Adhesions in the fallopian tubes: causes and treatment. Adhesions in the pelvis (adhesive disease)

In modern life, a person has to encounter various diseases that many did not even know about before. Perhaps someone will say that it is better not to have an idea about many ailments. But if you are aware of all the events happening in the body, then timely treatment will have a positive effect. This article will discuss the phenomenon of adhesions. What is it, what are the symptoms and how to deal with this disease?

Adhesive process

To begin with, it’s worth talking about what kind of disease this is. And define the word adhesions (what is it). This disease is characterized by the formation of the finest fibers or films in the human body. They glue closely located organs together. This disrupts the functioning of an individual human system.

It is worth noting that the adhesive process most often affects the fairer sex. In them, this disease occurs in the small pelvis. Despite this, the disease can appear in the digestive, circulatory, cardiac and other systems of the body.

Diagnostics

It is almost impossible to see adhesions. They are so thin and transparent that human vision is simply beyond their power. However, the presence of the disease can be suspected by the incorrect appearance. Often, the parts glued together are displaced.

The adhesive process can be diagnosed by manual examination or during ultrasound diagnostics. The gynecologist may suspect films located in the pelvis during an examination on the chair. The diagnosis is confirmed after an ultrasound procedure.

A disease such as adhesions has a variety of causes. Let's look at them in as much detail as possible.

Inflammatory process

Perhaps the most common cause of the disease is inflammation. During illness of a particular organ, it increases in volume and begins to secrete fluid. It is this mucus that over time turns into the thinnest threads, and subsequently becomes a dense film that connects the organ with the peritoneum or another part of one or another body system.

As mentioned above, women are most often affected by this disease. In them, the cause of adhesions in the pelvic area can be metritis (inflammation of the uterus), salpingitis (inflammation of the fallopian tube), adnexitis. It is worth noting that films are formed precisely in the organ where the inflammatory process occurred. However, with a severely advanced disease, fluid can also spread to neighboring organs.

Surgical operations

Almost always, after such manipulations, a person encounters a phenomenon called adhesions. You already know what it is. Why do these films form after such types of treatment?

Any operation is accompanied by blood loss. It can be moderate or abundant. After completing the manipulation, the doctor always performs a toilet of the abdominal cavity, clearing it of any remaining blood and mucus. But during the healing period of wounds and sutures, leakage of ichor, drops of blood, or mucus may occur. This is what causes the formation of adhesions. It is worth noting that pathology develops precisely in the organ on which the operation was performed.

For example, when removing the appendix or undergoing intestinal surgery, adhesions form there. During heart surgery, thin films may appear between the chambers. During surgery on the female genital organs, the adhesive process affects this particular system. The wider the surgical incision and the longer the operation, the greater the likelihood of the disease occurring.

Internal bleeding

During bleeding, adhesions may form inside the abdominal cavity. What it is? Let's consider this process.

Often, when an organ ruptures or is damaged, blood or a similar fluid is released. It is this that promotes the formation of threads, which subsequently become films. It is worth noting that each must be treated surgically, but this does not guarantee that the disease will not affect the body.

Female reasons for the formation of adhesions

Adhesions on the ovaries, in or on the uterus can form as a result of various hormonal diseases. These include endometriosis, endometritis, fibroids and other diseases.

Also, with infections that were acquired through sexual contact and were not cured, an adhesive process occurs. A similar outcome can occur due to improper use of intrauterine contraceptives or frequent abortions.

Symptoms of the disease

Depending on where the adhesions appear, symptoms may vary. Most often the disease manifests itself as follows:

• shortness of breath and difficulty breathing (with the formation of films on the area of ​​​​the respiratory system);
• indigestion and pain in the abdominal cavity (with adhesions on the stomach, liver or gallbladder);
• abnormal stool and pain during bowel movements (with intestinal adhesions).

Adhesive disease of the pelvis is characterized by the appearance of the following symptoms:

• intermenstrual bleeding;
• cycle disorders;
• the appearance of nagging, aching or sharp pain in the lower abdomen;
• the inability to become pregnant or the attachment of the fetal egg in an unusual place for him;
• fever, nausea or vomiting.

Disease correction

Treatment of adhesions of the pelvis or other organs can be carried out using various methods. In this case, the age of the patient, the intensity of the symptoms and the cause of the formation of adhesive disease must be taken into account.

There is a conservative, surgical and folk method for treating adhesions. Let's consider the detailed methodology for carrying out the correction.

Conservative way

Adhesions on the ovaries, fallopian tubes, or those located in other human organs can be treated with medications. It is worth noting that this method of correction is most often chosen when the symptoms of the disease are not too pronounced and do not cause discomfort to the patient.

