Adnexitis: Symptoms and Treatment
- The main causes of acute and chronic adnexitis
- Symptoms of adnexitis
- Diagnosis of adnexitis
- Adnexitis treatment
Adnexitis (salpingoophoritis) is the inflammatory process of the uterus, that is, the ovary and fallopian tubes. As a rule, this process is one-sided, appendages on the right and left sides are less often affected.
The main causes of acute and chronic adnexitis
Almost any microorganism can provoke the development of an infection process in the uterine appendages. The most frequent causative agents of inflammation of the appendages:
- gram-positive flora (streptococcus, staphylococcus, pneumococcus);
- Gram-negative flora (Klebsiella, Pseudomonas aeruginosa, Enterococcus);
- atypical microflora ( gardnerella , mycoplasma , chlamydia);
- specific pathogens of infectious diseases of the genital tract (gonococcus, pale treponema);
- viral agents (herpes viruses of various types).
The appendages of the uterus are in the pelvic cavity and do not have direct contact with the environment and, accordingly, with microbial agents. The infectious pathogen can penetrate the fallopian tube and further in the following ways:
- through the cervix (ascending path);
- inflammation of the adjacent parts of the digestive tract (descending);
- when a microbe is brought in by blood from other inflammatory foci (hematogenous route) or lymph (lymphogenous route).
The cervix contains a mucous plug, which performs a barrier function, preventing the penetration of microbial cells. However, the integrity of this barrier may be compromised during menstruation, unprotected intercourse, prolonged wear of the intrauterine device, after an abortion, and in the early postpartum period. Often, adnexitis affects women who have more than one sexual partner and do not use remedies during sexual intercourse. In this case, adnexitis is caused either by a specific causative agent of reproductive tract infections, or by an atypical agent.
Inflammation of the lower digestive tract (sigmoid or rectum) can spread to the adjacent connective and adipose tissue, thus reaching the uterine appendages from the inside (from the abdominal cavity). Often in this case, the pathogen from the group of gram-negative microbes.
Hematogenous and lymphogenous dissemination of microbes from other anatomical organs is possible in the case of a systemic weakening of the immune defense, that is, in the case of the development of sepsis. It is also possible the spread of infection with extensive surgery on the abdominal organs.
Infectious pathogen causes swelling of the tissues of the uterine appendages, it is manifested by pain. Serous or purulent secretions are secreted, sometimes mixed with blood. If acute adnexitis was treated incorrectly or not at all, there is a formation of chronic inflammation. In this case, the main manifestations of the pathological process will be the formation of connective tissue adhesions and a decrease in the lumen of the fallopian tube. That is why the most frequent outcome of chronic adnexitis is the absence of a lumen in the tube and the so-called tubal infertility.
Symptoms of adnexitis
The symptoms of acute and chronic variants of adnexitis are somewhat different, but in general, the clinical picture of adnexitis is similar to many other pathologies of the reproductive sphere. Therefore, attentive attitude of a woman to her health and careful implementation of all stages of diagnosis by the doctor are required.
Symptoms of acute adnexitis
Acute adnexitis is characterized by both general and local symptoms.
Among the general notes:
- a rise in temperature, sometimes to high numbers;
- weakness, general breakdown;
- decrease or complete lack of appetite.
Among local signs distinguish:
- pain of a different nature and intensity in the lower abdomen, sometimes radiating to the thigh or lower back;
- significant decrease in sexual desire, discomfort on the right or on the left during sexual intercourse;
- discharge from the genitals mucous or purulent character (leucorrhea), sometimes mixed with blood.
Symptoms of chronic adnexitis
Chronic adnexitis is manifested mainly by local symptoms. Chief among them is a chronic pain syndrome or the so-called pelvic pain syndrome. A woman complains of constant pain in the lower abdomen, which can increase during exercise or during sexual intercourse.
