Diseases of the fallopian tubes. Inflammation of the fallopian tubes
Salpingitis is one of the most common infectious diseases of the pelvis. Isolated inflammation of the fallopian tubes is rare, occurring only in 30 percent of cases. In other cases, inflammation also affects the ovaries with the development of so-called salpingoophoritis. According to various data, on average, one woman in 10 experiences inflammation of the fallopian tubes. In 20 percent of cases, salpingitis ends in infertility.
Anatomy of the uterine appendages
The uterus is an unpaired muscular organ of the female reproductive system. It is pear-shaped, and the fallopian tubes extend from its sides. Normally, the uterus occupies a central position in the pelvis with a slight tilt forward ( towards the bladder). This position is ensured by the ligamentous apparatus of the uterus and its appendages. The uterine appendages are represented by the fallopian tubes and ovaries. The fallopian tubes
The fallopian tubes, or fallopian tubes, are located on both sides of the uterus. They originate in the area of the upper corners of the uterus and go towards the side walls of the pelvis. On average, the length of one pipe is 10–12 centimeters, and the thickness is 0.5 centimeters. Anatomically, the fallopian tube has several parts.Parts of the fallopian tube:
- uterine part;
- isthmus;
- ampullary part;
- funnel.
The fallopian tube is located in the uterus, connecting the cavity of the fallopian tube with the cavity of the uterus itself. The funnel, opening into the abdominal cavity, communicates with the cavity of the fallopian tube. Thus, at one end the fallopian tube communicates with the abdominal cavity, and at the other with the uterine cavity. As a result of this anatomical feature, the uterine cavity communicates with the pelvic cavity and the abdominal cavity. This explains the process of infection spreading through the fallopian tubes. On the one hand, the infectious agent can penetrate the fallopian tube from the vagina and uterus ( upward path), and on the other hand it can penetrate from the abdominal cavity ( descending path).
The walls of the fallopian tubes are somewhat different from the walls of the uterus itself. Unlike the uterus, whose walls consist of three layers, the walls of the fallopian tubes consist of four.
The structure of the walls of the fallopian tubes:
- inner mucous layer;
- muscle layer;
- subserosal layer;
- serous or connective layer.
With the development of an inflammatory process affecting all layers, the walls of the pipes thicken and deform, and their patency is impaired.
Ovaries
The ovaries are paired female sex glands that are located in the pelvis on either side of the uterus. The average size of the ovaries ranges from 2 to 5 centimeters in length and from 1.5 to 3 centimeters in width. They perform a number of important functions in a woman’s body.Functions of the ovaries:
- storage of germ cells;
- monthly maturation of germ cells;
- synthesis of sex hormones ( estrogen, progestin).
The ovary has two layers - the cortex and the stroma. The cortex is represented by many vesicles called follicles. These vesicles contain female reproductive cells or eggs. In follicles, eggs are at different stages of maturation. The larger the follicle, the more mature the egg in it. The ovarian stroma consists of connective tissue.
The ovaries are located in close proximity to the fallopian tubes. One of the longest tube fimbriae approaches the tubal end of the ovary. This explains the fact that isolated inflammation of the fallopian tubes is extremely rare. Most often, salpingitis occurs with the involvement of the ovaries, and in this case it is called salpingoophoritis.
The ovaries are mobile organs of the small pelvis. Like the uterus itself, they are fixed in a suspended state by ligaments.
Causes of inflammation of the fallopian tubes
There are many reasons that cause inflammation of the fallopian tubes. Basically, these are various microbial associations, as well as viruses. Most often, infection occurs through an ascending route, that is, infection from the genitals ( vagina) or genitourinary organs ( urethra) rises to the fallopian tubes. Sexually transmitted infections
Sexually transmitted diseases include bacterial, viral and protozoal infections.The most common sexually transmitted infections:
- herpes simplex virus type 2.
The mechanism of infection penetration into the fallopian tubes
A feature of most infections is their asymptomatic course. As a result, women do not seek help from a doctor for a long time, and the disease becomes chronic. Prolonged residence of bacteria and viruses in the mucous membrane of the genital organs causes a local decrease in immunity and impaired circulation in these organs. Further infection under the influence of any factor ( stress, cold) begins to spread upward. From the vagina or urethra, penetrating through the cervical canal, it first enters the uterine cavity and then reaches the fallopian tubes.
The mechanism of development of salpingitis
Source of infection ( virus or bacteria) having penetrated the mucous membrane of the fallopian tubes, it begins to actively multiply there. The mucous membrane of the fallopian tubes becomes swollen, and blood circulation in it worsens. The proliferation of a bacterial infection is accompanied by the accumulation of pus in the pipes. Further, the inflammatory process affects all layers of the fallopian tubes, which leads to their thickening and the development of an adhesive process. As a result, tubal obstruction develops, which is one of the most common causes of female infertility. Salpingitis, which develops as a result of sexually transmitted infections, is usually bilateral.
Each sexually transmitted infection has its own mechanism of disease development and its own characteristics. Thus, gonococcal infection provokes the development of purulent bilateral salpingitis. Chlamydial salpingitis, which is diagnosed in 30–40 percent of cases, is more often than others complicated by an adhesive process. As a rule, chlamydia damages not only the lining of the tubes, but also the ovaries, disrupting the process of maturation of eggs in them.
Promiscuous sexual intercourse increases the risk of developing salpingitis several times. This is explained by the fact that this increases the risk of infection, as well as the simultaneous development of several infections or the so-called microbial association. At the same time, local immunity decreases, and the genital mucosa becomes less resistant to the penetration of bacteria.
Mechanical damage to the uterine mucosa and fallopian tubes
In addition to the immediate causes that trigger the inflammatory reaction, there are also provoking factors. These factors create conditions for the penetration of bacteria and the development of inflammation. These include various mechanical damage to the mucous membrane due to abortion and other manipulations.Normally, the penetration and further development of bacteria is prevented by a healthy mucous membrane. The topmost layer of mucosa ( epithelium) is one of the protective factors against infections. However, various damage to this epithelial layer becomes the main gateway for infections.
Manipulations leading to damage to the lining of the uterus and fallopian tubes:
- abortions with curettage;
- birth injuries;
- intrauterine devices;
- various intrauterine diagnostic procedures - salpingoscopy, metrosalpingography.
Abortions and birth injuries damage the integrity of the lining of the uterus and fallopian tubes. The greatest damage is caused by curettage, which can damage not only the mucous membrane, but also the muscle layer. Those places that were subject to trauma are subsequently overgrown with connective tissue. Blood circulation and nutrition are disrupted in them. All this makes the mucous membrane of the fallopian tubes less resistant to infections.
Intrauterine devices
But not only mechanical damage can reduce the resistance of the mucous membrane. Intrauterine devices are often perceived by the female body as a foreign body. As a result, a cascade of inflammatory and allergic reactions is launched in the uterine mucosa, which also leads to a decrease in local immunity.
The insertion and removal of the intrauterine device itself can also cause damage to the mucosa. The greatest danger is the removal of a complicated intrauterine device by instrumental means.
Diagnostic manipulations
During metrosalpingography, the patency of the fallopian tubes is visualized by introducing a contrast agent into the uterine cavity. After the contrast agent has been injected, its distribution is observed on x-rays. Contraindications to this manipulation are acute infectious processes, but at the same time the manipulation itself can contribute not only to damage to the mucous membrane, but also to the exacerbation of chronic genital tract infections.
Salpingoscopy is performed using a special apparatus ( salpingoscope), which is inserted into the fallopian tube through a funnel. The process of inserting a salpingoscope takes place during laparoscopy. In this case, not only the mucous membrane of the fallopian tube can be damaged, but also all its layers.
Thus, the leading mechanism in the development of salpingitis, on the one hand, is an infection ascending from the genital organs, and on the other, a violation of the integrity of the mucous membrane and a decrease in immunity.