Also, a similar technique is chosen when it is necessary to prevent the formation of thin threads and films between organs. This therapy is prescribed in conjunction with the treatment of inflammation, as well as after surgical operations.

Most often, the patient is prescribed injections of the drug Lidaza or Longidaza. When treating pelvic adhesive disease in women, the drug Longidaza is more effectively used in the form of rectal suppositories.

In addition, the doctor may recommend physical therapy. During manipulation, a special beam is directed to the area where adhesions are formed, which stops the growth of new tissue and prevents the formation of adhesions. Such preventive treatment is always prescribed after correction of inflammatory diseases.

Surgical method of treatment

Adhesions, the symptoms and treatment of which are described in this article, can cause quite severe discomfort. And in this case, often resort to surgical intervention. Most often, this method is chosen when conservative therapy has not brought results.

It is worth noting that the removal of adhesions can be carried out in two ways: laparotomy and laparoscopically. Both of these methods are surgical interventions. Laparotomy is a fairly old and popular option. However, if there is an opportunity and the medical institution has the necessary equipment and specialists, then the advantage is given to laparoscopy.

Sometimes minor films that are removed by laparotomy are formed in a larger amount after the manipulation. That is why before the operation it is worth considering the complexity of the disease and the possible consequences.

The most gentle surgical way to remove adhesions is laparoscopy. During the procedure, the patient is under general anesthesia. That is why there is no need to be afraid of pain and you should completely trust the doctor. The doctor makes several punctures in the abdominal cavity. A video camera is inserted into one of them, which transmits an image of the internal cavity to a large screen.

In addition, the doctor makes several more incisions through which the manipulators are inserted. The number of these punctures depends on which organ the operation is performed on. Their number can be from two to four. Using these manipulators, the surgeon carefully separates the glued organs and removes the adhesion.

After the manipulation, the holes in the peritoneum are stitched together, and the patient comes to his senses.

Traditional methods of treatment

Many people prefer traditional methods of treatment. It is worth noting that such a correction should not cancel the doctor’s prescription. Many experts recommend combining the traditional method and the method of treatment with medications.

- St. John's wort. Treatment with such a decoction is quite common. To prepare the medicine you will need a dried and crushed plant.

Pour one glass of boiling water over one spoon. After this, boil the medicine for a quarter of an hour. Next, you need to cool the liquid and drink it one glass a day. The portion should be divided into four doses.

- Bergenia for the treatment of illness in women. The use of this remedy is not so common, but it is quite effective. You need to take 50 grams of the plant (root) and pour 350 milliliters of hot water into this bulk mixture. This solution should be left for 8 hours in a dark place.

After this, the medicine is considered ready for use. The container with the decoction must be stored in the refrigerator. Every day, dilute a couple of tablespoons of the medicine in one liter of boiled water. You need to douche with this remedy before going to bed.

Self-rupture of adhesions

It is worth saying that pelvic pain can go away on its own after pregnancy. While waiting for the baby, the reproductive organ stretches and grows. This allows the thin threads to separate on their own.

This process is most often painful. If necessary, the doctor may prescribe the expectant mother to take analgesics and sedatives. In some cases, hospital treatment may be required.

In any case, the treatment of the adhesive process should always be under the supervision of a specialist. Sometimes a gynecologist prescribes additional ones to a woman in order to determine the state of her organs.

Prevention of adhesions

Everyone knows that the best treatment for a disease is its prevention. In order to avoid the appearance of an adhesive process, you must carefully monitor your health.

Women are advised to visit the local gynecologist regularly and once a year to be tested for possible infections. If an inflammatory process is detected, it is necessary to start its treatment as soon as possible. This will help avoid fluid secretion and prevent adhesions. Lifestyle also plays an important role. Give up bad habits and play sports.

Also, the fair sex needs to monitor the state of the hormonal background. To do this, it is not at all necessary to take a blood test. Carefully monitor the regularity of the menstrual cycle and your well-being. Avoid casual unprotected sex. This will help you avoid various infections that cause adhesions.

If you had to undergo any operation, it is also necessary to prevent the formation of adhesions. Talk to your doctor and ask him to prescribe the necessary medications. Full compliance with all appointments will help you avoid the appearance of adhesive disease and its consequences.

Conclusion

Now you know everything about adhesive disease. If you are at risk, then get tested and start treatment if necessary, before symptoms appear and various health problems begin.

Consult your doctor and choose the right treatment method. Watch your health and always try to be healthy!

