;
ectopic pregnancy.

Diagnostics of the adhesive process

In order to diagnose this disease, the gynecologist will need a lot of time. The first thing he does is to examine the patient on the chair, during which the patient may complain of pain. The final diagnosis will be made only after multiple studies. Namely:

delivery of a smear from the vagina;
research on urogenital infection;
if necessary, MRI of the pelvic organs is performed;
laparoscopy (diagnostic).

Stages of the disease

According to the results of the studies, we can talk about the belonging of the symptoms of the small pelvis to one of three stages:

the first - pelvic adhesions formed only near the ovary or fallopian tube and still do not interfere with the passage of the egg;
the second - adhesions are already between the ovary and the fallopian tube, but are already beginning to interfere with the passage of the egg;
the third stage - there is a torsion and blockage of the pipe with adhesions. The passage of the egg is impossible at all.

Treatment of pathology

The tactics of treating small pelvic adhesions largely depend on the severity (form) of the disease. Therefore, it can be divided into conservative and surgical.

To conservative treatment resorted to in the chronic form of adhesive disease. To do this, it is necessary to identify its cause, which should be eliminated. AT recent times Enzyme therapy is very popular - taking drugs whose action is aimed at resorption of adhesions. If no infectious disease then carry out laser and magnino-resonance therapy. But it is worth considering that such types of treatment will be effective only at the first stage of the development of pathology.

At the second or third degree of distribution this process, it is necessary to resort to therapeutic and diagnostic laparoscopy. This method is good because if the presence of adhesions was confirmed during the study, the doctor immediately performs an operation to remove them (dissection).

Prevention of recurrence of the disease

In order to avoid the recurrence of symptoms of pelvic adhesions, a woman needs to follow some rules:

adherence to a certain diet (avoidance of foods, bloating abdomen);
visit a gynecologist at least 2 times a year;
observance of physical rest for 4-6 months,
performing physiotherapy procedures;
light physical education;
with pain attacks, taking antispasmodics (papaverine, no-shpa);
For persistent pain, see a doctor.

Pelvic adhesions are a disease that responds very well to treatment. But it is much easier to prevent the disease than to treat it! Therefore, pay attention to your health a little more often, and everything will be fine with you!

Adhesive disease, or, more simply, adhesions in the pelvis, occur after frequent inflammations appendages, as well as due to untreated infections. Unfortunately, it is impossible to see adhesions on ultrasound. They can be suspected during normal manual gynecological examination. When all possible reasons pains are rejected, the diagnosis of adhesive disease is made.

Usually women go to the doctor with complaints of constant aching or drawing pains lower abdomen and lower back. Since these sensations are caused anatomical disorders, the use of painkillers does not bring relief.

Adhesion treatment

There are several methods for treating adhesions.. Conservative therapy should be started in combination with anti-inflammatory. It can also be effective initial stage adhesive disease, when the pain is intermittent and not too intense.

Aloe has a good therapeutic effect for the treatment of adhesions.. It is used in the form of injections of 2 ml every day (course - 10 injections). At the same time you need to take folic acid 1 capsule 3 times a day and vitamin E 2 capsules a day.

Now there are new effective drugs for the treatment of adhesive disease. Due to the content of special enzymes, they make adhesions more elastic and extensible. This helps to reduce pain. The course of treatment consists of 57 intravenous injections. But do not try to do it yourself - only a doctor can prescribe treatment.

Highly effective method treatment chronic inflammation and the adhesive process associated with it - physiotherapy. It allows you to soften adhesive structures, make them thinner and more extensible. This reduces, and in some cases completely stops pain, improves bowel function, which is often tightened with adhesions.

To the most effective physiotherapy methods include paraffin and ozocerite applications on the abdomen. During the procedure, a paraffin or wax compress is applied, which, as it were, warms up the adhesions, contributing to their resorption. The duration of the procedure is 10-15 minutes. The course of treatment is 10 procedures (it can be repeated after 2-3 months).

Good effect in the treatment of adhesions possesses electrophoresis with zinc, magnesium and calcium. With severe pain syndrome, novocaine is added to them. Procedures alternate every day (course - up to 20 sessions).

A contraindication to any of the physiotherapeutic methods is active inflammation. It is not necessary to conduct a course during menstruation.

It must be remembered that physiotherapy- this is not surgery, it cannot completely “resolve” adhesions. Therefore, if symptoms persist after a full course, an operation to dissect the adhesions may be necessary.

Most backfire adhesive process- obstruction of the fallopian tubes. To find out if they are passable, you can use hysterosalpingography. This is an X-ray examination of the uterus and tubes. At the same time, a special substance is injected into the uterine cavity and they watch how it is distributed in the tubes. If they are obstructed, the adhesions are separated by laparoscopy. If the pipes are in order, then physiotherapy is prescribed to reduce soreness and soften adhesions.

A few decades ago, few people knew about adhesive diseases pelvic organs, which most often attack women. Today, this disease is heard by all gynecologists, in connection with which many medical programs and methods of its treatment have been developed. Except constant feeling discomfort, annoying pulling pains in the lower abdomen and other unpleasant symptoms, this disease is dangerous and what can be fraught with.