Inflammation of neighboring organs
In the development of salpingitis, inflammatory processes of neighboring organs play an important role ( intestines, bladder). Due to the close location, infections from these organs can spread to the fallopian tubes. Most often, the infection penetrates through the lymphatic vessels with the lymph flow, but it can also penetrate with the blood flow ( tuberculous salpingitis) or by contact.Pathologies that may be complicated by the development of salpingitis:
- pelvioperitonitis;
For inflammatory bowel diseases ( colitis, appendicitis) the inflammatory process is transmitted both by contact and by lymph flow. Appendicitis can be not only the cause of the development of salpingitis, but also its complication.
Pelvioperitonitis is an inflammation of the serous membrane covering the walls of the pelvic cavity ( in the clinic it is called the peritoneum). Most often it is a complication of a primary infectious process, for example, appendicitis. The peritoneum lines not only the walls of the pelvic cavity, but also the pelvic organs, namely the uterus and fallopian tubes. Therefore, the inflammatory reaction from the peritoneum spreads to the organs that are covered with it.
Types of salpingitis
Salpingitis is classified according to several criteria, namely by location, nature of inflammation and course of the disease. According to the nature of the course, acute and chronic salpingitis are distinguished, by localization - right-sided and left-sided, and by the nature of inflammation - purulent and serous. Acute salpingitis
Acute salpingitis develops due to the penetration of an infectious pathogen into the fallopian tubes against the background of a general decrease in immunity. The pathogen can penetrate both through the ascending route ( from the vagina), and descending from any primary focus ( appendicitis). Most often, acute salpingitis develops against the background of inflammation of the ovaries, cysts or ectopic pregnancy. Its peculiarity is its pronounced symptoms, as well as the presence of general and local symptoms. Acute salpingitis begins with a sharp deterioration in the condition and an increase in temperature above 38 degrees.General symptoms of acute salpingitis:
- temperature increase;
- weakness, malaise;
- increased heart rate.
Increased heart rate
Increased heart rate is also a common symptom of an inflammatory response. It is caused by an increase in body temperature. It is known that heart rate correlates with body temperature. So, with an increase in temperature by one degree, the heart rate increases by 8 - 10 beats per minute. Accordingly, the higher the temperature, the stronger the heartbeat.
Weakness, malaise
Weakness, malaise, muscle and joint pain are caused by the effect of bacterial toxins on the body. Each type of infection has its own toxins, which are specific to various tissues. Thus, some are characterized by an affinity for nervous tissue, and at the same time develop symptoms such as nausea, vomiting, headache, and for others - to muscle tissue, which is manifested by severe muscle pain and weakness.
Local symptoms of acute salpingitis:
- pain in the groin area;
- pathological discharge from the genitals;
- gastrointestinal and urinary symptoms.
Pain in the groin area
The development of pain syndrome is caused by inflammatory reactions in the fallopian tube. In this case, mediators of pain sensitivity are released, primarily bradykinins and prostaglandins. As the inflammatory process develops, the pain intensifies. After all layers of the fallopian tube have been affected by inflammation, it increases in size, swells and begins to compress the surrounding tissues. In this case, the pain begins to radiate to the tailbone and rectum.
The location of the pain depends on which fallopian tube is inflamed. Thus, with right-sided salpingitis, pain is localized on the right and can often imitate acute appendicitis; with left-sided salpingitis, pain on the left; with bilateral pain is localized on both sides.
Pathological discharge from the genitals
The nature of discharge in acute salpingitis depends on the type of pathogen. With gonococcal salpingitis, purulent discharge is observed, with trichomonas - abundant, foamy discharge. In extremely severe cases, even spotting may occur.
In acute salpingitis, the discharge is usually always profuse. They may be accompanied by itching and burning, which will intensify with urination.
Gastrointestinal and urinary symptoms
As a rule, acute salpingitis is accompanied by disorders of neighboring organs. Disorders of the urinary system are most often observed. This is due to the close location of the bladder next to the uterus and fallopian tubes. Therefore, when the latter are inflamed, reflex irritation of the bladder is observed. This is manifested by painful and scanty, but frequent urination. Very often these symptoms are confused with cystitis.
In addition to the urinary system, the gastrointestinal tract is also irritated. Most often, there is a stool disorder, which is manifested by frequent bowel movements and loose, unformed stools.
Chronic salpingitis
Chronic salpingitis is characterized by very sluggish and meager symptoms. The general condition is satisfactory, temperature is observed extremely rarely. Even if there is a temperature, it ranges from 37 to 37.2 degrees. There is scanty discharge and mild but constant pain in the lower abdomen. The nature of the pain is not acute, but rather dull or aching. The course of chronic salpingitis is wavy. It can periodically intensify and also periodically fade. Exacerbations can be triggered by stress, hypothermia.In chronic salpingitis, menstrual irregularities are observed. Most often painful ( algomenorrhea) and scarce ( oligomenorrhea) menstruation. Bowel or bladder irritation is rare.
Despite the poor clinical picture, chronic salpingitis has a poor prognosis. Most often it is the cause of infertility. The most unfavorable prognosis concerns chronic bilateral salpingitis, since it affects both fallopian tubes at once.
Left-sided salpingitis
Left-sided salpingitis develops with inflammation of the colon in the sections that are located on the left side of the abdominal cavity. The infection can be caused by diseases such as pneumonia, sore throat, and influenza. The process is localized in the left fallopian tube and often accompanies a disease such as inflammation of the ovaries ( adnexitis).The course of left-sided salpingitis
The inflammatory process affects the mucous membrane of the fallopian tube, after which it spreads to muscle and connective tissue. The mucous membrane swells, redness occurs, and the surface layer becomes covered with ulcers. With the further development of the pathological process, the dying layers begin to stick together and form cavities in which blood, mucus and pus accumulate.
Symptoms of left-sided inflammation of the fallopian tubes can be either pronounced or blurred and depend on the form of the disease ( acute, chronic, subacute). The pathology is accompanied by both general and specific manifestations of salpingitis.
Prognosis of left-sided salpingitis
The prognosis of left-sided salpingitis is favorable in cases where the patient consults a doctor at the first symptoms. With timely treatment, recovery and restoration of uterine function occurs within a few weeks.
Right-sided salpingitis
With right-sided salpingitis, the inflammatory process is localized in the right fallopian tube. This pathology can be caused by chlamydia, fungi, E. coli or tuberculosis. The reason for the penetration of pathogens into the vagina may be a lack of proper personal hygiene, unprotected sexual intercourse, or negligence during gynecological operations. Also, right-sided inflammation of the fallopian tubes can develop with appendicitis.The course of right-sided salpingitis
Penetration of sources of infection into the fallopian tube causes swelling and impaired blood circulation. The inflammatory process affects muscle tissue, as a result of which the appendages become deformed and thicken. Next, the thickenings in the tube begin to stick together with the peritoneum, forming adhesions. The process can affect the appendicular process and cause secondary appendicitis.
Due to the peculiarities of the anatomical structure, right-sided salpingitis causes difficulties in diagnosis, since its symptoms are similar to a number of diseases. Most often it is confused with appendicitis or ovarian apoplexy.
Prognosis of right-sided salpingitis
If right-sided salpingitis is detected in a timely manner and appropriate treatment is prescribed, the prognosis is positive. Complete recovery of the patient and regeneration of all functions of the genital organs is possible in two to three weeks.
Purulent salpingitis
Purulent salpingitis in most cases is a consequence of gonorrheal infection. When chlamydia penetrates the fallopian tubes, the inflammatory process affects the uterus and ovaries. Purulent salpingitis can be caused by miscarriage, spontaneous miscarriages, or expired contraceptive devices.The mechanism of development of purulent salpingitis
This pathology is accompanied by the accumulation of purulent exudate in the cavity of the tube, which is the result of an inflammatory process. When pus enters the abdominal cavity, purulent salpingitis provokes inflammation of the serous covering of the peritoneum ( peritonitis). Also, pus can break into the bladder, rectum, or vagina. As a rule, purulent salpingitis is unilateral.
Symptoms of purulent salpingitis
In most patients, the manifestation of purulent salpingitis is accompanied by fever, chills, severe and acute pain in the lower abdomen. At the onset of the disease, the pain is local in nature, its typical location is the left and right groin areas. Subsequently, the pain radiates to the lumbar and rectal area. With concomitant inflammation of the mucous membrane and muscles of the uterus ( endometritis) median pain predominates.