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Questions and answers on: how to find out if there are adhesions

2015-05-31 01:51:11

Zhenya asks:

Good evening. I am 32 years old. At the age of 25, she lost her virginity and was sexually active for three months. I have not been sexually active for 7 years now. After checking with my only partner, there are no infections. But even before the onset of sexual activity, I had female inflammations several times, as soon as my legs freeze a little, pain immediately begins. After treatment, the doctor said that I have adhesions, but they did not prescribe any treatment for them. To my question about the patency of the corpse and fear suddenly this affected the ability to conceive, the answer was, who knows. I really want to become a mother. Tell me if it is difficult to get pregnant and give birth after the age of 32 and beyond (t, I still have not met a man) And what to do with spikes. For the first time I learned on your site that they had to be treated fresh. Doctors say it’s not worth examining for patency, because it often causes obstruction later on, is it? They say you will come when you are trying to get pregnant.

Answers Gumenetsky Igor Evgenievich:

Hello, Zhenya! On the basis of what objective examinations did the gynecologist speak about the adhesive process? Indeed, enzyme preparations for adhesions are effective if prescribed on time, immediately after the course of treatment. An examination of the patency of the fallopian tubes cannot cause their obstruction, since during the study a special anti-inflammatory solution is introduced (if necessary, an antibiotic can be added). However, I do not see the need for you to check the fallopian tubes now, because you do not live a sexual life and do not plan a pregnancy in the near future. Of course, it is still rational to think about the possibility of conception before the age of 34, then the woman's fertility decreases sharply.

2013-02-06 12:17:30

Anatoly asks:

Sometimes sharp pains in the navel area are disturbing - the puncture site - an operation to remove the gallbladder with a stone was several years ago. How to find out - these are adhesions (this place hurt for a long time after a puncture), or there is a hernia - I work as a parquet floorer. Frequent bending, bending.

Answers Medical consultant of the website portal:

Hello! The cause of pain in the peri-umbilical region after removal of the gallbladder can only be determined after additional examination, including X-ray contrast examination of the stomach and intestines, FEGDS, and ultrasound of the abdominal cavity. Determining the cause on your own can lead to untimely detection of the source of the problem and subsequent complications (the most dangerous are strangulated hernia, intestinal obstruction). You should contact the surgeon who operated on you for a re-examination and prescribing the most appropriate treatment. Self-medication can be dangerous to health and life. Be healthy!

2012-07-03 14:59:01

Alena asks:

Hello! In February I had pleurisy, 2 liters of water were pumped out, after which there was a positive trend and the x-ray was also good. Nothing was found in the fluid and sputum, I was treated at a tuberculosis clinic. It seems that I have more strength. But I almost still have a temperature of 37.2 and 37, then I haven’t had one for a week. A general blood test is good, there is no inflammatory process. There is unpleasant pain in the lung, if I walk in the sun, it doesn’t matter either. I don’t feel healthy, I don’t work. How long can the temperature last, do the adhesions cause pain and how do you know that they are there? And is it possible to go to the sea in this condition? What else needs to be further examined? Thanks in advance for your answer.

Answers Telnov Ivan Sergeevich:

Hello. Pleural adhesions can cause minor pain during physical activity and sudden changes in body position. Their presence can only be confirmed by X-ray examination. A temperature reaction may not always be a sign of an inflammatory process, and judging by your description, it does not pose any danger to your health.

2011-08-08 13:32:48

Alena asks:

Good afternoon, I have a question that worries me very much, I would like an answer from a qualified specialist.
I have been delayed for more than a month, in July there was no delay at all, now it seems like they are about to go, my chest hurts and my ovary is also starting to ache, my history has been constantly treating all sorts of infections for about 5 years, either mycoplasma or eroplasma, this arose against the background of cervical erosion, which developed into dysplasia, had cauterization done, underwent a course of treatment for ureoplasma and mycoplasma and HPV, after the course no ureoplasma and mycoplasma were detected, but on one side of the cervix in the commissure a scraping showed HPV again, again she underwent a course of treatment and so did her husband, after that I haven’t been checked yet, they said the incubation period has not yet arrived, they said you’ll pass later, well, right now the delay is more than a month, there is no pregnancy, although we’ve been trying to get pregnant for three months now, I’m very worried about this, questions about infertility are haunting me.
Tell me, what tests should I take now for HPV again, scraping and smear? Which ones should I give to my partner? I learned that a partner can be a hidden carrier of infection and only with a certain test with an injection can this be revealed, we live in the open, maybe this is the problem that every year I am treated for sexually transmitted infections?
And an ultrasound also showed a cyst in my right ovary, I don’t know about its nature, since it was before my period, but after it shrank or ruptured, I don’t know, should I do an ultrasound before and after my period? How to find out about its nature.
Thank you in advance, I want to get pregnant soon, help me with this.
Alena, 28

Answers Nechidyuk Alla Korneevna:

Dear Alena. Firstly, if you have been diagnosed with HPV, then it is not possible to cure it. This is a virus that can be eliminated from the body itself or reactivated, it all depends on the level of your immune system. Ask why they were treated? We treat existing changes in the cervix caused by this virus, dysplasia, and also strengthen the immune system. The partner, if he has no symptoms, then does not require special treatment. Secondly, uro and mycoplasma infection also requires additional examination before it is necessary treatment, namely culture and sensitivity to antibiotics. The number of them is important here. Thirdly, the nature of the cyst can be determined by ultrasound in dynamics and by a blood test for cancer marker CA-125. In general, 3 months is not a reason to think about infertility .