What is the adhesive process in the small pelvis, how to recognize what are the main causes of its occurrence, treatment methods and consequences - we will consider all this in our article.

Description and characteristics

This problem most often affects the feminine and leads to extremely negative consequences among which one of the most deplorable is infertility. If a few decades ago, few people encountered such a disease, now, for many reasons, it is too common.

In gynecological circles, this disease is known as "plastic pelvioperitonitis".

To understand what kind of disease it is, you need to delve into the physiology human body, and in particular - and . This part human body lined inside with a peritoneum (smooth membrane), the blood supply and nutrition of which occurs due to the organs that it covers.
The abdominal cavity is filled with peritoneal fluid, which contains a large number of protein and enzymes. This fluid contributes to the proper and high-quality functioning and movement of organs. In the event of provoking factors (trauma, damage to the pelvic organs), inflammation of the tissues and their swelling occur.

The body instantly turns on a defensive reaction, it tries to eliminate the process as quickly as possible by releasing fibrin, which sticks together the tissues located near the focus of inflammation. This forms a kind of protective shell that does not allow inflammation to spread to healthy cells.

This is how the adhesive process occurs in the small pelvis, the treatment of which will require a lot of effort and patience.

Causes of appearance: how adhesions are formed

Modern luminaries of medicine name several reasons that provoke the occurrence this disease. At risk are people whose relatives have already encountered this problem. Or those whose pelvic organs were subjected to mechanical or physiological damage.

Also, the disease can be a consequence of weak immune system person. Consider the most common causes of adhesions in.

Important! According to multiple medical research, this disease most often manifested in people who are genetically predisposed to it.

Inflammatory diseases

One of the most common causes occurrence of plastic pelvioperitonitis are inflammatory diseases. In most cases, adhesions are a consequence of parametritis, pelvioperitonitis,.

Such diseases can be triggered by various factors:

latent infections of the genital organs and tracts, among which gonococci and others have primacy;
sexual tuberculosis;
poor-quality treatment of pelvic diseases, including self-medication;
use by a woman as a means of protection against unwanted pregnancy.

Did you know? The adhesive process in the pelvic organs affects women 2.6 times more often than men. Wherein fatal outcome This disease is 10-15% more common among men.

The listed causes of the onset of the disease are the consequences of a chaotic sexual life, improper, hypothermia, non-compliance with personal, bad conditions life.

Postoperative consequences

Often the cause of the formation of adhesions are surgical interventions. on the abdominal cavity and located nearby organs lead to injuries and the formation of foci of inflammation on the operated organs, in addition, hemorrhages occur in abdominal cavity. As a result, aseptic inflammation occurs, which entails the appearance of postoperative adhesions.

endometriosis

But in any case, if there are adhesions on the uterus, one should not despair and kill oneself with the question of whether it is possible. It is possible if the disease is diagnosed on early stages and choose a quality course of treatment. Last resort - .

Signs and symptoms

The symptoms of this disease include pulling pains in the lower abdomen, frequent, malfunctions of the intestines, constant fatigue, depression. Untimely access to a doctor can lead to the fact that adhesions entangle reproductive organs women are like cobwebs, and will practically nullify a woman's chances of becoming a mother.

When the disease becomes sharp shape, a woman begins to suffer from ever-increasing pain in the lower abdomen, bouts of nausea and vomiting, rapid heartbeat, fever and other unpleasant manifestations. In this case, the patient needs emergency medical care.

How to diagnose a deviation

Diagnosis of this disease is a rather complicated process. It is impossible to make such a diagnosis with the naked eye, that is, one examination alone is not enough to establish it.

The last two diagnostics are the most effective in this case. Also, the doctor may refer the woman to the study of the patency of the uterine appendages.

The most reliable results are invasive technique, which not only helps to detect adhesions, but also provides information about the stage of the disease.

What to do: methods of treatment

Treatment of adhesions in the small pelvis can be carried out both with the help of traditional medical techniques and resorting to alternative medicine.

Medical

Speaking of traditional medical practice getting rid of adhesive sutures, doctors will recommend you two options: conservative therapy or surgery.

Conservative therapy is to eliminate the cause of the disease as soon as possible. If it is, for example, an infection, then it can be eliminated by others, but if the adhesive process is a consequence, it is necessary to undergo a course of hormonal treatment.

Also, the doctor may advise enzyme therapy - this is the use of fibrinolytic drugs that dissolve fibrin. Another common method is magnetic laser therapy.

If the disease progresses, new adhesive sutures form, doctors will advise you to resort to surgery, during which the adhesion is dissected and removed. Surgical manipulations can be carried out using a laser, water and an electric knife.

Important!There is a risk that after the operation, the adhesive process will resume with renewed vigor. To avoid this, doctors create a kind of barrier between healthy and diseased areas in the abdominal cavity: special preparations, which protect it from the pelvic organs, envelop the sore spots with a special shell, which resolves after the damaged area has healed.

Folk

Folk methods and means of treating the adhesive process in the small pelvis steadily assert positions among the broad masses, but they cannot give a full guarantee of recovery.