Often a woman does not pay enough attention to the acute phase of adnexitis, the process goes into a chronic stage. Far from every woman pain is expressed significantly, and a woman simply does not pay for non-intensive pain. This actually asymptomatic variant of the course of chronic adnexitis is detected as an accidental find in infertility of a woman.
Attempts to become pregnant will be absolutely in vain if the fallopian tube is impassable or partially passable. The ovum simply cannot enter the uterine cavity and is necessary to penetrate the endometrium. Especially serious and unfavorable prognosis, if there is a bilateral lesion of uterine appendages.
Not the best course of chronic adnexitis - ectopic pregnancy. It occurs in the case of partial patency of the fallopian tube, when the fertilized egg is introduced into the mucosa of the tube, and not the uterus. As the duration of pregnancy increases, the pipe increases in size and at some point breaks. In this case, intra-abdominal bleeding and peritonitis (inflammation of the peritoneum) develops.
In the diagnosis of adnexitis (both acute and chronic), an important point is to collect the complaints of the woman, since it is the details of the development of the disease and the microsymptomes that allow excluding other diseases similar in manifestations.
The next necessary step is an internal bimanual gynecological examination. During the study, the gynecologist detects enlarged and painful uterine appendages.
In order to prescribe an effective and adequate antimicrobial treatment, it is necessary to perform seeding from the vagina and urethra. As a result, not only the specific microbial agent that caused the development of adnexitis, but its sensitivity to certain antimicrobial agents according to the antibiogram will be established.
For the diagnosis of chronic adnexitis, various instrumental studies are used to determine the prevalence of the process, tubal patency and possible treatment planning. These include:
- ultrasound using a special vaginal probe;
- X-ray examination with a contrast agent (hysterosalpingography);
- computer contrast tomography of the pelvic organs;
- diagnostic laparoscopy.
Adnexitis therapy should be comprehensive, aimed not only at the pathogen, but at all the main links of the pathological process.
Treatment is preferably carried out in the hospital. Recommended compliance with bed or half-bed mode. Position the patient in bed with a raised head end to prevent the process from spreading upwards.
The main link in the treatment of acute adnexitis is antimicrobial therapy. As a rule, broad-spectrum drugs are prescribed, in the average, but not the maximum dose, the course duration is at least 1-2 weeks. A woman should understand that early interruption of the course of antibiotics or self-reduction of the dose will lead to deterioration of the process and / or its transition to a chronic course. The appointment of an antimicrobial agent is made on the basis of antibiogram.
In severe cases, in addition to antibiotic therapy, specific immunoglobulins are prescribed (contain antibodies against certain microbes), for example, antistaphylococcal, antiherpetic.
Detoxification therapy is necessary for the removal from the body of a woman of toxic products of vital activity of microorganisms. For this purpose, low molecular weight plasma substitutes are assigned: reopolyglukine, neogemodez, neocompensant. The total amount of fluid injected is determined by the severity of the condition and the body weight of the woman. To improve the blood supply in small vessels, preparations that improve the rheological properties of blood (heparin, fraxiparin), and aminocaproic acid are used.
The analgesic component includes the appointment of nonsteroidal anti-inflammatory drugs: ibuprofen, diclofenac, meloxicam. Local dosage hypothermia has a positive effect: hardware or ice for 10 minutes three times a day.
Local treatment is carried out by assigning baths or douches with disinfecting solutions (furatsilin, dimexide, dioxidine, chlorophyllipt), as well as decoction of herbs (celandine, calendula, rose petals, chamomile, sage, yarrow, etc.).
In the absence of progression of the inflammatory process, physiotherapeutic methods of treatment are prescribed in 10-15 days: ultraviolet therapy, magnetic therapy, diadynamic currents.
Treatment of chronic adnexitis only in some cases provides for the appointment of antibacterial agents. Drug therapy should be kept to a minimum. All appointments are aimed at eliminating pain and reducing the manifestations and consequences of chronic adnexitis.
Elimination of chronic pain syndrome is possible in the following ways:
- all the same non-steroidal anti-inflammatory drugs, if their effectiveness is maintained (indomethacin, celecoxib);
- microclysters with a warm solution of novocaine;
- microclysters with a 5% solution of potassium iodide, especially when the adhesive process in the small pelvis;
- presacral novocainic blockade.
In the treatment of chronic adnexitis to reduce the activity of the inflammatory process helps the widespread use of physiotherapy, such as:
- galvanization (electrophoresis K, Ag vaginal or intrauterine);
- electric currents (darsonvalization, diathermy, inductothermy);
- UHF, microwave;
- ultrasound, phonophoresis, peloidophonophoresis;
- magnetic therapy;
Some women need hormonal correction: electrostimulation of the cervix from 5 to 23 days of the menstrual cycle, electrophoresis with vitamin B1, laser stimulation, vitamin therapy (vitamin B1 1 ml per day in phase I of the cycle, vitamin C in phase II), with non-hormonal inefficiency Therapies are prescribed sex and gonadotropic hormones depending on the type of imbalance of the menstrual function.
Often, the effect of destabilizing the pathological center is assigned to protein preparations, amino acids and mixtures (alvezin, polyamine, aminosterol), bacterial polysaccharides (prodigiosan and pyrogenal), depending on the response to a course of 10-15 injections. With increasing temperature, accompanied by changes in the blood picture, prescribe antibiotics. In the absence of changes in the blood picture, fever should be regarded as a reaction of the center of inflammation, the woman does not need the appointment of antibiotic therapy.
Often in the case of chronic adnexitis, immunosuppression takes place (immunosuppression). Stabilization of the immune response, especially cellular, allows you to achieve some success in treatment. Synthetic immunostimulants such as licopid, thymalin, timohexin and biostimulants (aloe, peat, vitreous, mabistin, peloidistilledilat) can be used.
In case of infertility, which is caused by adnexitis and obstruction of the fallopian tubes, enzymes are used (lidaza, chymotrypsin, ronidaza), which can be assigned as an adjunct to physiotherapy or as an independent drug.
Certainly a positive effect brings a woman visiting the spa resorts, where it is possible not only local application of certain natural factors, but also a general calming effect. Sanatorium treatment (with the obligatory consideration of hormonal background), combines the action of many factors:
- sanatorium regime (exclusion of everyday working and living conditions, calm, balanced diet);
- climatic conditions (climatotherapy);
- sunbathing (heliotherapy);
- mud therapy with a thermal factor (natural or artificial heating of the mud);
- irrigation of the vagina and mineral baths (carbonic, chloride, sodium, having arsenic in the composition, slightly mineralized), which affect the body in a versatile way, destabilizing the pathological center, improve blood circulation in it, increase the estrogenic activity of the ovaries. Mud therapy is combined with physiotherapy, potentiating each other.
In addition to conservative therapies for treating adnexitis, surgical techniques are also used. The following conditions are considered indications for surgical intervention:
- diffuse peritonitis (inflammation of the inner wall of the abdominal cavity);
- pyosalpinx rupture;
- no effect during the day after the drainage of the abdominal cavity laparoscopic method.
In a planned manner, in the period of remission, an operation is performed to remove the appendages, which are modified by purulent inflammation in bag-like inflammatory tumors. The scope of the operation depends on the age of the patient, the nature and distribution of the destructive process, and the potential for onconsistence.
When performing the operation, it is necessary to be very careful about the ovary at all ages of the woman, while at the same time observing the principle of maximum oncological alertness. In young patients, as a rule, only the affected organ is partially or completely removed. In older patients, the operation can be extended to complete removal of the uterus, possibly with appendages.
As in many other cases, it is much better and easier to prevent the disease than to treat it. To do this, a woman must follow a few simple rules:
- follow the rules of intimate hygiene;
- to give preference to linen of free cut from natural fabrics;
- dress according to the season and do not sit in the cold even in warm weather;
- use protection during sexual intercourse;
- regularly undergo preventive examinations at the gynecologist.