Adhesions in the pelvis, symptoms, diagnosis. Adhesions: how to treat adhesions in the pelvis. Diseases caused by inflammation in the pelvic organs


When the process of connection occurs in the body internal organs, because of which their normal mobility is disturbed, then this is the formation of adhesions. Since the human internal organs function perfectly with each other and have a coating in the form of a mucous membrane, which qualitatively allows you to perform the necessary functions of the body, the adhesions of the small pelvis lead to a malfunction. this body and, of course, to its structural violations.

Why do adhesions occur in the pelvis?

The causes of this disease are surgical interventions and inflammatory processes. Spikes in - this is a defensive reaction human body. In essence, with the help connective tissue the body limits the site of inflammation. There is a possibility of disruption of normal blood circulation and lymph flow, as well as a high risk of spasms.

What are the consequences?

Unfortunately, the consequences are very dangerous, because they can lead to a decrease in immunity, and this instantly provokes various inflammatory processes in the body. Adhesions in the small pelvis lead to the fact that the inflow and outflow of blood is difficult, which is why stagnation occurs in this area. This disease can also affect as it leads to complete closure of the uterus or its deformation.

There are three streams adhesive disease:
- acute is a sudden or gradually developing pain, vomiting, fever;
- intermittent - these are different in intensity, but regular bouts of pain;
- chronic - this is intestinal obstruction, abdominal pain (aching), weight loss.

Causes of adhesive disease:
- injuries and abdominal cavity;
- appendicitis;
- inflammatory processes of organs located in the small pelvis;
- hemorrhage in the abdominal cavity;
- chem. impact on the peritoneum;
- surgical intervention on the organs that are located in the pelvic area and peritoneum;
- endometriosis.

Adhesions of the small pelvis are detected with the help of a gynecological examination, laparoscopy, hysterosalpinography, ultrasound.

Treatment of adhesions in the pelvis.

To date, there are several ways to treat this disease. In the initial stages of this disease, when the pain is not yet too intense and frequent, it is prescribed conservative treatment which involves the use of anti-inflammatory medicines, vitamin E, folic acid. Modern medicines, which are designed to combat adhesive disease, quickly reduce pain, make adhesions soft and elastic. But only a doctor can prescribe such drugs, and you should not take them yourself.

Various physiotherapy procedures are effective in the treatment of adhesions, but paraffin applications work best.
In cases where conservative treatment together with physiotherapeutic procedures do not give the desired result in the treatment of adhesions, surgical intervention is used. The most unfavorable consequence of pelvic adhesions is the obstruction of the uterine tubes, in which laparoscopy is prescribed.

Studies show that today the percentage of women who are faced with the problem of infertility is very high, but the real problem is precisely in the formation of adhesions in the pelvic area. As you know, this process of connecting ligaments or tissues is capable of spreading in a variety of directions, choosing the most weak organ and damage it. As a result, women develop:
- pain in the lower abdomen;
- ectopic pregnancy;
- bending of the uterus;
- infertility;
- obstruction of the uterine tubes;
- menstrual irregularities.

Therefore, if a woman is concerned about pain in the lower abdomen or the problem of infertility, it is necessary to consult a specialist, because these may be adhesions in the small pelvis.

Adhesive disease is usually called a condition in which the patient has the formation of specific connective tissue strands - they are called adhesions - in the organs of the small pelvis, as well as the abdominal cavity.

Per last years there is a significant increase in the number of patients in whom a gynecologist diagnoses a similar disease. The specifics of the occurrence, manifestation, course and treatment of the disease will be discussed further.

Symptoms of adhesions in the pelvis

Symptoms of the manifestation of the disease are due to the degree of its prevalence. Spikes can appear and are completely asymptomatic.

Also, the features of the manifestation of this disease depend on the clinical form in which it flows:

  • Acute: severe pain syndrome, nausea, severe vomiting, hyperthermia, rapid pulse. When pressing on the stomach, it begins to hurt sharply. There is intestinal obstruction. Water-salt metabolism in the body is disturbed, and protein is not absorbed.
  • Intermittent stage of adhesive disease: intestinal disorders; occasional aching or sharp pains in a stomach;
  • chronic form: clinical picture veiled. Periodic aching pains in the lower abdomen may occur. At times the patient suffers from constipation. In such a situation, the adhesive process can cause obstruction of the fallopian tubes and, accordingly, leads to infertility.

