Adnexitis: symptoms and treatment
- The main causes of acute and chronic adnexitis
- Symptoms of adnexitis
- Diagnosis of adnexitis
- Treatment of adnexitis
Adnexitis (salpingo-oophoritis) refers to the inflammatory process of the appendages of the uterus, that is, the ovary and the fallopian tubes. As a rule, this process is one-sided, the appendages on the right and left side are less likely to be affected.
The main causes of acute and chronic adnexitis
Almost any microorganism can provoke the development of the infectious process in the uterine appendages. The most frequent pathogens 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 (herpesviruses of various types).
The adherents of the uterus are in the cavity of the small pelvis and have direct contact with the environment and, accordingly, with microbial agents do not. The infectious agent can enter the fallopian tube and then in the following ways:
- through the cervix (ascending way);
- inflammation of the adjacent parts of the digestive tract (descending);
- when the microbes are brought by the current of blood from other inflammatory foci (hematogenous path) or lymph (lymphogenous pathway).
The cervix of the uterus contains a slimy plug that fulfills the barrier function, preventing the penetration of microbial cells. However, the integrity of this barrier can be disrupted during menstruation, unprotected intercourse, prolonged wearing of the intrauterine device, post abortion and in the early postpartum period. Often, adnexitis affects women who have more than one sexual partner and do not use protective equipment during intercourse. In this case, adnexitis is caused either by a specific causative agent of infections of the genital tract, or by an atypical agent.
Inflammation of the lower parts of the digestive tract (sigmoid or rectum) can spread to the adjacent connective and adipose tissue, thus reaching the uterine appendages from the inside (from the side of 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 systemic weakening of immune defense, that is, in case of development of sepsis. It is also possible to spread the infection with extensive surgical interventions on the abdominal organs.
An infectious agent causes swelling of the tissues of the uterine appendages, this is manifested by a pain syndrome. A serous or purulent secret is isolated, sometimes with an admixture of blood. If acute adnexitis was treated incorrectly or not treated at all, the formation of chronic inflammation occurs. 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 uterine tube. That is why the most frequent outcome of chronic adnexitis is the absence of lumen in the tube and the so-called tubal infertility.
Symptoms of adnexitis
Symptoms of acute and chronic variants of adnexitis are somewhat different, but in general the clinical picture of adnexitis is similar to a multitude of other pathologies of the reproductive sphere. Therefore, a woman's attentive attitude to her health and careful execution of all stages of diagnosis by the doctor is required.
Symptoms of acute adnexitis
Acute adnexitis is characterized by both general and local symptoms.
Among the general notes:
- increase in temperature, sometimes to high figures;
- weakness, a general decline in strength;
- decrease or total absence of appetite.
Among the local features distinguish:
- pain of a different nature and intensity in the lower abdomen, sometimes giving back to the hip or lower back;
- a significant decrease in sexual desire, discomfort to the right or left during sexual intercourse;
- separation from the genitals of mucous or purulent nature (leucorrhoea), sometimes with an admixture of blood.
Symptoms of chronic adnexitis
Chronic adnexitis is manifested primarily by local symptoms. The main among them is a chronic pain syndrome or so-called pelvic pain syndrome. A woman complains of persistent pain in the lower abdomen, which may increase with physical activity or during sexual intercourse.
Often, a woman does not pay due attention to the acute phase of adnexitis, the process goes into a chronic stage. Not every woman has pains expressed significantly, but the woman does not simply turn to non-intensive pains. This virtually asymptomatic version of the course of chronic adnexitis is found as an accidental finding in women's infertility.
Attempts to become pregnant will be completely futile if the uterine tube is impassable or partially passable. The egg cell simply can not enter the uterine cavity and enter the endometrium in the necessary manner. Especially serious and unfavorable prognosis, if bilateral defeat of uterine appendages is observed.
Not the best variant of a course of a chronic adnexitis - an ectopic pregnancy. It occurs in the case of partial patency of the uterine tube, when a fertilized egg is introduced into the mucous tube, and not the uterus. As the gestation period increases, the tube increases in size and at a certain point is broken. In this case, intra-abdominal bleeding and peritonitis develops (inflammation of the peritoneum).
In the diagnosis of adnexitis (both acute and chronic), an important point is the collection of complaints by a woman, since it is the details of the development of the disease and the microsymptoms that exclude other similar manifestations of the disease.
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 effective and adequate antimicrobial treatment, it is necessary to sow from the vagina and the urethra. As a result, not only the specific microbial agent that caused the development of adnexitis will be established, but its sensitivity to certain antimicrobial agents according to the antibioticogram.
For the diagnosis of chronic adnexitis, various instrumental studies are used to ascertain the prevalence of the process, the patency of the fallopian tubes and the planning of possible treatment. These include:
- ultrasound examination using a special vaginal sensor;
- X-ray examination with contrast material (hysterosalpingography);
- computer contrast tomography of pelvic organs;
- diagnostic laparoscopy.
Treatment of adnexitis
Therapy of adnexitis should be complex, directed not only to the pathogen, but to all the main links of the pathological process.
Treatment is desirable in a hospital. It is recommended to observe a bed or half-bed regime. The position of the patient in bed with an elevated head end to prevent the process from spreading upward.