2011-04-19 05:28:26

Roman asks:

Hello!

I hope very much for your help. Let's talk about all the problems in order. Thank you in advance!

We are already in our 7th month of fighting warts. Last fall, my girlfriend (25 years old) and I (25 years old) developed genital warts. The girl was prescribed therapy: Lavomax (on days 1, 2, 4..., 38, 1 tablet) and Viferon No. 10 suppositories, one at night (due to her thyroid and kidney problems, they did not prescribe Valtrex and Cycloferon to her). They also cauterized her condylomas with nitrogen and since then she has had
This crap didn't appear anymore. I was prescribed Lavomax (on days 1, 2, 4..., 38, 1 tablet), Valtrex (10 days, 2 tablets per day + 20 days, one tablet per day), Viferon-3 No. 10 suppositories, one at night , after which Cycloferon one ampoule IM every other day. During the entire period of treatment for genital warts, I took 3 similar courses of therapy (and the girl, in addition to the first course, also plus one course
Lavomax, because I thought that she also needed to join me a second time, although she no longer had condylomas) and did electrocoagulation 4 times, since condylomas appeared again and again after each course of therapy, once I even had to Cauterize 2 times in one course, as new condylomas appeared during treatment. (In my anamnesis, 3.5 years ago in the fall, with an interval of 2 months, I had infectious mononucleosis, and then chickenpox.) Just when they found out that we had condylomas, we were tested for syphilis and HIV (the girl had to go to the hospital with her kidneys, and I took it for the company), the tests were negative. And before the New Year, I took a urethral smear for 8 infections, the tests were also negative. The girl periodically goes to the gynecologist for examination, has smears done, everything is negative.

1. Is there something wrong with the prescribed therapy? I guess I have that kind of immunity. How to make herpes go into hibernation? How can I find the right therapy for my immune system?

2. Does a girl need to periodically take at least Lavomax, even if she does not develop condylomas, but I do?

3. After cauterization with nitrogen, the girl developed tassels on her vulva, and her cervix was normal. The gynecologist said that there is no need to do anything with the brushes. Is it true? Does the presence of tassels on a girl prevent oral sex?

4. Provided that the girl and I are already infected, is it possible to have oral sex in cases where the passive partner has condylomas and when he does not have them (i.e., the virus is dormant)?

5. Will my girlfriend develop new condylomas, and how will it affect the fetus during conception if in these two situations I am without a condom and with condylomas on the penis, and also without a condom and with condylomas on the penis? As I understand it, I can infect a fetus with the virus itself, either with or without condylomas on the penis, but in a girl, condylomas can appear again only if condylomas are present on the penis? Do I understand correctly that with condylomas on the penis it is still better to use condoms, since I may have a secondary infection if the condylomas rupture?

6. After the last 4th electrocoagulation and wound healing, 3 scars remained on the foreskin. In the previous 3 cauterizations, I didn’t even have scars, there wasn’t even a trace left at all, everything was clean and smooth. Most likely this time the scars were formed due to incontinence, I did not wait for the wounds to heal completely after cauterization and after sexual intercourse 2 wounds out of 3
they fell off and scars probably formed, plus a small scar remained from the third wound. And just recently, after another sexual intercourse, these 2 new scars were already torn off, new wounds formed, they healed on the second day, and the scars became smoother and not so noticeable. Can you tell me how I can completely remove all these 3 scars? Will Contratubeks, Clearwin or something else help?

7. Also, after the last 4th electrocoagulation, under the crown of the glans, where there was a colony of condylomas, an adhesion of the glans to the foreskin formed. How can I remove this adhesion, otherwise there is an unpleasant sensation under the head when you pull back or pull on the foreskin. Is it possible to ask a urologist to cut this adhesion with the same current, or with a scalpel, or something else better?