Due to inexperience, the symptoms of adhesive disease can be easily confused with appendicitis, intestinal obstruction, poisoning, or ectopic pregnancy.

Important! Self-treatment in similar situation contraindicated - at the first sign you need to contact a specialist who will help prevent dangerous consequences diseases.

What provokes this formation?

The factors that can lead to the occurrence of adhesions in the pelvis include the following:

enough for them to appear. long time wear an intrauterine device, have an abortion at least once, and also become a “victim” of a sexually transmitted infection.

The mechanism that contributes to the appearance of adhesions in this situation is as follows: in any inflammatory process, the tissues of the affected organs swell strongly, the peritoneum is covered with a coating of fibrin. This substance plays the role of a kind of glue that connects tissues. As a result, adhesions arise, they are also adhesions.

  • Chronic inflammatory processes of any organs located in the peritoneum (for example, appendicitis);
  • multiple mechanical injuries of the small pelvis - these can be both domestic injuries and surgical operations. Adhesive disease in such a situation develops after the occurrence of hemorrhage in the abdominal cavity, especially in the case when it has become infected.
  • Foreign bodies in the pelvis as a result of unskilled surgical intervention also provoke the appearance of adhesions;
  • ectopic pregnancy;
  • chronic endometriosis is a disease that leads to the growth of the internal uterine tissue.

According to statistics, most often adhesions appear due to inflammation of the characteristic appendix and appendectomy. The second place is occupied by operations associated with intestinal obstruction: adhesions in the pelvis are their integral attribute.

Consequences of the adhesive process?

Neoplasms can spread within the small pelvis, resulting in the formation of single monolithic chains of
ligaments and connective tissues. Such designs affect already unhealthy organs. The axis of movement of adhesions decreases over time, and the area of ​​distribution increases, which, in turn, leads to a decrease in the dynamics of internal organs.

Complications caused by adhesive disease include the following consequences:

  • bending of the uterus;
  • violation of the menstrual cycle;
  • infertility;
  • ectopic pregnancy;
  • intestinal obstruction.

Treatment of adhesions in the pelvis

The technology of combating the disease depends on the degree of its severity. Both conservative and radical surgical methods can be used.

The intermittent stage involves only laparoscopy.

The chronic form can also be cured by traditional medication.

If adhesions arose as a result of an infection, then it is necessary to fight directly with the cause of the disease. So, in a similar situation, doctors prescribe anti-inflammatory drugs and antibiotics. a wide range actions. Good for endometriosis hormone therapy, symptomatic and desensitizing treatment technologies.

Modern medicine also actively uses enzyme therapy to combat adhesions - in particular, it includes drugs that dissolve fibrin. Such drugs quickly and effectively cope with local small adhesions.

A variant of physiotherapy is possible - it is appropriate when an infection has become the cause of the disease.

If all of the above methods are powerless, it is worth talking about a radical surgical intervention, the components of which can be:

  • laser removal of adhesions;
  • aquadissection - a technology for removing neoplasms by supplying a jet of water under strong pressure;
  • use of an electric knife.

The selection procedure is carried out by the doctor upon the fact of laparoscopy. It is determined by the degree of prevalence of the disease, as well as the place where the adhesions themselves are located.

When conducting surgical intervention the surgeon must necessarily inject the patient with barrier fluids, as well as cover the ovaries and the fallopian tubes polymer films, which will dissolve over time.

So that the diagnosis of "adhesive disease" does not lead to additional relapses, you should follow these simple rules:

  • visit a gynecologist at least once every six months;
  • eat right - you should eat only in small portions, every two to three hours; avoid foods that inevitably lead to flatulence;
  • regularly conduct physiotherapy - for example, it can be electrophoresis, light training, massage;
  • with a strong pain attack, mild antispasmodics are allowed - for example, papaverine or but - shpa. If the symptoms do not disappear, you should immediately contact a gynecologist to avoid the unpleasant consequences of self-treatment.