A feature of the symptoms of purulent salpingitis is constant leucorrhoea ( genital discharge) purulent type. The prognosis for purulent salpingitis is favorable with timely surgical treatment. Otherwise, purulent salpingitis is complicated by peritonitis.
Salpingitis with oophoritis
Salpingitis with oophoritis ( salpingo-oophoritis) – is an inflammation of the ovaries and fallopian tubes. This form of salpingitis is the most common. Predisposing factors to the occurrence of salpingoophoritis are a weakened immune system, hypothermia, and stress.Course of salpingitis with oophoritis
The development of the inflammatory process during salpingitis with oophoritis begins with the entry of a pathogenic factor into the mucous membrane of the fallopian tube. Next, the process moves to muscle tissue and the serous membrane, then captures the pelvic peritoneum and the integumentary epithelium of the ovary. After ovulation occurs, the infection penetrates the ovary and continues to develop there. With salpingitis with oophoritis, the tube and ovary merge together, forming a common inflammatory conglomerate.
If treatment is started in a timely manner and carried out correctly, the prognosis for restoring reproductive function is favorable; in the opposite case, salpingoophoritis is complicated by infertility and ovarian hypofunction.
Symptoms of inflammation of the fallopian tubes
Symptoms of inflammation of the fallopian tubes depend on the nature of the inflammation, the location of the source of inflammation, as well as on the individual characteristics of the woman. The woman's concomitant diseases have a great influence on the symptoms of salpingitis. First of all, this concerns sexually transmitted infections. This or that infection in a woman’s body determines the nature of inflammation, the severity of general and local symptoms of salpingitis. Symptoms of inflammation of the fallopian tubes:
- pain in the lower abdomen;
- increased body temperature;
- discharge;
- menstrual irregularities;
- painful sexual intercourse;
- female infertility.
Pain in the lower abdomen
Pain is the main symptom of salpingitis. Pain is present in both acute and chronic salpingitis. The development of pain symptoms is associated with the development of inflammatory edema in the mucous membrane of the fallopian tubes. In this case, the fallopian tube ( or pipes) swells and increases in size, irritating the serosa ( peritoneum), which is penetrated by numerous nerve endings. As the fallopian tube increases in size, it begins to compress other nearby organs and nerve endings, causing pain to spread.In acute salpingitis, the pain is burning, sharp, and often radiates to the rectum. With right-sided salpingitis, the pain is located on the right; with left-sided inflammation of the fallopian tube, the pain is localized on the left. With chronic salpingitis, dull, constant pain in the lower abdomen is observed. The pain intensifies during urination or during sexual intercourse.
Increased body temperature
Elevated body temperature is a mandatory symptom for purulent and acute salpingitis. The appearance of temperature is caused by the activity of bacteria at the site of inflammation. First of all, this is the release by bacteria of substances that cause temperature. These substances are called pyrogens. Pyrogens can be produced not only by bacteria, but also by the body itself in response to the penetration of bacteria into it. In this case, they are called endogenous pyrogens. The temperature in acute salpingitis is caused by both body pyrogens and bacterial pyrogens.In acute and purulent salpingitis, a temperature of 38 – 38.5 degrees is observed. It occurs suddenly and is accompanied by chills and increased sweating.
In chronic salpingitis, low-grade fever may be observed ( 37 – 37.2 degrees). In this case, temperature fluctuations may occur during the day. There may be no temperature at all, for example, with chlamydial salpingitis. However, the presence or absence of temperature does not always correlate with the prognosis of the disease. Thus, chlamydial salpingitis, which is characterized by a blurred clinical picture and absence of fever, is most often complicated by infertility.
Discharge
The nature and intensity of discharge during salpingitis depends on the source of infection. Basically, inflammation of the fallopian tubes is characterized by scanty mucopurulent discharge. They are formed due to the intensive proliferation of bacteria in the uterine mucosa and represent an accumulation of mucus, epithelial cells of the uterus and pathogenic bacteria. By multiplying in the mucous membrane of the uterus and fallopian tubes, bacteria stimulate increased secretion of the glands, which are located in the mucous membrane. As a result of this, more mucus is formed than is expected to be normal. Subsequently, cells involved in inflammation join it ( leukocytes) and the bacteria themselves.In chronic forms of salpingitis, discharge may be absent and observed only periodically during exacerbations.
Menstrual irregularities
Menstrual irregularities are an integral symptom in chronic forms of salpingitis. Violations can manifest themselves in the form of heavy or, conversely, scanty menstruation. Most often, periods become heavy and painful, and the discharge may be accompanied by blood clots. But scanty discharge with severe pain can also be observed.The duration of the entire menstrual cycle may be shortened, and menstruation becomes irregular.
Menstrual irregularities occur primarily due to changes in ovarian function. With chronic inflammation of the fallopian tubes, a decrease in ovarian function is observed, which leads to a decrease in the level of female hormones. The consequence of this is menstrual irregularities, as well as sexual dysfunction.
Painful sexual intercourse
Pain during sexual intercourse is a common symptom in subacute and chronic forms of salpingitis. The pain is localized in the lower abdomen and is dull, drawing in nature. The pain syndrome is caused by both inflammation in the mucous membrane and decreased ovarian function. In the first case, pain occurs due to irritation of the inflamed vaginal mucosa. In the second case, the cause of pain is a decrease in estrogen levels. This symptom is also accompanied by a lack of sexual desire itself.Female infertility
Female infertility is more a complication of salpingitis than a symptom. It develops due to obstruction of the fallopian tubes. The development of fallopian tube obstruction is based on the adhesive process that is observed in chronic salpingitis. Due to prolonged inflammation and damage to all layers of the fallopian tube ( or pipes) adhesions are formed. Adhesions are connecting cords that form both in the tube itself and between the fallopian tube and other organs. The adhesions themselves form around the inflammatory fluid that accumulates in the pipes. This inflammatory exudate may flow from the fallopian tube through the infundibulum into the pelvic cavity. As a result, adhesions begin to form between the tube and the ovary, thereby closing the lumen of the tube.The consequence of the intense adhesive process is obstruction of the fallopian tubes. If the lumen of the tube closes in the funnel area, then the tube becomes completely impassable and therefore the mature egg, after leaving the follicle, cannot penetrate it and further reach the uterus. But even if the strands have formed somewhere in the middle of the fallopian tube, this still prevents the egg from entering the uterus. The released egg, although it penetrates the fallopian tube, gets stuck somewhere in the middle, never reaching the bottom of the uterus.
The greatest risk of developing female infertility is observed with bilateral chronic salpingitis, since it affects two fallopian tubes at the same time. With unilateral salpingitis, even if an adhesive process has developed, one fallopian tube remains functional. The risk of developing infertility in this case is reduced by half.
Diagnosis of inflammation of the fallopian tubes
Methods for diagnosing salpingitis:
- gynecological examination;
- Ultrasound of the pelvic organs;
- laparoscopy;
- radiocontrast methods;
- bacteriological examination of a smear from the cervix.
Gynecological examination
A gynecological examination is a method consisting of several stages of examination by a gynecologist. It includes digital vaginal examination and speculum examination. The examination is carried out on a gynecological chair using disposable latex gloves. The patient is lying on her back with her knees bent and ankles on a special stand.Research using mirrors
This study consists of visualizing the walls of the vagina, its fornix and the cervix using vaginal speculum. There are many models of vaginal specula, which are selected by a gynecologist. The most commonly used mirrors are Sims spoon mirrors. Initially, the lower mirror is introduced, and then the front one. With salpingitis, mucopurulent mucus is visible on the walls of the vagina and cervix. Also, various pathological changes in the form of erosions, dysplasias, and tumor-like formations may be present on the mucosa.