8. Also, after the last 4th electrocoagulation, even during abstinence, a lump appeared on the foreskin near the crown, which subsequently turned into condyloma. I burned it myself with “Super Celandine”, did everything as in the instructions: I smeared baby cream around the condyloma, dripped a little celandine onto the condyloma. But a drop from the condyloma spread in two directions and resulted in burns. I rinsed the burns with cold water for 10-15 minutes and anointed the burns after rinsing with “Rescuer” (Poland). Then I went to the treating urologist, both burns were wet, he said to rinse with furatsilin and then lubricate with brilliant green. Now the burns are almost no longer wet, only wounds with blood spots, one burn in the form of a long groove. To this day I have never smeared it with brilliant green, and after washing it with furatsilin I only smeared it with “Rescuer”. Simply the desire to prevent any scar after a severe burn is stronger than the desire to do as the urologist said, namely to smear with brilliant green after washing. Tell me, did I do the right thing, that I did not smear with brilliant green, but only with "Rescuer"? Please tell me what exactly I need to do now with these burns so that not a trace remains of them? After the electrocoagulations themselves, the burns always passed without traces; I only washed them with furatsilin and never lubricated them with anything, since the burns from the current were shallow and did not cause any fear of being left with a scar.

Answers Zhiravetsky Taras Mironovich:

Good afternoon. Thank you for the detailed information regarding the treatment. Regarding drug treatment, it will not harm but is unlikely to help you, I have a suspicion that you may have lipid (fatty) growths that the doctor mistook for condylomas and that is why they are recurring in you. Regarding the best treatment, this is laser vaporization, which we have been performing in our Biocourse clinic for 10 years and does not leave scars or depigmentation. It’s difficult to advise anything without an examination; I recommend looking for a clinic that, like ours, performs laser vaporization.

2010-06-29 15:46:55

Svetlana asks:

Hello! A month ago, I suffered a tubal pregnancy of the type that began as a tubal miscarriage, they did a laparotomy with squeezing out the fertilized egg, the tube was saved. They discharged me for 10 days, the tests were normal, what should I do now, because this could happen again. The doctor sent me for hardware therapeutic hydrotubation, there is Is there any point in going or going straight to laparoscopy, how can I find out what’s wrong with me, I think old inflammations and adhesions are to blame, I had an abortion 10 years ago, I had acute cestitis half a year ago, the smears are all clean, what should I do?

2010-01-27 18:15:01

Tatiana asks:

Hello! I’ll probably start with this. At the beginning of April 2009. gave birth to a child. 3 months after giving birth, I had an operation to remove a cyst (there was a torsion of the leg in the tube) and along with it the entire left side of the appendages was removed. And now I found out that I am pregnant, 4 weeks. Please tell me if I can carry a child and give birth if half a year has passed since the operation? And before pregnancy, during menstruation (in the first days) there was pain on the side where the ovary and tube were removed, the gynecologist says that these could be adhesions. What should I do? But the child we want. Thanks in advance!

Answers Palyga Igor Evgenievich:

Good afternoon. I see no contraindications to pregnancy. Even during pregnancy, operations are performed and after that the woman carries the baby to term without any problems.

2009-04-15 15:04:49

Alesya asks:

Good afternoon, I have a very exciting question. On March 30, 2009, I had a surgical abortion at a period of 9 weeks after the abortion, within 2 weeks I changed 4!!! doctors who gave me various diagnoses, starting with hematometra, right-sided oophoritis, adhesions of the left ovary and uterus, and so on. The last doctor still showed me more confidence in him during the ultrasound and told me everything in detail, no adhesions and hematometers, but he said that since the abortion 2 weeks have passed, then, in theory, menstruation should pass in 2-3 weeks, but according to the ultrasound she said that the endometrium has not grown and is now linear. She said that most likely menstruation will not come and will need to be treated with hormones. I want to know from you whether there is a possibility that the endometrium is still will it grow and if not, what is the likelihood of it growing and having a child in the future? and exactly one month after the abortion should menstruation begin?
Sincerely.

Answers Bystrov Leonid Alexandrovich:

Hello, Alesya! Often, after a medical abortion (surgical), the next period may come with a delay, especially if the abortion is long term, since the corpus luteum of pregnancy can inhibit the natural cycle. Therefore, you need to wait 1-1.5 months. But, unfortunately, a delay in menstruation may be associated with the so-called. “by scraping the endometrium,” then this will require hormonal treatment to restore menstruation. cycle. That is, time and periodic ultrasound should tell you what the reason is.

Despite the long period of studying adhesive processes in the abdominal cavity, in particular in the pelvis, common views on the mechanism of their occurrence and prevention have not yet been developed. Mortality from intestinal obstruction caused by adhesions, according to US researchers, is about 2000 people per year. In women, adhesions in the pelvis occur 2.6 times more often than in men, and adhesive intestinal obstruction occurs 1.6 times more often. At the same time, the mortality rate as a result of this pathology among women is 10-15% lower.

What is the adhesive process in the pelvis

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

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

• physiological restoration of the peritoneum;
• development of adhesions.