And healers have found ways to treat adhesive disease with the help of healing infusions and decoctions.

One of the first remedies that the healer will recommend to you is an infusion, which consists of 1 tablespoon of dill seeds, 1 tablespoon of parsley seeds and 0.5 liters of boiling water. This mixture should stand for a day, after which it can be drunk every day, like tea. The course of treatment is 2-3 months.

In order to treat adhesions in the small pelvis, you can take a decoction of St. John's wort in proportions of 1 tablespoon per glass of water. It is necessary to boil this mixture for 15 minutes and take a quarter cup three times a day.

Important! If you do not trust either doctors or healers, combine the efforts of both: traditional medicine paired with non-traditional, they will help you get rid of a depressing diagnosis better.

Any disease is easiest to treat in the early stages. Therefore, do not postpone health problems indefinitely. You should listen to your own body, catch and understand the signals that it gives. Timely seeking qualified help will allow many women to avoid a depressing diagnosis - infertility, which develops as a consequence of the formation of adhesions in the pelvic area.

The reasons that lead to the formation of such a pathology, experts divide into 5 groups:

Various inflammatory processes;
Development of endometriosis;
Surgical operations;
Entry of blood into the pelvis or abdominal cavity;
development of appendicitis.

Pelvic adhesive disease develops against the background of processes that provoke increased formation of connective tissue. The immediate causes of the formation of adhesions are:

They can appear in the postoperative period:

Operations in the field of gynecology;

Urology;

As well as operations to remove the appendix;

Inflammation of self-adhesions

Inflammation of self-nodular adhesions is an acute clinical form diseases associated with the following symptoms:

growing pain
vomiting and nausea,
fever body,
strong pain at the slightest pressure on the stomach,
intestinal obstruction,
frequent pulse.

low pressure,
insufficient urination,
weakness and drowsiness
protein and water-salt metabolism is disturbed.

Treatment of this extremely dangerous and serious condition at home is unacceptable, immediate hospitalization is required.

Adhesions after gynecological surgery

It is worth noting that women do not immediately agree to the operation and hope for the removal of adhesions. folk remedies. Here it should be understood that decoctions of herbs or tinctures are not able to remove even absorbable properties. this pathology. Spikes are connective tissue, dense enough, it can only be dissected.

For prevention and in the initial stage, home methods can prevent the process or stop the growth of strands. Before treating adhesions on your own, it is better to undergo an examination in a medical facility. Diagnostics will allow you to find out the degree of the process and the area of \u200b\u200bits distribution.

- the bend of the uterus occurs due to the filling of the cavity with strands or their growth from the outside

At the same time, there is a drop Bladder, varicose veins of the inferior vena cava

AT fallopian tubes strands fill the cavities, obstruction develops - one of the causes of infertility.

Adhesions in the pelvis after cesarean section are formed very often, due to the following factors:

This operation is highly traumatic.

Blood loss during the procedure is significant and can reach a volume of 1 liter.

Caesarean section is often performed on an emergency basis, which is also an additional risk in the formation of adhesions.

Adhesions after caesarean section are almost mandatory consequences of the operation.

Firstly, C-section is abdominal operation and is carried out with high tissue trauma.
Secondly, massive blood loss during surgery (from 600 to 1000 ml) is also an important factor in adhesion formation.
In addition, often a caesarean section is performed for emergency reasons, which is one of the reasons for the development of postoperative metroendometritis and additionally contributes to the formation of adhesions.

Symptoms of adhesions

The more strands in the cavity, the larger the area they occupy, the brighter the symptoms of pelvic adhesions.

At the beginning of the disease, as a rule, the patient is not even aware of its presence, since there are no symptoms of it. As the adhesion progresses, there may be mild signs of discomfort. At some point, the disease gives a sharp progression and goes into an acute phase. It is during this period that vivid symptoms of the disease develop. You can talk about the presence of adhesions in the pelvis when the following manifestations of the disease are observed:

expressed pain syndrome in the area of the uterus and appendages;
severe nausea;
repeated vomiting;
temperature increase from subfebrile values to 40 degrees;
increased heart rate;
increase in pressure;
significant drowsiness;
severe weakness;
severe metabolic disorder.

Doctors consider the patient's condition in the acute phase as severe or extremely severe, requiring immediate medical intervention. During this period, even with slight pressure on the abdomen, the pain syndrome in the uterus increases to unbearable. With this nature of the disease, it is strictly forbidden to postpone treatment.

In the event that the disease after an exacerbation was not completely treated, it passes into chronic form, which manifests itself by revealing the following symptoms:

alternating diarrhea and constipation;
constant It's a dull pain in the lower abdomen;
menstrual irregularities.

Symptoms of the adhesive process depend on the place of its occurrence:

Respiratory system - when adhesions appear, shortness of breath appears, it becomes more difficult for a person to breathe.

1. The method will help to detect the presence of adhesions x-ray examination using hysterosalpinography and irrigoscopy.

2. Adhesions can be identified and treated with laparoscopy. This method is the most correct in determining the disease and its therapy.