After it was carried out complex therapy, patients are strongly recommended physical rest for six months, as well as regular visits to a gynecologist. Intensify the process of recovery well-chosen physical exercises and therapeutic activities. When right approach to rehabilitation, the prognosis of physicians regarding recovery is favorable.

Adhesions in the pelvis are a disease that is sensitive to therapeutic manipulations. Nevertheless, do not forget about timely prevention and regular visits to a gynecologist. This will help protect yourself from the occurrence of adhesive disease.

Despite a long period of study of adhesive processes in the abdominal cavity, in particular, in the small pelvis, no common views on the mechanism of their occurrence and prevention have been developed so far. Mortality from intestinal obstruction caused by adhesions, according to US researchers, is about 2000 people in 1 year. In women, the adhesive process in the pelvis occurs 2.6 times more often than in men, and adhesive obstruction of the intestine - 1.6 times. At the same time, the mortality rate as a result of this pathology among women is lower by 10-15%.

What is the adhesive process in the pelvis

The abdominal cavity is lined with peritoneum, which is a closed serous membrane. It consists of 2 sheets, passing one into the other. One of them, parietal, lines inner surface the entire abdominal cavity and the pelvic cavity, the second, visceral - covers the internal organs.

The main functions of the peritoneum are to ensure the free mobility of organs, reduce friction between them, protect against infection and localize the latter when it penetrates into the abdominal cavity, and preserve the adipose tissue of the abdominal cavity. As a result of exposure to damaging factors, there is a violation of the oxygen supply to the damaged zone (hypoxia). In the future, there are 2 options for development:

  • physiological restoration of the peritoneum;
  • adhesion development.

In the second case, adhesion (“sticking”) occurs between different sections visceral peritoneum or the latter with a parietal sheet, the formation of strands (fusions, adhesions). This process occurs in phases:

  1. Reactive, occurring within the first 12 hours after an inflammatory or mechanical damage peritoneum.
  2. Exudative - for 1-3 days, vascular permeability increases, which leads to the release of undifferentiated cells, inflammatory cells and a liquid blood fraction containing fibrinogen protein into the pelvic cavity.
  3. Adhesive - on the third day, fibrinogen is transformed into fibrin, which falls on the surface of the peritoneum in the form of threads. Undifferentiated cells develop into fibroblasts. The latter synthesize collagen, which is the main substance of connective tissue.
  4. The phase of young adhesions, lasting from 1 to 2 weeks. They are loose due to insufficient amounts of collagen. In adhesions, new vessels and nerve endings grow, smooth muscle cells migrate into them.
  5. The formation of dense fibrous connective tissue mature adhesions lasts from two weeks to 1 month. They are compacted by increasing the density of collagen and the transformation of capillaries into vessels of a larger caliber.

Causes and risk factors

The entire multi-phase adhesive process of the pelvic organs is universal for any damage - inflammatory or mechanical in nature (due to trauma, inflammation, operations). It is an adaptive mechanism that is aimed at separating the site of inflammation from healthy sections. In itself, the formation of adhesions is a protective reaction of the body in response to tissue damage and a decrease in their oxygen supply. However, the tendency to adhesive process, the degree of its severity and prevalence in all people are different, which depends on the genotypic and phenotypic (associated with the genotype) signs and characteristics.

In this way, main reason The adhesive process is currently considered to be genetically determined excessive reactivity of the connective tissue, reduced immunological protection and predisposition of the peritoneum to the corresponding type of reaction. In this regard, the risk factors for the occurrence of adhesive disease are divided into:

  • endogenous, or internal, which are genetically determined features of the body that reduce its adaptive ability to the occurrence of hypoxia;
  • exogenous, or external - these are those that are outside the body and, in terms of their area and strength of influence, exceed the degree of its adaptive capabilities;
  • a combination of endogenous and exogenous factors, which greatly increases the likelihood of formation and prevalence of adhesions.

adhesive process of the small pelvis in its severity is interconnected with the severity of the adhesive process of the entire abdominal cavity. Clinically most common causes are:

  1. Surgical interventions. The severity and frequency of adhesions are affected by urgency surgical treatment(in 73%), type of access, volume of operation, introduction of drains into the small pelvis for outflow of blood and inflammatory fluid (in 82%). So, for example, laparoscopic access is less traumatic than laparotomy (with an incision in the anterior abdominal wall); removal of the fallopian tube, ovary, fibroids, supravaginal amputation of the uterus without appendages or its extirpation, etc. also differ in the degree of damage to the peritoneum. Significantly increased incidence of adhesive disease after repeated operations on the various departments abdominal cavity: after the first operation, it averages 16%, and after the third - 96%.
  2. Inflammatory processes of the uterus and appendages, bacterial vaginosis(colpitis). Most often, the adhesive process is provoked by inflammation caused by chlamydia, gonococci, as well as a combination of sexually transmitted infectious agents.
  3. Complications of pregnancy and childbirth, diagnostic curettage uterine cavity, artificial termination of pregnancy, especially repeated instrumental abortions, contraception using intrauterine device. All this contributes to the development of an ascending infection.
  4. External endometriosis of the pelvic organs (proliferation of cells of the inner lining of the uterus beyond its limits). Endometriosis damage in many cases stimulates immune mechanisms leading to the formation of fibrinous connective strands between adjacent structures.
  5. Systemic immune diseases of the connective tissue (scleroderma, dermatomyositis, rheumatism, systemic lupus erythematosus, etc.).

In ongoing studies, one reason for the formation of adhesions was found only in 48%, in other cases it was a combination of two or more factors.

Clinical course of adhesive disease and its diagnosis

Adhesions become a clinical problem only if they lead to specific complications, on which the symptoms of the adhesive process of the pelvic organs also depend. The main complications include:

  1. Intestinal obstruction
  2. Violation of gestation, infertility

Signs of intestinal obstruction

Intestinal obstruction can occur in acute and chronic forms. Acute intestinal obstruction occurs as a result of a decrease in the lumen of the intestine due to its compression by adhesions, infringement of the wall of the intestine or entry of the intestinal loop in the form of a double-barrel into the “window” formed by adhesions, etc. As a result of the infringement of the intestine, the passage of fecal masses and discharge gas through the intestines, which leads to overstretching of its upper sections. In addition, irritation of the nerve receptors of the intestinal wall causes spasm of the terminal branches. mesenteric arteries, violation of microcirculation in them, deterioration of outflow venous blood and lymph, effusion of the liquid part of the blood into the intestinal lumen.

This simplified mechanism of acute intestinal obstruction explains:

  • the appearance in the abdomen of pains of a cramping, and then a permanent character;
  • dry mouth;
  • bloating;
  • nausea and vomiting;
  • lack of act of defecation and discharge of gases.

When providing timely surgical care the prognosis is favorable. Otherwise, necrosis (necrosis) of the wall or a certain section of the intestine occurs, which requires not only the dissection of adhesions and the release of the intestine, but its resection (partial removal). With a longer course of the disease, dehydration of the body, electrolyte disturbances, hypovolemic shock, vascular, cardiac and respiratory failure etc., followed by a likely adverse outcome.

Chronic intestinal obstruction can sometimes last for years and not lead to more grave consequences. It is manifested by intermittent short-term cramping pains of varying intensity, constipation, sometimes diarrhea, moderate bloating of a transient nature, nausea, and rarely vomiting. Such symptoms can sometimes be triggered by physical activity, the use of foods that promote gas formation (garlic, legumes, foods rich in fiber).

Chronic pelvic pain syndrome

Pain is associated with the tension of adhesions when the pelvic organs are displaced. This causes irritation pain receptors and transient ischemia (impaired blood supply) as a result of both mechanical impact the cords themselves, as well as reflex vasospasm.

Chronic pelvic pain is characterized by:

  1. Prolonged, almost constant, with a periodic increase in the intensity of pain in lower sections abdomen, inguinal and lumbar areas. These pains can be sharp, aching, or dull. Often their tendency to increase is associated with psycho-emotional and physical stress, hypothermia, a certain position of the body for a long time.
  2. Painful menstruation and periods of ovulation.
  3. Pain during excessively active sexual intercourse, heavy lifting or physical education, during the act of defecation, overflow Bladder or its emptying.

The presence of at least one of this group of symptoms supports the diagnosis of chronic pelvic pain syndrome.

Violation of gestation and infertility

The adhesive process of the small pelvis during pregnancy can to some extent limit the mobility of the uterus and its increase. Stretching of fibrous adhesions in this case may be accompanied by frequent, and sometimes almost constant pain in the lower abdomen, urge to frequent urination, constipation, discomfort during bowel movements, bloating and forced restrictions in the full nutrition of a woman. Symptoms depend on the location and severity of the adhesive process.

The danger lies in the fact that the strands can lead to impaired innervation and blood circulation in various parts of the uterus and its associated hyperactivity. The latter can cause spontaneous abortion or premature birth.

But the adhesive process has an even greater influence on the possibility of fertilization. Deformation of the fallopian tubes, a change in position in relation to other organs, a decrease in their lumen, occlusion (closure) of the fimbrial or ampullar sections with the development of hydrosalpinx (accumulation of fluid in the fallopian tube), impaired mobility of the fimbriae - all this can cause a deterioration in transport through these sections of the egg or / and spermatozoa, the absence of fertilization or the occurrence of the latter, but with the subsequent development of an ectopic pregnancy. In addition, the presence of adhesions inhibits the growth of follicles, which is associated with a decrease in the adequacy of the blood supply to the ovaries.

Adhesions are the cause of obstruction of the fallopian tubes and, as a result, infertility

Diagnosis of the disease

Based on:

  • symptoms and clarification of anamnesis data (survey): the presence in the past of inflammatory processes in the small pelvis, abortions, surgical interventions, endometriosis, intrauterine device;
  • data from a vaginal examination by a gynecologist, during which the location of the uterus and its mobility, the presence of pain, size, degree of mobility and displacement of the appendages and other organs are determined;
  • data, hysterosalpingography or ultrasonic hysterosalpingoscopy, allowing to assess the patency of the fallopian tubes, and, if necessary, laproscopic examination.

Principles of treatment

Treatment of the adhesive process in the small pelvis is carried out by such conservative methods, as diet therapy, the use of ultrasound, high frequency currents, iontophoresis with enzyme preparations, magnetotherapy, mud therapy and others. However, any conservative therapy in order to eliminate adhesions is ineffective. To some extent, it helps in eliminating the symptoms of adhesions in chronic intestinal obstruction, chronic pelvic pain syndrome, and even less in infertility.

When acute obstruction only surgical dissection of adhesions and restoration of bowel function is indicated, if necessary, its resection.

For the treatment of infertility, attempts are possible to restore the location of the fallopian tubes by dissecting adhesions using the laparoscopic method and their subsequent hydrotubation (washing the tubes with solutions), which is also ineffective.

Most often, with infertility, it is necessary to use modern assisted reproductive technologies (ART), including ovarian stimulation in order to obtain single mature follicles (ovulation induction), methods of artificial introduction of selected and processed sperm into the uterine cavity (artificial insemination) and in vitro fertilization (IVF) .

Many women who have undergone gynecological diseases, operations or manipulations suffer from adhesive disease of the small pelvis. This disease is unpleasant not only for its manifestations, but also frequent complications. The treatment of adhesive disease is a complex and difficult task, therefore it is easier to prevent than to deal with adhesions.

Definition of the concept of "adhesive disease of the small pelvis"

Adhesions in the small pelvis Adhesive disease of the small pelvis (plastic pelvic peritonitis) is a disease characterized by the formation of connective tissue strands or adhesions between the internal organs of the small pelvis (uterus, appendages, ligaments, bladder and loops of the large intestine). The internal organs are externally covered with a serous membrane - the visceral peritoneum, while the entire abdominal cavity is enveloped by the parietal peritoneum. The visceral peritoneum, due to the peritoneal fluid in the abdominal cavity, provides free displacement of organs relative to each other (for example, during pregnancy, the growing uterus changes the topography of the bowel and bladder loops, which does not interfere with their normal functioning). Adhesions in the small pelvis violate the freedom of movement of organs, which causes certain symptoms.

How adhesions form

Under the influence of predisposing factors (inflammation, surgery, etc.), a protein, fibrin, is exuded on the serous membrane of internal organs as a result of exudation, the task of which is to “glue” nearby organs, thereby limiting the process of inflammation. For example, with the development of tubo-ovarian formation, purulent fusion of the tube and ovary leads to gluing them together, with the formation of a conglomerate and from closely spaced loops of the intestine and / or bladder. After the inflammation subsides and in the absence of adequate treatment, adhesions begin to form. If inflammation captures only the fallopian tube, then its ampullar part, and often the lumen, are obliterated, which leads to obstruction of the fallopian tube and development.

Causes of adhesive disease

  • Inflammatory diseases of the pelvic organs.
    These include:, adnexitis, parametritis, pelivoperitonitis. Predisposing factors are:, (especially with perforation of the uterine cavity), prolonged wearing, promiscuity.
  • Diseases of the abdominal organs (appendicitis, colitis, pancreatitis and others).
  • Operational intervention.
    During surgery, the formation of adhesions depends on four factors. Firstly, prolonged ischemia of organs, secondly, exposure of internal organs to the open air and their drying, thirdly, gross manipulations (blunt dilution, compression, pressure) with the latter, and, fourthly, the presence of blood in the small pelvis and foreign bodies(glove talc, fibers from gauze swabs). Therefore, every surgeon tries to reduce the time of surgical intervention.
  • Diseases accompanied by intra-abdominal bleeding.
    Ectopic pregnancy, characterized by massive hemorrhage into the abdominal cavity and small pelvis, and blood is a source of proteins and is a catalyst for the development of adhesions.
  • .
    Endometriosis is characterized by the growth of cells that are similar in structure to inner shell uterus outside. Any localization of endometriosis will necessarily lead to the development of adhesive disease of the small pelvis. Firstly, this is due to the monthly release of blood from endometrioid foci, and, secondly, endometriosis causes an aseptic inflammatory process.

Symptoms of adhesive disease

Adhesive disease of the small pelvis can occur in three forms:

  • Acute.
    Symptoms acute form adhesive disease are pronounced and tend to gradually worsen. Pain in the lower abdomen increases, nausea and vomiting occur, body temperature rises, pulse quickens. On palpation of the abdomen, its sharp pain in the lower sections and peritoneal symptoms are noted, which indicates intestinal obstruction. In the absence of treatment, the patient's condition deteriorates sharply, an acute kidney failure and hypovolemic shock. Treatment of this form is urgent and consists in surgical intervention.
  • Intermittent.
    This form is characterized periodic pain in the lower abdomen and disorders of bowel function (constipation alternating with diarrhea).
  • Chronic.
    The chronic form of adhesive disease of the small pelvis can proceed in two ways. Either there are no signs of the disease, or patients are concerned about periodic aching pain in the lower abdomen, which increase during heavy physical exertion, a sharp change in body position, during a gynecological examination and during intercourse. Also, patients may be disturbed by disorders of the functions of the intestines and bladder. Often, adhesive disease with its asymptomatic course is diagnosed after a woman consults a doctor about (obstruction of the tubes or endometriosis is detected).

Diagnostics


Diagnosis of adhesive disease During a gynecological examination in the area of ​​the appendages, heaviness in the area of ​​the appendages, pain in the ovaries and uterus are palpated, the uterus does not move or is limitedly mobile, shortening is determined in the vaginal vaults. Ultrasound of the small pelvis is uninformative in the diagnosis of adhesive disease, but allows you to identify chronic inflammation uterus or appendages, as well as endometriosis.

The most reliable diagnostic method is diagnostic laparoscopy, which allows you to visualize adhesions in the pelvis. To determine the patency of the fallopian tubes, metrosalpingography is performed. Tests for sexually transmitted infections are also indicated.

Treatment of adhesive disease

Treatment of adhesions depends on the severity of the process and its form. Acute and intermittent forms are subject to surgical intervention (laparoscopic dissection of adhesions).

At chronic form diseases, it is recommended to follow a diet with restriction of products that enhance gas formation (legumes, cabbage, milk). It is necessary to eat fractionally, at least 5 times a day and in small portions. In order to prevent the development of complications, it is necessary to limit physical exercise. Also used in the treatment of adhesive disease physiotherapy exercises, gynecological massage and physiotherapy. In physiotherapy, preference is given to electrophoresis with enzymes (lidase, trypsin) on the lower abdomen. Of the drugs that dissolve adhesions in the pelvis, sodium thiosulfate, aloe extract, FIBS are used. With pronounced pain syndrome used antispasmodics and analgesics.

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