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

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

Causes and risk factors

The entire multiphase adhesive process of the pelvic organs is universal for any injury - inflammatory or mechanical in nature (in case of injury, inflammation, surgery). It is an adaptation mechanism that is aimed at delimiting the area of ​​inflammation from healthy areas. The formation of adhesions itself is a protective reaction of the body in response to tissue damage and a decrease in their oxygen supply. However, the tendency to the adhesive process, the degree of its severity and prevalence are different in all people, which depends on genotypic and phenotypic (genotype-related) signs and characteristics.

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

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

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

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

In the studies conducted, one reason for the formation of adhesions was identified only in 48%; in the remaining cases, it was a combination of two or more factors.

Clinical course of adhesive disease and its diagnosis

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

1. Intestinal obstruction
2. Violation of gestation, infertility

Signs of intestinal obstruction

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

This simplified mechanism of acute intestinal obstruction explains:

• the appearance of cramping and then constant pain in the abdomen;
• dry mouth;
• bloating;
• nausea and vomiting;
• absence of defecation and release of gases.

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

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

Chronic pelvic pain syndrome

The pain is associated with the tension of the adhesions when the pelvic organs are displaced. In this case, irritation of pain receptors and short-term ischemia (impaired blood supply) occurs as a result of both the mechanical action of the strands themselves and reflex vascular spasm.

Chronic pelvic pain is characterized by:

1. Long-term, almost constant, with a periodic increase in the intensity of pain in the lower abdomen, groin and lumbar regions. These pains can be sharp, aching or dull. Often their tendency to increase is associated with psycho-emotional and physical stress, hypothermia, and a certain body position for a long time.
2. Painful menstruation and ovulation periods.
3. Pain during overly active sexual intercourse, lifting heavy weights or physical exercise, during bowel movements, bladder overflow or emptying.

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

Impaired pregnancy and infertility

The adhesive process of the small pelvis during pregnancy can to some extent limit the mobility of the uterus and its enlargement. Stretching of fibrous adhesions can be accompanied by frequent and sometimes almost constant pain in the lower abdomen, the urge to urinate frequently, constipation, discomfort during bowel movements, bloating and forced restrictions on a woman’s nutritional intake. Symptoms depend on the location and severity of the adhesive process.

The danger is that the cords can lead to disruption of innervation and blood circulation in various parts of the uterus and its associated hyperactivity. The latter can cause spontaneous abortion or premature birth.

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

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

Diagnosis of the disease

Based on:

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

Principles of treatment

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

If acute obstruction occurs, only surgical dissection of adhesions and restoration of intestinal function are indicated, and if necessary, its resection.

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

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

Adhesive disease is the growth of strands (adhesions) of connective tissue in the abdominal cavity and pelvic organs. In recent years, cases of such pathology in gynecological practice have become more frequent. Adhesions not only can cause discomfort and pain, but also lead to female infertility. In view of this, many are interested in the question: are adhesions visible on ultrasound?

To understand what should be visible during an ultrasound examination, first of all, you should understand what the adhesive process is, delve into the mechanism of their formation and understand in which case their presence can be suspected.

Why and how do adhesions form?

When an inflammatory process occurs in the pelvis, this leads to the formation of fibrin. This high-molecular protein glues tissues adjacent to each other and thus prevents the spread of the inflammatory process. When the pathological condition is normalized, the previously glued tissues form adhesions of connective tissue - adhesive cords. Their primary task is to restrain the inflammatory process in the body.

Among the main reasons for the proliferation of adhesions are the following:

• Inflammatory processes in the fallopian tubes and ovaries, in the surface layer of the endometrium (inner mucous membrane of the uterine body), in part of the pelvic peritoneum, in the peri-uterine tissues of the vagina. In addition, all kinds of injuries can provoke the process of growth of adhesions.
• Endometriosis. This disease is characterized by the growth of endometriotic tissue outside the uterine mucosa. The formed pathological foci change cyclically, just like the normal endometrium. This provokes the development of microscopic bleeding, and subsequently inflammatory reactions and fibrotic changes (adhesions, scars).
• Surgical manipulations on the pelvic and intestinal organs. The formation of adhesions and scars is a normal physiological process that is inevitable after surgery. But over time, the adhesive process should go away on its own and without complications. And with adhesive disease we are talking about pathological growth and thickening of connective tissue.
• Pathologies leading to accumulation of blood in the abdominal cavity and pelvis: sudden disruption of the integrity of the ovary, tubal, ovarian, abdominal pregnancy, retrograde menstruation.

The longer the internal organs are in contact with air, the more stitches are placed, the more dry the peritoneum is, the more likely the subsequent process of pathological adhesions is.

The more extensive the adhesive process is, the more severe the symptoms will be.