The main link in the treatment of acute adnexitis is antimicrobial therapy. As a rule, preparations of a wide spectrum, in average, but not the maximum dose, duration of a course not less than 1-2 weeks are appointed. A woman should understand that premature interruption of the course of antibiotics or self-reduction of the dose will lead to a worsening of the process and / or its transition to a chronic course. The antimicrobial agent is administered on the basis of an antibioticogram.
In severe cases, in addition to antibacterial therapy, specific immunoglobulins are prescribed (contain antibodies against certain microbes), for example, antistaphylococcal, antiherpetic.
Desintoxication therapy is necessary to remove from the body of a woman the toxic products of the life of microorganisms. For this purpose, low-molecular plasma substitutes are prescribed: rheopolyglucin, neohemodez, neocomensane. The total volume of the injected fluid is determined by the severity of the condition and the body weight of the woman. To improve blood supply in small vessels use drugs that improve the rheological properties of the blood (heparin, fractiparin), as well as aminocaproic acid.
The analgesic component includes the administration of non-steroidal anti-inflammatory drugs: ibuprofen, diclofenac, meloxicam. Positive effect is provided by local dosed hypothermia: hardware or ice for 10 minutes three times a day.
Local treatment is carried out by the appointment of trays or syringes with disinfectant solutions (furacilin, dimexid, dioxidin, chlorophyllipt), and also decoctions of medicinal herbs (celandine, calendula, rose petals, chamomile, sage, yarrow, etc.).
In the absence of progression of the inflammatory process, physiotherapeutic methods of treatment are prescribed after 10-15 days: ultraviolet therapy, magnetotherapy, 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 persists (indomethacin, celecoxib);
- microclysters with a warm solution of novocaine;
- microclysters with a 5% solution of potassium iodide, especially in the adhesive process in the small pelvis;
- Presocal neocaine blockade.
In the treatment of chronic adnexitis, the wide use of physiotherapeutic procedures, such as:
- galvanization (electrophoresis K, Ag vaginal or intrauterine);
- electric currents (darsonvalization, diathermy, inductothermy);
- UHF, microwave;
- ultrasound, phonophoresis, peloidophonophoresis;
Some women need correction of the hormonal background: electrostimulation of the cervix from 5 to 23 day of the menstrual cycle, electrophoresis with vitamin B1, laser stimulation, vitamin therapy (vitamin B1 1 ml per day in the I phase of the cycle, vitamin C - in the II phase), with ineffectiveness of non-hormonal Therapies prescribe sexual and gonadotropic hormones, depending on the type of imbalance of menstrual function.
Often, protein preparations, amino acids and mixtures (alvezine, polyamine, aminosterol), bacterial polysaccharides (prodigiosan and pyrogenal) are often prescribed to destabilize the pathological center, depending on the response to a course of 10-15 injections. With an increase in temperature accompanied by changes in the pattern of blood, antibiotics are prescribed. In the absence of changes in the picture of blood, the increase in temperature should be regarded as the reaction of the center of inflammation, the woman does not need the appointment of antibiotic therapy.
Often in the case of chronic adnexitis, there is a depression of immunity (immunosuppression). Stabilization of the immune response, especially cellular, allows to achieve certain successes in treatment. Synthetic immunostimulants such as lycopid, thymalin, thymohexin and biostimulants (aloe, peat, vitreous, mabistin, peloidodistilate) can be used.
Infertility, which is due to adnexitis and obstruction of the fallopian tubes, enzymes (lidase, chymotrypsin, ronidase), which can be prescribed as a supplement to physiotherapy or as an independent drug, are used.
Undoubtedly, the positive effect comes from a visit to a woman balneological resorts, where not only local application of certain natural factors is possible, but also a general soothing effect. Sanatorium treatment (with the obligatory consideration of the hormonal background), combines the action of many factors:
- sanatorium treatment (excluding everyday working and living conditions, tranquility, rational nutrition);
- climatic conditions (climatotherapy);
- solar baths (heliotherapy);
- mud therapy with thermal factor (natural or artificial heating of mud);
- irrigation of the vagina and mineral baths (carbon dioxide, chloride, sodium, which have arsenic in the composition, slightly mineralized), which multiply affect the body, destabilizing the pathological center, improve blood circulation in it, enhance the estrogen activity of the ovaries. Mud therapy is combined with physiotherapy, potentiating each other.
In addition to conservative ways of treating adnexitis treatment, surgical ones are also used. Indications for surgery are the following conditions:
- diffuse peritonitis (inflammation of the inner wall of the abdominal cavity);
- rupture of the pyosalpinx;
- no effect within 24 hours after abdominal drainage by laparoscopic method.
In the planned order during the period of remission, an operation is performed to remove the appendages, which are altered by purulent inflammation in the saccular inflammatory tumors. The scope of the operation depends on the age of the patient, the nature and distribution of the destructive process, the potential on-alertness.
When performing the operation, you should be as cautious as possible about the ovary in all age periods of a woman, while observing in parallel the principle of maximum oncologic alertness. In young patients, as a rule, partial or complete removal of only the affected organ is performed. 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. For this, a woman must observe several simple rules:
- observe the rules of intimate hygiene;
- give preference to loose-cut linen from natural fabrics;
- Dress for the season and not sit in the cold even in warm weather;
- use protective equipment during intercourse;
- regularly undergo preventive examinations at the gynecologist.