Digital vaginal examination
A digital vaginal examination is carried out following a speculum examination. During this examination, the gynecologist inserts two fingers of one hand into the patient’s vagina, and places the other hand and lightly presses on the lower abdomen. This determines the shape and position of the uterus, the condition of the fallopian tubes and ovaries. With salpingitis, the doctor feels a compacted, sharply painful fallopian tube ( one or two) and ovary. With the development of an adhesive process in the fallopian tubes and ovaries, the gynecologist probes the tumor-like formation, which consists of adhesions, the ovary and the fallopian tube.
Ultrasound of the pelvic organs
Ultrasound examination is a non-invasive research method using ultrasonic waves. An ultrasound of the pelvic organs is performed by an ultrasound diagnostic specialist.When examining the pelvic organs, two types of ultrasound are used - transabdominal and transvaginal. In the first case, the sensor is applied to the lower abdomen at the projection points of the fallopian tubes and ovaries, that is, to the right and left groin area. In the second case, the sensor is inserted into the vagina. In both cases, the woman is in a supine position on a couch. Before performing a transabdominal ultrasound, a woman should fill her bladder as much as possible by first drinking 4 to 5 glasses of water.
Signs of salpingitis on ultrasound:
- thickening of the walls of the fallopian tube;
- dilation of the fallopian tube with hypoechoic contents ( for chronic salpingitis);
- adhesions ( for chronic salpingitis);
- accumulation of fluid in the retrouterine space.
- spherical shape of the ovary with a vague outline;
- heterogeneous structure of the ovary, on ultrasound it appears hypoechoic ( dark) and hyperechoic ( light) areas;
- accumulation of fluid in the pelvis;
- blurred visualization of follicles.
Laparoscopy
Laparoscopy is the main method for diagnosing acute salpingitis; its accuracy is 80–90 percent. However, this method is associated with numerous risks, including the development of adhesions.Laparoscopy consists of visualizing the uterine appendages ( fallopian tubes and ovaries) using a laparoscope. This method is a kind of mini-operation, which is performed under local anesthesia. A laparoscope, which is a tube with a lens system, is inserted into the abdominal cavity through small holes. Through an optical cable connected to it, the doctor visualizes the fallopian tubes and ovaries. Thus, tissues are directly visualized and inflammatory processes in them are determined.
With purulent salpingitis, the doctor can visualize the accumulation of pus or even blood in the fallopian tube. The fallopian tube itself looks swollen, enlarged, and sharply red.
X-ray contrast methods
Radiocontrast methods include metrosalpingography, which is used mainly to assess the patency of the fallopian tubes. The method allows you to evaluate the shape, structure, as well as the lumen of the uterus and fallopian tubes.Metrosalpingography
The method consists of injecting a contrast agent into the uterine cavity and fallopian tubes, with further tracing of this substance on x-rays. This procedure is performed in an x-ray room. The woman is in a gynecological chair with her knees bent. The chair is placed under the fluoroscope camera. The doctor inserts a catheter into the cervix, after which contrast is injected into it. Gradually, the contrast agent fills the uterus and fallopian tubes. In this case, delayed images are taken. The procedure lasts from 15 to 30 minutes, after which the catheter is removed.
Next, using the images, the doctor evaluates the passage of the substance through the fallopian tubes. If the substance passes completely and evenly through the pipes, then there is no obstruction. If the contrast ceases to fill the fallopian tube at a certain level, then there is obstruction of the fallopian tubes.
Most often, obstruction in the fallopian tubes is caused by adhesions in chronic salpingitis. Adhesions deform the fallopian tube and also fill its lumen. As a result, the lumen of the fallopian tube becomes impassable for the egg, which causes infertility.
Bacteriological examination of a smear from the cervix
Bacteriological examination of a smear from the cervix is one of the mandatory methods for diagnosing salpingitis, since the most common cause of salpingitis is sexually transmitted infections ( STI).Infections most often enter the fallopian tube via an ascending route through the vagina, cervix, and uterus itself, eventually reaching the fallopian tubes. Therefore, when treating salpingitis, it is necessary to find out which infection persists in the woman’s genital tract. To do this, during a gynecological examination, a smear is taken for bacteriological examination. The doctor takes a smear from the cervix and urethra with a special brush. Next, it is fixed on a glass slide and sent to the laboratory, where it is studied under a microscope. With salpingitis, an increased number of leukocytes, opportunistic bacteria, and a decrease in the number of good bacteria are detected ( lacto- and bifidobacteria)
However, not all infections are detected by this method. Therefore, if the smear shows signs of inflammation ( increased white blood cell count), but the pathogen has not been identified, the doctor may recommend bacteriological culture or smear analysis using the PCR method ( polymerase chain reaction) .
Treatment of inflammation of the fallopian tubes
Drug treatment
Drug treatment of salpingitis includes not only eliminating the infection and anti-inflammatory therapy, but also enhancing the woman’s immune system.Antibacterial drugs aimed at eliminating infection from the woman’s genitourinary system take first place in the treatment of salpingitis. For acute salpingitis, symptomatic treatment is also used, namely antipyretic and anti-inflammatory drugs. The main role in chronic salpingitis is given to immunomodulators.
Antibacterial drugs for salpingitis
| Drug name | Mechanism of action | Mode of application |
| Ampicillin | Prevents the development of most bacteria by inhibiting the synthesis of their wall. | Ampoules of 500 mg or 1 g are diluted with saline or novocaine solution. Intramuscularly 500 mg every 6 hours. For purulent salpingitis, 1 gram every 8 hours. The maximum dose is 3 – 4 grams per day. |
| Ampicillin + Oxacillin
(trade name Ampiox) | Has antibacterial and bactericidal effects. | Orally 500 mg, which is equal to two capsules, every 6 hours. |
| Cephalexin
(trade name Ecocephron) | Inhibits the synthesis of cellular elements of most bacteria, thereby preventing their reproduction. | One or two capsules inside ( 250 – 500 mg) 3 – 4 times a day. Intramuscularly, one ampoule ( 250 mg) every 6 hours. |
| Cefotaxime
(trade name Claforan) | Inhibits the synthesis of cellular elements of most bacteria, thereby preventing their reproduction. It is a newer drug from the group of cephalosporins. | Intravenously or intramuscularly. For salpingitis of moderate severity, a single dose of the drug is 1 gram, and a daily dose is 3 grams, that is, 1 gram every 8 hours. For severe salpingitis, the dose is doubled. |
| Erythromycin | Prevents the proliferation of bacteria at the site of inflammation. | One capsule inside ( 250 mg) 4 times a day. In severe cases, the dose is doubled to 2 grams ( 8 capsules) per day. |
| Metronidazole
(trade name Klion) | Blocks the proliferation of not only bacteria, but also protozoa ( trichomonas). | One tablet each ( 250 mg) 3-4 times a day. The maximum dose of metronidazole is 1.5 grams. |
| Furazolidone | Has antimicrobial and antiprotozoal effects. | 100 mg each ( 2 capsules) 4 times a day, in combination with the main antibiotic. |
| Tetracycline | Stops the growth and reproduction of bacteria at the site of inflammation. | 250 – 500 mg ( one to two capsules) 4 times a day after meals. |
| Kanamycin | It disrupts the synthesis of proteins in bacteria, thereby preventing their reproduction. | The powder is diluted with saline solution or 0.5 percent solution of novocaine Intramuscularly 1 gram ( one ampoule) twice a day. |
The drugs of choice for salpingitis are penicillin antibiotics, as well as combined penicillins ( for example, ampiox). For purulent salpingitis, drugs from the cephalosporin group are used ( cephalexin and cefotaxime) and aminoglycosides ( kanamycin). Most often, antibiotics are combined with nitrofuran derivatives ( furazolidone), and for salpingitis caused by Trichomonas - with metronidazole. For chlamydial salpingitis, it is advisable to use tetracycline antibiotics ( tetracycline) and macrolides ( erythromycin).
Common symptoms after surgical treatment of salpingitis:
- weakness;
- not severe nausea;
- frequent urge to urinate.
Recommendations for nutrition and lifestyle after surgery
During the first day after laparoscopy, you must refrain from eating. On the second and third days, preference should be given to dairy products
low fat ( kefir, yogurt), breadcrumbs and lean meat. From the fourth day you need to gradually return to a normal diet. Bed rest should be discontinued the day after laparoscopy to prevent the development of thrombosis.
For two to three weeks after surgery, you should avoid heavy physical activity and sports. Sudden movements, heavy lifting, long flights and trips should be avoided. When taking a shower, you should not rub the seams with a washcloth, and after water procedures you should treat the surface of the wounds with antiseptics ( solutions of brilliant green or potassium permanganate). For two weeks you should not take a bath, visit saunas, or swim in pools, lakes and other bodies of water. Clothing should be loose and does not put pressure on the seams.
You should return to sexual activity depending on the recommendations given by your doctor.
Planning pregnancy after surgical treatment
Removing obstruction of the fallopian tubes increases the patient's chances of becoming pregnant. Over time, the likelihood of conception decreases, since after a year or two a new adhesive process may occur. Those women who want to become pregnant need to start taking hormonal medications for several months after surgery. Next you should start planning your pregnancy. The chances of restoring fertility depend on the location of the adhesions. If it was around the fallopian tube, more than half of the patients manage to get pregnant naturally ( 60 percent). If adhesions form inside, the likelihood of pregnancy is reduced to 10 percent.
Traditional methods of treatment
Treatment of salpingitis with traditional medicine includes the following procedures:- baths;
- douching;
- medicinal tampons;
- infusions and decoctions.
Baths
When the fallopian tubes are inflamed, baths have a tonic and cleansing effect and help reduce pain during exacerbations of the disease. Baths also help strengthen the immune system. According to the method of carrying out the procedure, they are divided into water and steam.Baths with juniper
These water procedures are recommended for patients with bilateral salpingitis. To prepare such a bath, you should take 50 grams of common juniper ( veres) and fill with a liter ( four glasses) boiling water. Berries and plant stems can be used as raw materials. After the juniper has infused ( two - three hours), add the infusion to a bath of water. The water temperature should be 35 - 37 degrees. The duration of the bath should not exceed half an hour ( thirty minutes).
Sage baths
Baths with sage infusion are recommended for women with chronic salpingitis. Add clary sage infusion to a bathtub filled two-thirds with fresh water, the temperature of which does not exceed 35 degrees. To prepare the decoction you will need one hundred grams of dry sage. Fill the raw material with one liter of water ( four glasses) and put on low heat for an hour and a half.
Baths with valerian
Baths with valerian extract have a relaxing and restorative effect on the body. Fill the bathtub with water so that the water level in a sitting position does not exceed the chest line. The water temperature should not exceed forty degrees. Add fifty milliliters to the bath ( three and a half tablespoons) valerian extract. The duration of the procedure is twenty to thirty minutes.
Rosemary baths
To prepare a rosemary bath, you will need thirty milliliters ( two tablespoons) extract of this plant, which must be purchased at the pharmacy. The pharmaceutical product can be replaced with an infusion prepared at home. To do this, pour three hundred grams of rosemary leaves with three liters of water ( twelve glasses) and, bringing to a boil, keep on low heat for thirty to forty minutes.
Milk steam bath
A milk bath will help relieve pain from inflammation of the tubes. To carry out this procedure comfortably and effectively, you need to purchase a stool or chair with a hole in the seat. To prepare a milk steam bath, boil three liters of fresh cow's milk. Cool the milk slightly and pour it into a basin or other container, the volume of which does not exceed ten liters. Place a stool over the container and sit on it, giving the steam access to the genitals. If you don't have a chair with a hole, you can do without it by squatting over the steam. The lower part of the body must be wrapped in a warm blanket. The procedure must be carried out until the milk cools down. Systematically - once a day before bed for three to four weeks.
Douching
The principle of douching is to rinse the vagina with herbal decoctions. To carry out the procedure, a gynecological syringe is required, which must first be disinfected. Douching can be done while lying on your back. It is more convenient to do the procedure in a horizontal position in the bath. Fill a syringe with a pre-prepared decoction. Treat the vaginal vestibule with sterile Vaseline or baby cream. Lie down on the bottom of the bathtub and put your feet up on the sides. Relax your muscles and insert the tip of the syringe into the vagina, releasing the air from it. Pour the solution inside the vagina. The duration of the procedure should not exceed fifteen minutes. The temperature of the decoction during the first procedure should be thirty-seven to thirty-eight degrees. When carrying out subsequent procedures, the temperature of the liquid must be gradually increased to forty-five to forty-eight degrees. If during douching the body temperature rises or pain increases, the temperature of the infusion should be reduced. To increase the effect, after douching, you need to put a heating pad or make a warm compress on the lower abdomen.Douching affects the natural microflora of the internal genital organs, so the procedures should be carried out in a course, the duration of which does not exceed two weeks.
Infusions and decoctions for douching
Plants for preparing solutions that are used for douching:
- calendula;
- sage;
- Oak bark;
- Linden;
- hog queen;
- bergenia.
Collection components #1:
- knotweed ( knotweed) – fifty grams;
- nettle ( leaves) – thirty grams;
- oak bark - ten grams;
- Potentilla root - ten grams.
- black elderberry ( flowers) – two tablespoons;
- chamomile ( flowers) – two tablespoons;
- flax seeds - two tablespoons.
- Chernobyl ( wormwood) – twenty grams;
- Veronica Dubravnaya ( flowers and leaves) – twenty grams;
- chamomile ( flowers) – twenty grams;
- sweet clover – five grams.
Therapeutic tampons
In the treatment of salpingitis using traditional methods, medicinal tampons are widely used, which are a feminine hygienic tampon soaked in decoction or juice of a medicinal plant. The procedure is carried out in the evening. A medicated tampon is inserted into the vagina and left overnight. To prepare therapeutic tampons, you should use natural cotton tampons.Tampons with incense decoction
Bergenia has an anti-inflammatory effect and promotes the resorption of adhesions. To prepare the infusion, take one hundred grams of dried bergenia root and grind it in a coffee grinder. Pour the raw material into two glasses ( 500 milliliters) boiling water, cover the container with a towel and leave to steep for six to eight hours. After this, strain the broth and soak the tampon. The course of treatment with bergenia should not exceed twenty days.
Aloe tampons
Aloe has a strong antimicrobial effect and is widely used in folk medicine to treat inflammation of the fallopian tubes.
Rules for using aloe:
- use only the lowest leaves, the length of which does not exceed fifteen to eighteen centimeters;
- aloe must be more than two years old;
- To increase the concentration of nutrients, do not water the plant for several days before use.
Recipes for aloe-based tampon solutions:
- With plantain. Bring one hundred milliliters of water to a boil, add one tablespoon of chopped plantain and simmer for two to three minutes. Strain the broth and add fifteen drops to it ( tablespoon) aloe juice;
- With cabbage. Chop fresh cabbage leaf and squeeze. Mix a tablespoon of cabbage juice with the same amount of aloe juice;
- With honey. Take one tablespoon of natural honey of liquid consistency and mix with a tablespoon of aloe juice.
Means for oral use
Medicines based on medicinal plants are used to reduce inflammation and improve immunity. To prepare medicines according to folk recipes, you should use fresh ingredients, and buy herbs only in pharmacies.Herbal collection with absorbable effect
The herbs included in the collection promote the resorption of adhesive processes. Also, drinking the decoction helps restore the body’s hormonal levels and reduce pain.
Infusion components:
- evasive peony ( Maryin root) – twenty grams ( one and a half tablespoons with top);
- celandine ( nipplewort) – twenty grams;
- calendula flowers ( marigold) – twenty grams;
- common nettle - twenty grams;
- field grass – ten grams ( level tablespoon);
- sweet clover - ten grams.
Anti-inflammatory agent
This folk remedy contains marshmallow root ( 50 grams) and rendered fat from lard or lard ( two tablespoons).
Pour dry marshmallow root with water in a glass or ceramic container and leave for twenty-four hours in a dark place. After this, place the container over low heat, bring to a boil and leave to simmer for several hours until the root becomes soft. Cool the plant and grind it in a meat grinder or blender. Combine lard and marshmallow pulp and simmer for two to three hours in a thick-walled container. After removing from heat, stir and place in a container with a lid that is convenient for storage in the refrigerator. You need to take three tablespoons at a time with meals.
Decoctions that eliminate inflammation
Recipes that reduce the inflammatory process during salpingitis:
- With viburnum. Pour fifty grams ( three tablespoons with top) dried flowers with one liter of boiling water and leave for thirty minutes ( half an hour) in a water bath. Strain the broth, add natural linden honey to taste. You need to drink one hundred grams of the drink three times a day;
- With birch bark. Place one liter of water on the fire in an enamel or glass container. After the water boils, add two tablespoons of crushed dry birch bark. After twenty minutes of slow boiling, remove from heat, strain, add a tablespoon of natural honey and five drops of iodine. You need to drink the decoction warmed before bed, half a glass;
- With mother and stepmother. Combine two tablespoons of crushed sweet clover and centaury herbs. Add three tablespoons of coltsfoot flowers and pour a liter of boiling water. Place the container with the drink in a dark place for two to three hours to infuse. You need to take 80 milliliters of the decoction ( one third glass) five to six times a day.
Prevention of inflammation of the fallopian tubes
Prevention of salpingitis involves timely and correct treatment of genital infections. To do this, it is recommended to undergo preventive gynecological examinations with bacteriological analysis once a year. Identified infections should be completely cured. To prevent the infection from becoming chronic, you should complete the course of treatment, even if there are no visible symptoms of the disease. Another important point is the treatment of the sexual partner. Because, even after successful treatment, the infection can reenter the genital tract.
It is also recommended to avoid casual sex and unprotected sex. A woman’s immune system should be maintained at a high level, since weak immunity provokes the development of infections. The entry point for bacteria is the injured mucous membrane of the genital tract, so it is advisable to avoid the use of intrauterine contraceptives.
Inflammatory diseases of the fallopian tubes (salpingitis) can be caused by a variety of flora, mainly bacterial. Typically, pathogens spread upward from the uterus; hematogenous and lymphogenous infections are much less common.
Acute serous salpingitis usually does not cause severe clinical symptoms. Macroscopically, swelling and hyperemia of the pipe wall are observed. On microscopic examination, edema, congestion, and mild leukocyte infiltration are usually limited to the mucosa.
In acute purulent salpingitis, the fallopian tube is thickened, with a dull surface, and covered with fibrinous-purulent exudate. Pus is released from the lumen of the tube. Microscopically, sharp hyperemia, edema and infiltration of the tube wall with polymorphonuclear leukocytes are observed. Characteristic is severe damage to the tubal epithelium, its degeneration, necrosis, and desquamation.
Chronic salpingitis often develops after acute salpingitis. The formation of adhesions on the outer surface of the fallopian tube and between the folds of the endosalpinx is determined; microscopically in all layers of the tube - lymphomacrophage infiltration and sclerosis of varying degrees of severity, atrophy of the muscle layer and epithelium gradually progresses.
When the lumen of the tube is obliterated, an accumulation of purulent exudate (pyosalpinx) or transudate (hydrosalpinx) may be observed in it, which is accompanied by an expansion of the lumen, first by hypertrophy, and later by atrophy of the muscular and mucous membranes.
Tuberculosis of the fallopian tubes develops with the hematogenous spread of Mycobacterium tuberculosis. A productive reaction with the formation of granulomas is characteristic. Inflammation is accompanied by a pronounced adhesive process with the formation of tubal obstruction.
Fallopian tube tumors are relatively rare. Among benign tumors, leiomyoma and mesothelioma have been described; morphologically, these tumors have the same structure as in the uterus. Malignant tumors (adenocarcinoma, sarcomas, carcinosarcoma) are even rarer. In the fallopian tubes, the formation of metastases of cancer of the ovaries, body and cervix, breast, and stomach is possible.
More on the topic Fallopian tube diseases:
- DISEASES OF THE FEMALE GENITAL ORGANS AND BREAST GLANDS. DISEASES OF THE CERVIX. DISEASES OF THE BODY OF THE UTERUS. DISEASES OF THE FALLOPY TUBES. OVARIAN DISEASES. BREAST DISEASES
Salpingitis is a female disease in which the reproductive system is affected, and in 20% of cases leading to infertility. The pathology is manifested by inflammation of the fallopian tubes; it occurs as a result of an infection entering the body that affects the ovaries, uterus and its appendages.
Causes of inflammation of the fallopian tubes
According to the type of microorganisms that caused the pathology, salpingitis can be specific and nonspecific.
The first occurs when infected with chlamydia, trichomonas, gonococci, and mycobacterium tuberculosis. The second can be caused by Staphylococcus aureus, streptococcus, E. coli, and fungi.
Factors that increase the risk of inflammation include:
Diseases of neighboring organs can provoke salpingitis:
- acute appendicitis;
- oophoritis;
- colitis.
Symptoms of the disease
Inflammation occurs in acute, subacute and chronic forms.
The acute form is characterized by the following symptoms:
- body temperature rises to 38 ºC;
- there is a sharp pain in the lower abdomen, which radiates to the sacrum;
- with salpingitis, the amount of vaginal discharge increases, serous-purulent, bloody, foamy leucorrhoea may be observed, their quantity and type depend on the pathogen that caused the pathology;
- nausea, sometimes vomiting and diarrhea occur;
- the woman feels weakness, dizziness, tachycardia;
- urination disorders occur: urine becomes less, and the urge is frequent and painful.
In the subacute form of salpingitis, the symptoms may be the same, but the pain is not as sharp and the body temperature does not rise above 37.3 ºC.
The chronic form of the disease often occurs without any special symptoms. A woman may feel a slight aching pain throughout the day. The number of discharges increases. Body temperature remains within normal limits. A woman with a chronic form of salpingitis has menstrual irregularities. Menstruation is often scanty and painful. A woman may experience pain during sexual intercourse, vaginal irritation and decreased libido. This form of the disease is the most difficult to identify and cure.
The localization of pain in pathology depends on how widespread the inflammation is. Salpingitis can be:
- left-handed;
- right-handed;
- double-sided
Diagnostics
It is important to diagnose the pathology in time. To achieve this, women should not neglect preventive examinations by a gynecologist. This is the only way to identify the chronic form.
In the acute stage, in order to correctly diagnose, the doctor carries out:
- examination on a chair;
- palpation examination of the patient’s abdomen;
- ultrasound examination of the pelvic organs;
- transvaginal ultrasound.
For salpingitis the following are prescribed:
- a general blood test, which in case of inflammation will show a high level of ESR and leukocytes;
- PCR analysis to exclude the presence of Trichomonas, gonococcus or chlamydia;
- a smear from the vagina and urethra to determine the causative agent of the disease.
To assess the patency of the fallopian tubes, metrosalpingography (x-ray contrast method) is done. A contrast agent is injected into the uterus and fallopian tubes, then the condition of the tubes is assessed using X-rays.
The laparoscopy method is now performed in rare cases when salpingitis is in an advanced form. This procedure is traumatic. Holes are made in the abdominal cavity and the laparoscope is inserted through them. Using this method, you can examine the condition of the fallopian tubes, take a smear, see the extent of the disease and the presence of adhesions.
Treatment of salpingitis
Women with acute inflammation are treated in a hospital; other forms can be treated on an outpatient basis.
For salpingitis, the patient is prescribed bed rest, cold on the stomach, and a gentle diet.
Drug treatment includes:
- antibiotics;
- anti-inflammatory and painkillers;
- if necessary, antipyretics;
- immunomodulators;
- vitamins and minerals.
Antibacterial therapy for inflammation of the fallopian tubes is carried out after the results of culture and identification of the causative agent of the disease. Then the doctor must check the sensitivity of the bacteria to antibiotics. Taking this into account, antimicrobial agents of the following classes can be prescribed:
- penicillins;
- cephalosporins;
- macrolides;
- tetracyclines, etc.
In order to neutralize the pathogen, for salpingitis the following is used:
In order to relieve symptoms of inflammation, reduce body temperature and relieve the patient of pain, the doctor may prescribe tablets, injections or suppositories:
- Butadion;
- Ibuprofen;
- Advil;
- Nurofen;
- Nimesil;
- Acetaminophen;
- MIG 400.
To quickly restore the body after salpingitis, you need to take vitamins. The most essential vitamins for women's health are vitamins C, E, B12, B6, and cocarboxylase.
Immunomodulators that the patient needs to take for a speedy recovery include:
- Imunofan;
- Groprinosin;
- Polyoxidonium.
In severe forms of the disease, surgery cannot be avoided. Indications for surgery may be the following cases:
- when the therapy does not help;
- when tumors are detected on the appendages;
- when salpingitis leads to purulent formations;
- adhesions of one or two fallopian tubes.
In the chronic form, physiotherapy methods are effective. Such procedures include:
To treat salpingitis, you can use folk remedies, but only after consulting a doctor. Effective are:
- Baths with juniper, sage, rosemary, with the addition of milk. Such procedures have anti-inflammatory, analgesic, and sedative effects. Baths improve a woman’s immunity and promote rapid recovery. The water temperature should not exceed 38 ºC. The procedure should last 20–25 minutes.
- Douching with infusions and decoctions of herbs: linden, chamomile, calendula, sage, etc. Such manipulations, which help with salpingitis, should be carried out in courses of 7 to 14 days. When douching, you must adhere to all standards of disinfection and hygiene.
- Aloe tampons. Therapeutic tampons are good at relieving inflammation, since aloe juice is an antimicrobial agent.
- Anti-inflammatory teas with viburnum, coltsfoot, calendula, birch bark.
Complications
The most dangerous complication of salpingitis is purulent damage to the fallopian tubes, their perforation and blood poisoning. This condition can be fatal.
Other consequences of inflammation are the formation of adhesions and scars on the fallopian tubes. A woman may not be aware of them for many years. Such formations lead to the fact that the fertilized egg cannot enter the uterus. A woman does not become pregnant for many years for no apparent reason. And when this happens, an ectopic pregnancy develops, which often leads to the fact that the fallopian tube has to be removed.
Prevention
To reduce the risk of salpingitis you need to:
- undergo preventive examinations with a gynecologist in a timely manner;
- consult a doctor in a timely manner if symptoms of pathology of the female genital organs occur;
- always complete treatment to the end, and not quit after the condition improves;
- protect yourself from sexually transmitted diseases using barrier contraception methods;
- observe the rules of personal hygiene.
In order not to get salpingitis, a woman must maintain the state of her immune system at a high level, not overwork, exercise, and eat right.
what are fallopian tubes
The female body has a very important organ responsible for a woman’s ability to give birth to children - the uterus. This organ is connected to the abdominal cavity through tubular formations called fallopian tubes. It is through these pipes fertilized The egg descends from the ovary to the uterus in order to gain a foothold there and further develop. If the patency of the fallopian tubes is not all right, then the egg will not be able to reach the uterus, which can lead to an ectopic pregnancy.
Usually in this case a diagnosis of “obstruction of the fallopian tubes” is made.
This disease is considered one of the main causes of female infertility.
If a woman has this disease, the lumens of the fallopian tubes close due to adhesions, and the shape of the tubes may also change, which will also interfere with the movement of eggs into the uterus. When the fallopian tube becomes inflamed, its lumen narrows due to swelling of its inner surface, and the ability to contract is also reduced, without which the egg simply will not move through the tube. And the consequence of the inflammation is adhesions in the fallopian tubes, blocking their lumen.
Symptoms of fallopian tube diseases
Pain when palpating the pipes indicates problems
The main symptom that suggests the patient has tubal obstruction is infertility. Of course, it can be caused by a host of other reasons, but the first step is to diagnose the condition of the fallopian tubes.
Obstruction of the fallopian tubes can be complete, when both tubes are closed by adhesions, or partial, when only one tube is in a normal state, and also when inflammatory processes develop around both tubes.
Other symptoms of tubal obstruction include the fact of having an ectopic pregnancy, when it is normal fertilized the egg, unable to reach the uterus, tries to attach to the walls of the fallopian tube. In this case, a so-called tubal miscarriage usually occurs, which can be complicated by rupture of the fallopian tube.
Causes of fallopian tube diseases
The main causes may be hormonal or infectious in nature
Doctors name various inflammatory processes in the fallopian tubes caused by exposure to sexually transmitted infections, as well as the presence of endometriosis and tubal tumors of various etiologies as the causes of fallopian tube obstruction. The infection enters the fallopian tube from the vagina or through the lymphogenous route, for example, if the patient has tuberculosis of the fallopian tube.
Tumors in the tubes are quite rare and are removed through surgery.
In addition, the adhesive process in the fallopian tubes can begin in response to an artificial termination of pregnancy.
In rare cases, women experience congenital pathology of the fallopian tubes, which is expressed in their underdevelopment, but such abnormalities are usually detected before the onset of puberty, and may not manifest themselves clinically at all.
Quite often, the processes leading to the occurrence of adhesions in the fallopian tubes can take place secretly and do not in any way affect the woman’s well-being. But she just can’t get pregnant.
Diagnosis of fallopian tube diseases
Ultrasound and laparoscopy are considered the most informative diagnostic tools
Naturally, at first they use gynecological examination with palpation of the uterus, then other methods of checking the fallopian tubes are prescribed. The main and perhaps most effective method for diagnosing fallopian tube obstruction is hysterosalpingography. This method is based on the introduction of special contrast agents into the uterus and fallopian tubes for subsequent X-ray imaging. The results of the x-ray will allow us to determine the patency of the fallopian tubes in the patient and, with a high degree of probability, determine the reasons for the abnormal processes of fluid movement inside them.
There is another method called echohysterosalpingoscopy– are introduced into the patient’s uterine cavity physiological solution, and then, using methods ultrasonic research, monitoring the movement of fluid through the fallopian tubes.
Recently it has been widely used laparoscopic a method for studying the processes occurring inside the tubes - through a pair of small holes in the abdominal cavity, optical tubes are inserted inside, with the help of which you can examine in detail the mucous membrane of the inner surface of the uterus, as well as assess its condition, and, if necessary, immediately excise adhesions. Tubal laparoscopy is performed using gentle methods, and the patient can return to normal life after some time.
Treatment of fallopian tube diseases
Treatment of fallopian tube diseases directly depends on the nature of the disease and symptoms
Treatment of tubal obstruction is mainly aimed at eliminating adhesions that interfere with the normal movement of eggs into the uterus. At the initial stage, it may be prescribed physiotherapeutic treatment, which is aimed at softening the adhesions existing in the pipes against the background ongoing inflammatory process in pipes. This method will give results only if no more than six months have passed from the onset of inflammation in the tubes and the formation of adhesions.
Laparoscopy is the optimal method of diagnosis and treatment
Basically, if there are adhesions in the pipes, surgical methods such as hysteroscopy are used - surgical dissection of the adhesions is performed to restore the patency of the pipes, and also restorative plastic surgery of the walls of the fallopian tubes.
Methods of blowing pipes with air or liquid are no longer used due to the high percentage of complications that arise after them.
Treatment of diseases of the fallopian tubes with folk remedies
You can use ortilia and red brush for folk treatment of diseases of the fallopian tubes
Although you can find many traditional medicine recipes on the Internet aimed at treating tubal obstruction, you still cannot rely solely on these methods.
Taking medicines such as boron uterus, milk thistle and marsh cinquefoil should act as maintenance therapy aimed at treating ongoing inflammatory process in the uterus and its tubes.
If adhesions have already formed in the pipes, and quite a long time ago, then the effect of using folk remedies will not come. In this case, you should not rely on herbs, but it is better to go to the hospital for surgical intervention such as HSG of the fallopian tubes, especially since in modern conditions it is carried out using gentle methods.
Inflammation of the fallopian tubes is an infectious disease that develops on the uterine appendages on one or both sides and can involve the ovaries, ligaments, and spread to the pelvic organs.
The fallopian tubes start from the corners of the uterus and end in a funnel that communicates with the abdominal cavity. Therefore, infectious processes from them can spread further into the abdominal cavity.
Pathology may differ in localization in the pipes, nature of the course and etiology.