Provoking factors and signs of adhesions

The risk of adhesions increases in the following cases:

• the patient is a carrier of infections that affect the reproductive organs;
• Koch's stick settled in the appendages of the uterus;
• running inflammatory processes in the uterus and appendages;
• examination and treatment of the uterine cavity using optical equipment;
• curettage of the inner layer of the uterus, abortion;
• intrauterine contraception;
• promiscuous sex life;
• frequent hypothermia.

Symptoms depend on the form of the pathological process:

1. Acute form. It is characterized by increasing severe pain, nausea, vomiting, rapid heartbeat, and increased body temperature. Quite often there is acute intestinal obstruction. Blood pressure decreases, coma, oliguria, and absence of bowel movements develop. In this case, it is necessary to urgently seek medical help.
2. Episodic form. This adhesive disease is characterized by periodic pain, and it is often accompanied by diarrhea or constipation.
3. Chronic form. Symptoms in this case are mild or completely absent. Sometimes patients complain of occasional pain in the lower abdomen and abnormal bowel movements. As a rule, women turn to a specialist for help with their main problem - the inability to conceive a child.

The risk of cord formation after surgery is significantly reduced if the patient, with the doctor’s permission, begins to move actively as early as possible.

With minor damage to the patency of the fallopian tubes, after therapeutic manipulations, reproductive ability is restored in every second patient

Diagnosis of adhesive disease

Diagnosing the presence of adhesions in the pelvis is quite difficult. And here again a popular question arises - is it possible to see adhesions on ultrasound? To put it simply, yes, during an ultrasound examination you can see adhesions that have grown quite actively and for a long time. If the process began relatively recently, then it is almost impossible to identify adhesions using ultrasound, so specialists resort to other diagnostic methods.

An examination that helps confirm the diagnosis should be comprehensive:

• smear bacterioscopy;
• PCR diagnostics for the detection of pathogens of infectious diseases;
• vaginal ultrasound examination;
• MRI of the uterus and appendages;
• contrast ultrasound examination for the patency of the appendages;
• visual examination of the pelvic organs using an additional manipulator (laparoscope).

The most informative is the latest study. Laparoscopy can detect:

1. The first stage of adhesive disease, when they are located near the ovary, the duct through which a mature egg passes, the uterus, or next to other organs, but does not interfere with the advancement of the egg.
2. The second stage of adhesive disease, when adhesions are located between the ovary and the canal through which the egg moves, and the latter process is hindered.
3. The third stage of adhesive disease, in which there is torsion of the ovary or appendages, as well as obstruction of the fallopian tubes.

If a woman suspects that the cause of infertility may be an adhesive process in the pelvic organs, then relying only on the result of ultrasound diagnostics is not enough. It is more correct to conduct a comprehensive, full examination and receive qualified assistance. After all, it is possible to get pregnant even with adhesions of the fallopian tubes, you just have to take care of your health.

Adhesive process in the pelvis

Adhesive
process in the pelvis Maybe
arise for a variety of reasons and significantly interfere with normal
the work of organs.

Pelvic organs: uterus,
fallopian tubes, ovaries,
bladder, rectum covered
thin membrane - the peritoneum. Smoothness of the peritoneum combined with a slight
the amount of fluid in the abdominal cavity normally ensures good mobility
uterus, fallopian tubes, ovaries and intestines. In the absence of inflammation in the peritoneum
the egg enters the fallopian tube after ovulation, and the growth of the uterus during
pregnancy does not interfere with the normal functioning of the intestines and bladder.

With the development of an inflammatory process in the pelvis–
with inflammation of the fallopian tubes, uterus, ovaries, accompanied by
inflammation of the peritoneum (peritonitis), the surface of the peritoneum becomes covered with a sticky
plaque containing fibrin. Fibrin film on the surface of the peritoneum in the lesion
inflammation glues adjacent surfaces to each other, resulting in
a mechanical obstacle arises to the spread of the inflammatory process
— developsadhesive processV
pelvis.

Reasons for the formation of adhesions

The adhesive process is initiated by various factors. Main reasons– consequences of operations and inflammatory diseases. The adhesive process in the pelvis can be caused by chronic inflammation of the fallopian tubes (salpingitis), endometriosis, and inflammation of the ovaries.

Let's take a little closer look at the physiological principles of the formation of adhesions. The pelvic and abdominal organs are separated from the muscular abdominal wall by a special layer of thin film - the peritoneum. Due to the smoothness of the peritoneum and the fluid inside the abdominal cavity, the internal organs can move if necessary, and the intestinal loops lie in a position natural for digestion. Also, due to the smoothness of the peritoneum, the process of movement and fertilization of the egg, subsequent maturation of the fetus in the uterus with a natural displacement of other pelvic organs as the fetus enlarges, occurs unhindered.