According to localization, inflammation of the tubes can be:
- left-handed;
- right-sided;
- two-way.
According to the nature of the course, it is divided into acute, subacute and chronic.
The etiology, or cause, is the pathogen that caused the inflammatory response.
They can be:
- specific (gonorrhea, chlamydia, trichomonas, syphilis, HIV, herpes simplex virus or human papillomavirus);
- nonspecific (staphylococci, streptococci, Pseudomonas aeruginosa, Proteus), these are microorganisms that are normally detected in the genital tract.
In 60% of cases, inflammation of the ovaries and fallopian tubes is caused by chlamydial infection. Sometimes it is not one microorganism, but a microbial association. The disease becomes acute when infection penetrates the fallopian tubes and lasts up to 2 months.
This may happen:
- sexually;
- ascending - through the cervical canal, the uterine cavity into the tubes;
- hematogenous - from foci of infection located elsewhere in the body;
- lymphogenous - through lymphatic vessels;
- along the length - from nearby foci of infection, for example, from appendicitis directly into the pipe on the right.
If inflammation of the fallopian tubes lasts up to 6 months, then this is a subacute process. A chronic disease develops after an acute illness and can bother you for years. In this case, periods of remission alternate with periodic exacerbations.
Symptoms
If this is acute inflammation of the fallopian tubes, the symptoms are pronounced. Body temperature rises to 38–39 degrees. The pain in the lower abdomen is sharp. Left-sided salpingitis is accompanied by pain on the left, right-sided - on the right, bilateral - on both sides. The severity of the syndrome depends on the involvement - the greater its irritation, the more painful.
In 2/3 of patients, inflammation of the fallopian tube spreads to the ovary. The appendages swell and increase in size. Irritation of neighboring organs occurs, urination disorder is observed, and lower back pain appears. In some cases, fluid accumulates in the appendages, formed during inflammation. It expands them, does not flow into the abdominal cavity, and hydrosalpinx develops. A purulent infection transforms this condition into pyosalpinx; it can leave behind a large number of adhesions, which leads to infertility.
Uncontrolled use of antibiotics and a decrease in the body's reactivity makes the course of the acute process erased and increases the likelihood of its transition to a protracted one. If developed, symptoms will appear as the process worsens. The temperature will rise, there will be chills, pain in the lower abdomen, radiating to the lower back.
Disorders of the genitourinary system consist of painful sexual intercourse and impaired urination. Disturbances in the digestive, cardiovascular and endocrine systems may occur. The discharge may acquire a purulent tint, which is more often observed with gonorrheal infection, causing irritation and itching in the perineum.
Inflammation of the fallopian tubes and ovaries causes a change in their function, which is manifested by menstrual irregularities. Menstruation becomes abundant or, on the contrary, scanty, painful, duration and regularity may change.
Chronic inflammation of the fallopian tubes causes infertility in women.
Causes of inflammation
Risk factors for salpingitis are exogenous influences:
- abortion;
- behavior of intrauterine manipulations (probing, installation of a spiral);
- operations.
Endogenous causes:
- weakened immune system;
- hormonal changes;
- chronic diseases;
- abnormal development of the genital organs.
Features of behavior that cause inflammation of the fallopian tubes:
- frequent change of sexual partners;
- sexual intercourse during menstruation;
- early onset of sexual relations;
- unconventional ways of intercourse.
Social factors play a certain role in the development of pathology - standard of living, stress, alcohol consumption and smoking.
Consequences of the disease
Acute or chronic inflammation of the tube can cause ectopic pregnancy, infertility, miscarriage or pregnancy complications. The adhesive process leads to chronic pelvic pain and painful sexual intercourse. For a pregnant woman, pathology of the placenta, infection of the fetus, stillbirth, and complicated pregnancy and childbirth are possible.
Diagnostics
The first stage of the examination is a gynecological examination. Examination in the mirrors reveals changes in the vaginal mucosa, erosion on the cervix, and the nature of the discharge from it. Using a digital examination, a sign of inflammation of the appendages is detected - their compaction, pain when displaced, limited mobility. The uterus is not involved in the process, so it is of normal size.
During the examination, smears are taken from the vagina to determine the flora. Depending on the number and type of bacteria, the presence of leukocytes, the degree of cleanliness of the vagina and the presence of an inflammatory process are determined. STI pathogens are diagnosed using polymerase chain reaction (PCR).
Pelvic ultrasound is a non-invasive and safe research method. Can be performed through the abdominal wall or with a vaginal probe. Salpingitis on ultrasound is defined as thickened walls of the tubes and expansion of their lumen, the presence of fluid in them and in the retrouterine space, adhesions. Associated with enlarged ovaries and blurred contours, the structure of the organ is heterogeneous with hyper and hypoechoic areas, the follicles are not sufficiently visualized.
Metrosalpingography is an X-ray method for determining tubal patency. A contrast agent is injected into the uterine cavity, and its distribution through the tubes is determined using an x-ray. The narrowing areas become noticeable, and fluid does not enter the abdominal cavity. The obstruction is usually caused by an adhesive process.
Laparoscopy is a diagnostic and treatment procedure. A special instrument and a video camera are inserted into the abdominal cavity through small punctures. The affected tube appears red and swollen and may be dilated due to hydrosalpinx or collection of pus. In chronic inflammation, a large number of adhesions are found.
Treatment is carried out simultaneously - adhesions are cut, tube patency is restored using plastic surgery. If this cannot be done, they are simply deleted. Pipes with hydrosalpinx are a source of infection for the entire body.
Treatment
Indications for hospitalization are the following:
- ineffectiveness of home treatment;
- serious condition of the woman;
- pregnancy;
- tubo-ovarian abscess;
If inflammation of the fallopian tubes occurs, treatment should be prescribed by a doctor. Self-medication is fraught with the development of complications or transition to a chronic form.
Conservative therapy
The basis of treatment is antibacterial drugs. Broad-spectrum antibiotics are used: Ampicillin, Cephalexin, Cefotaxime, Erythromycin, Metronidazole, Furazolidone. The attending physician selects the optimal dosage and course of medication. The drug is selected based on the type of pathogen and its sensitivity to antibiotics.
After treatment with antibacterial drugs, fungal flora may be activated and thrush may develop. Fluconazole is used for prevention purposes. Dysbacteriosis is prevented by taking probiotics (Linex, Bioflor). Paracetamol, Ibuprofen, Butadione will help relieve inflammation and eliminate pain.
Immunomodulators increase the body's resistance to infection, have antioxidant activity, and reduce the risk of developing adhesions. Representatives of this group are Polyoxidonium, Imunofan, Groprinosin. Be sure to use vitamin complexes. Chronic salpingitis is recommended to be treated with physiotherapy - electrophoresis, ultrasound, reflexology.
ethnoscience
When the symptoms are correctly identified and treatment is aimed at eliminating the cause of salpingoophoritis, folk remedies therapy can be used as a supplement to.
Baths have a tonic effect and relieve pain. The optimal temperature is 35–37 degrees. For preparation, use infusion of juniper, sage, rosemary, and valerian extract.
Douching is carried out with herbal decoctions. They are prepared from plant collections, 2-3 tablespoons per 0.5 liter of boiling water. The following combinations are recommended:
- In a 1:1 ratio, flax seeds, elderberry and chamomile flowers.
- 2 tablespoons of chamomile inflorescences, speedwell and wormwood herbs, a teaspoon of sweet clover.
- 10 g of oak bark and cinquefoil root, 30 g of nettle and 50 g of knotweed.
To prepare medicinal tampons, a hygienic tampon, or one rolled independently from a bandage, is soaked in a decoction of bergenia, plantain and aloe juice. Douching and tampons affect the vaginal microflora. They are conducted in small courses.
To reduce inflammation, decoctions of birch bark, viburnum flowers, and coltsfoot grass are used internally. They are prepared from 1 spoon of dry raw materials and 200–300 ml of boiling water. Bring to a boil and leave to cool. Honey is added to the decoctions.
If timely treatment is started, then acute inflammation in the fallopian tubes is less likely to become chronic, and the risk of complications is reduced.