Most often, adhesions occur with peritonitis– a disease that develops when appendicitis ruptures and its contents enter the abdominal cavity. In addition, the adhesive process is a completely natural consequence of abdominal operations, in which the integrity of the peritoneum is disrupted. It is also worth noting that the occurrence of adhesions is a completely natural reaction of the body to infections that enter the body sexually. In about 70% of cases, such neoplasms occur in women who have previously been treated for all kinds of sexually transmitted diseases.

Injuries to the pelvic organs and hemorrhages in the abdominal cavity can also cause the development of adhesions. Plus, similar connective tissues are formed in women who suffer from endometriosis, a gynecological disease in which the tissue of the inner layer of the uterus grows.

Is it possible to confuse adhesions with another disease?

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

Adhesions occur when there are foreign bodies in the abdominal cavity, usually drains or napkins. But inflammation in the peritoneal area does not in all cases lead to the development of adhesions. If therapy is started in a timely manner and everything is done correctly, then the risk of developing this pathology is reduced. The disease occurs if the acute process becomes chronic, and the healing period is extended over time.

Features of the disease

Displacement of other members of the microbial community by opportunistic microorganisms (Lactobacillus spp., Prevotella spp., Micrococcus spp., Propionibacterium spp., Veilonella spp., Eubacterium spp., etc.) can also lead to the development of severe dysbiosis, the extreme degree of which manifests itself as bacterial vaginosis.

In the majority of patients with chronic HPV, significant associates in the combination of identified microorganisms are pathogens of sexually transmitted diseases (STDs). Features of the biology of pathogens of chronic infections, such as the low concentration of the pathogen in organs and tissues, their antigenic variability, as well as the difficulty of isolating a culture from clinical material, make the use of the PCR diagnostic method effective for diagnostic purposes, since this study is compared with other routine methods has higher sensitivity and specificity.

Thus, during a DNA study of cervical mucus in patients with chronic hepatitis VPO, Clamidia trachomatis, Mycoplasma genitalis, Ureaplasma urealiticum, Gardnerella vaginalis, Cytomegalovirus, Trichomonas vaginalis, Mycoplasma homenis are most often detected. This may be due to the fact that with chronic HPV infection, conditions are created in the reproductive tract for the persistence of microorganisms that support low-grade inflammation and interfere with normal reparative processes.

From the above, it becomes clear that for maximum effectiveness of treatment of patients with exacerbation of chronic hepatitis VPO, it is necessary to use new scientific approaches.

Adhesions cannot be seen on ultrasound, but, nevertheless, methods for detecting them exist. Among these methods, the most primitive is a manual gynecological examination, which makes it possible to establish the presence of a pathological process. More accurate methods for diagnosing adhesions, allowing not only to see the adhesions, but also to understand the condition of the fallopian tubes: USGSS (ultrasound hysterosalpingoscopy), HSG (x-ray hysterosalpingography), CPT (kymopertubation) and diagnostic laparoscopy.

Stages of the adhesive process

Experts distinguish 3 stages of the adhesive process in the pelvic organs, which can be seen as a result of diagnostic laparoscopy:

Treatment

Of course, in the topic of adhesive disease, the question is: “How to treat adhesions in the pelvis?” remains the main one. There are 2 methods of treating connective tissue cords: conservative and surgical. Treatment of adhesions in the pelvis should be carried out at the “pre-adhesive” stage, that is, prophylactically or preventively. This implies early administration of resolving therapy immediately after detection of a significant inflammatory process or during surgery. But it is important to note that most often doctors combine both treatment methods, as they complement each other.

Conservative therapy after surgery

After abdominal surgery, patients are immediately recommended to normalize their diet and lifestyle, given that the development of adhesive disease takes 3 to 6 months, when the first signs appear. After operations, patients, in the absence of contraindications, are activated already on the first day. Getting out of bed early and light physical activity not only activates intestinal motility, but also prevents the formation of adhesions. Immediately and subsequently, such patients are prescribed fractional meals up to 5-6 times a day in small portions, so as not to overload the stomach and small intestine and not provoke the latter, tied by adhesions, to intestinal obstruction.

In addition, patients at risk of developing adhesions or already diagnosed with adhesions should avoid heavy lifting and heavy physical activity. During and after the operation, so-called adjuvant therapy is carried out, which includes the introduction into the pelvic cavity of liquids that act as a barrier between organs and prevent adhesions: dextran, mineral oils and others in combination with glucocorticoids, and also immerse the fallopian tubes in a polymer absorbable film to prevent tubal infertility.

Then, in the postoperative period, fibrinolytic agents are indicated: