Inflammation of the appendages. Symptoms of inflammation “feminine”
Inflammatory diseases in women are much more common than other diseases of the genital organs. Their causative agents can be various bacteria: staphylococcus, streptococcus, intestinal Escherichia, gonococcus, tuberculosis bacillus (mycobacterium), trichomonas, fungi, as well as anaerobic bacteria, etc. Pelvic inflammatory disease is characterized by constant or recurring infection of the internal female reproductive organs and is one of the most common causes of pelvic pain in women. The infection usually begins in the cervix, spreads into the uterus and fallopian tubes and then invades the pelvic cavity. In most cases, proper treatment leads to complete recovery in about a week, although recurrence of the disease is common. If left untreated, pelvic inflammatory disease can lead to serious complications, including life-threatening abdominal abscess, abdominal infection (peritonitis), and blood poisoning. Additionally, pelvic inflammatory disease can cause scar tissue to form in the fallopian tube, which greatly increases the risk of infertility and ectopic pregnancy (which occurs when a fertilized egg remains in the fallopian tube rather than passing into the uterus).
The occurrence and course of the inflammatory process depends on the nature of the pathogen and the characteristics of the protective forces of the women’s body. When the body's defenses are disrupted, generalization of the process (sepsis) can occur. During the inflammatory process, acute, subacute and chronic stages are distinguished. Inflammatory diseases of the genital organs often have a very long course. As a result of repeated exacerbations of a long-existing inflammatory process, the glucocorticoid function of the adrenal cortex often decreases and the gonadotropic function of the pituitary gland changes, sometimes symptoms of dysfunction of the thyroid gland and nervous system are observed, and they are accompanied by various vascular disorders.
Inflammatory diseases of the internal genital organs (uterus, ovaries, tubes, pelvic peritoneum) are accompanied by menstrual disorders (various menstrual disorders) and reproductive function (infertility, spontaneous miscarriage, etc.).
Reasons
Various vectors of infection, especially chlamydia and gonorrhea, can be transmitted by sexual partners and cause pelvic inflammatory disease.
Less commonly, pelvic inflammatory disease is associated with the use of intrauterine contraceptives or can occur after a false pregnancy, a full pregnancy, or a gynecological procedure such as an intrauterine biopsy or curettage.
Risk factors include having sex at a young age and having a large number of sexual partners. Using condoms reduces the risk.
Sometimes the infection can spread from other organs (for example, as a complication of appendicitis).
Symptoms
Dull pain in the lower abdomen or back.
Pain during sexual intercourse.
Mild fever, possibly with chills.
Irregular or unusually heavy or absent periods.
Excessive vaginal discharge with a foul odor.
Frequent, painful urination.
Loss of appetite.
Nausea and vomiting.
Diagnostics
A pelvic examination is necessary. Pelvic inflammatory disease can be difficult to diagnose because it can sometimes be difficult to distinguish from other types of infection, such as appendicitis.
Based on the analysis of smears of vaginal discharge, the main causative agents of infection can be identified. However, a patient may be infected with gonorrhea or chlamydia even if a culture cannot be isolated.
An examination of the pelvis using a small flexible tube inserted through a small incision in the abdomen (laparoscopy) may be done to confirm the diagnosis or drain an abscess.
Treatment
If pelvic inflammatory disease is suspected, antibiotics are often prescribed immediately because delaying treatment is dangerous. Therapy can be clarified after the results of laboratory tests become known.
Hospitalization may be considered in more serious cases if the diagnosis is in doubt, if the patient is a pregnant woman or adolescent, or if the infection does not resolve with outpatient treatment. Treatment may include intravenous antibiotics and surgical drainage of the abscess. A ruptured abscess is life-threatening and may require a complete hysterectomy with removal of the ovaries.
Surgery may also be necessary in complex cases or for recurring infections that do not respond to antibiotics. A woman who has been successfully treated can become infected again from a sexual partner, so all partners, even those without symptoms, should be treated for gonorrhea and chlamydia.
Vulvitis
Vulvitis is an inflammation of the external genitalia and the opening of the vagina. Primary vulvitis is rare and occurs due to unclean conditions and injury to the genital organs. Secondary vulvitis is observed in diabetes mellitus, genitourinary and enterogenital fistulas, and irritation of the external genitalia. Inflammatory diseases of the genital organs can be of nonspecific and specific (tuberculosis, gonorrhea) etiology. It should be emphasized that in the era of antibiotics, the so-called opportunistic microflora has become the causative agent of various severe septic diseases (for example, the Proteus group, intestinal Escherichia, etc.).
Sometimes inflammatory diseases develop as a result of the transfer of infection from neighboring organs (appendicitis, typhlitis). However, as a rule, inflammatory diseases occur when the integrity of the uterine tissue is damaged (after abortion and childbirth).
The causes of vulvitis can be: irritation from leucorrhoea, menstruation, masturbation, dirty linen, dirty hands.
Symptoms
In the acute period, itching, burning, copious discharge, redness and swelling of the labia minora and majora, pain after urination (irritation of inflamed tissues by urine) are noted. The diagnosis is made on the basis of the patient’s complaints, changes in the vulva detected during examination and bacteriological examination (diabetes must be excluded).
Signs of vulvitis: a tickling sensation on the outer parts that turns into pain when walking and urinating, inflammation of the labia minora and majora, the appearance of a yellowish-greenish leucorrhoea with an unpleasant odor.
To prevent vulvitis, it is very important to follow the rules of personal hygiene and the hygiene of your sexual partner.
Traditional medicine recommends washing the labia with carbolic soap 2-3 times a day and adding a little potash to the water. Compresses made from lead water or a cloth with boric petroleum jelly are applied to the genital slit. Washing with silver water 2-3 times a day gives a good effect.
Treatment of the underlying disease that caused vulvitis. In the acute period, it is recommended to wash the external genitalia with a solution of potassium permanganate, chamomile decoction or boric acid solution, warm sitz baths with a solution of potassium permanganate or chamomile decoction, and irradiation of the external genital area with ultraviolet radiation.
Vulvovaginitis
Vulvovaginitis is inflammation of the external genitalia and vagina. It is observed mainly in children and much less frequently in adults. Its causes may be violations of hygiene rules, constant trauma, chronic tonsillitis, exudative diathesis.
Symptoms
In the acute stage there is burning, itching and copious discharge. In the chronic stage, inflammation phenomena decrease. On examination, swelling and hyperemia of the vulva and vaginal mucosa are noted (in girls this is determined using vaginoscopy), serous-purulent or purulent-bloody discharge (especially in the presence of foreign bodies).
Treatment is the same as for vulvitis.
Vaginitis (colpitis)
Vaginitis (colpitis) is inflammation of the vaginal mucosa due to infection by various microorganisms, metabolic disorders, hormone deficiency in the body (premature menopause, after removal of the ovaries, in old age), as well as chemical or mechanical trauma.
Symptoms
Mucopurulent and purulent discharge, a feeling of heaviness in the lower abdomen, pain in the vaginal area, burning, itching. On examination, hyperemia of the mucous membrane, swelling, and sometimes small nodules on it and the vaginal part of the cervix (granulosa colpitis) are noted. With senile colpitis, there are signs of age-related atrophy, the vaginal mucosa is smooth, pale, hyperemic in places with bleeding areas. To determine the cause of colpitis, a bacterioscopic examination of the discharge is necessary.
Treatment. Elimination of factors that contribute to the occurrence of colpitis, restorative therapy, treatment of the external genitalia with a solution of potassium permanganate or chamomile decoction. For fungal colpitis - douching with a solution of sodium bicarbonate, introducing into the vagina a 20% solution of borax in glycerin, beads with nystatin.
Condylomas acuminata
Genital condylomas (benign - multiple growths on the surface of the external genitalia and vaginal opening). May spread to the perineum, vagina, cervix. The cause of condylomas is a filterable virus; the development of the process is facilitated by copious discharge from the genital tract during colpitis and endocervicitis. Genital warts grow especially quickly during pregnancy.
Symptoms
Most often they are localized on the external genitalia, perineum, and around the anus. In cases of necrosis of condylomas and the addition of a secondary infection, purulent discharge appears. Condylomas of the vagina and cervix during pregnancy and childbirth can cause bleeding. The diagnosis is made based on examination. It is necessary to differentiate from syphilitic condylomas that have a wide base.
Treatment. For small condylomas, apply powder with resorcinol and boric acid or treat with a solution of resorcinol in 70% ethyl alcohol. It is necessary to first lubricate the skin around the condylomas with Vaseline.
Rp.: Resorcini_
Acidi borici aa 15.0 M.D.S. Powder
Rp.: Resorcini 1.5
Spiritus aethylici 70% 50.0 M.D.S. External
In case of extensive damage, condylomas are removed surgically or by electrocoagulation.
Trichomoniasis
Trichomoniasis is a specific disease caused by Trichomonas vaginalis (protozoa); transmitted sexually. Most often, trichomonas colpitis is observed; trichomonas often also cause urethritis, cervicitis, and proctitis.
Symptoms
In the acute stage, itching, burning, and heaviness in the lower abdomen are pronounced. On examination: hyperemia of the vaginal mucosa, abundant purulent foamy discharge.
In the chronic stage, hyperemia disappears, but abundant characteristic discharge remains. The course of the disease is long, there is a tendency to relapse.
The diagnosis is made based on microscopic examination of vaginal discharge.
Treatment is carried out simultaneously for the sick woman and her husband. Treatment of concomitant diseases and functional disorders is necessary, as well as an impact on existing trichomoniasis foci. Metronidazole (Flagyl, Trichopolum, Orvagil, Klion) is prescribed. The drug is used orally for the treatment of acute and chronic trichomoniasis in women and men. Dosage: 0.25 g 2 times a day for 7-10 days. The total dose per course of treatment for adults is 5 g. Metronidazole is contraindicated during pregnancy, especially in the first 3 months.
Simultaneously with the use of metronidazole, it is recommended to wash the external genitalia and douche the vagina with a chamomile decoction or a solution of potassium permanganate. Metronidazole tablets of 0.5 g are also available for insertion into the vagina. Trichomonacid has relatively high anti-trichomoniacal activity. Used internally and topically. Orally prescribed 0.3 g per day (in 2-3 doses) after meals for 3-5 days. For children, the dose is reduced according to age.
Endocervicitis
Endocervicitis is an inflammation of the mucous membrane of the cervical canal. It can occur with the penetration of various bacteria (staphylococci, streptococci, gonococci, intestinal Escherichia, etc.). Endocervicitis is often combined with an inflammatory process in other parts of the reproductive system - colpitis, salpingoophoritis, cervical erosion.
Symptoms
Mucopurulent discharge from the vagina. There is no pain. Clinical signs are mild. In the acute stage, hyperemia around the external pharynx and mucopurulent discharge are detected. In the chronic stage there is almost no hyperemia, the discharge remains. With a prolonged course of the process, hypertrophy (thickening) of the cervix develops - cervicitis. To clarify the etiology of the process, a microscopic examination of vaginal discharge is necessary.
Treatment depends on the nature of the pathogen: for gonorrhea and trichomoniasis, appropriate therapy is prescribed; for viral endocervicitis - tetracycline; for nonspecific endocervicitis, douching with a solution of potassium permanganate, chamomile decoction, as well as syntomycin or streptocide emulsion is used. In the chronic stage of endocervicitis, physiotherapy is indicated.
Cervical erosion
Cervical erosion is a defect in the integumentary epithelium of the vaginal part of the cervix. The formation of erosion occurs under the influence of pathological secretions from the cervical canal, which cause maceration and subsequent desquamation (desquamation) of the stratified squamous epithelium.
Symptoms
Purulent or mucopurulent discharge from the vagina. When examining the cervix with the help of mirrors, hyperemia around the external pharynx is determined, most often on the posterior lip of the cervix. The surface of the erosion can be smooth or velvety, sometimes bleeding is noted when touched.
The diagnosis is made by examining the cervix using a speculum. Colposcopy is mandatory, with the help of which the issue of the need for a targeted biopsy with subsequent histological examination is resolved. Cervical erosion should be differentiated from cervical cancer, tuberculosis and syphilitic ulcers.
Treatment. Along with the treatment of endocervicitis, treatment of concomitant diseases of the genital organs is necessary. Use tampons with fish oil, sea buckthorn oil, emulsions containing sulfonamides and antibiotics. For long-term non-healing erosion, electrocoagulation is indicated (after biopsy data).
Endometritis
Endometritis is an inflammation of the mucous and muscular lining of the uterus.
Symptoms
Acute endometritis is characterized by pain in the lower abdomen, fever, purulent or purulent-bloody discharge from the uterus.
Two-manual palpation examination reveals tenderness of the uterus, enlargement and soft consistency. With chronic endometritis, pain, prolonged bleeding are observed, the temperature is usually normal, and there is no tenderness of the uterus during examination. The diagnosis is made based on medical history (out-of-hospital abortion, postpartum period), fever, and gynecological examination data.
Metritis
Metritis is inflammation of all the linings of the uterus. It develops with the progression of endometritis, often as a manifestation of a generalized septic infection.
Symptoms
They resemble the clinical picture of endometritis, but are more severe and are often accompanied by pelvioperitonitis.
Parametritis
Parametritis is inflammation of the periuterine tissue, most often observed after childbirth, abortion and other interventions (probing, dilatation of the uterus).
Symptoms
With the so-called lateral parametritis, the infiltrate is located next to the uterus and reaches the bony wall of the pelvis. The lateral arch of the corresponding side is smoothed. The consistency of the infiltrate is dense, with suppuration a fluctuation is determined. With anterior parametritis, the infiltrate is localized anterior to the uterus, with posterior parametritis - posteriorly. The acute stage is characterized by pain, fever, chills, increased heart rate, disturbances in appetite and sleep. There may be dysuric phenomena, constipation, and menstrual irregularities. When the infiltrate suppurates, the clinical picture is characteristic of purulent septic processes. The diagnosis is made based on the indicated symptoms and laboratory data.
Pelvioperitonitis
Pelvioperitonitis is inflammation of the pelvic peritoneum.
Symptoms
It is characterized by acute abdominal pain, nausea, vomiting, bloating, stool and gas retention, fever, and increased heart rate. The tongue is dry, covered with a white coating. On palpation of the abdomen, tension in the muscles of the anterior abdominal wall in the lower section is noted, a positive Blumberg-Shchetkin sign. In the blood there is an increased ESR, leukocytosis, a shift of the white blood count to the left. With a modern (erased) course, there may be a low severity of symptoms or the absence of some of them. This often makes diagnosis difficult. With pelvioperitonitis, pus may accumulate in the pouch of Douglas. An abscess may spontaneously rupture into the vagina or rectum.
Vaginal examination is of great importance, in which protrusion of the posterior fornix with exudate is noted. Patients with pelvioperitonitis need special monitoring due to the possibility of transition of pelvioperitonitis into diffuse peritonitis, which requires emergency surgery.
Salpingoophoritis (adnexitis)
Salpingoophoritis (adnexitis) is inflammation of the uterine appendages. Isolated damage to the tube or ovary is observed very rarely; usually the inflammatory process involves the tube and ovary, often spreading to the pelvic peritoneum.
Symptoms
In the acute stage, pain in the lower abdomen, vomiting, and fever are observed. There may be menstrual irregularities (menorrhagia and metrorrhagia). During vaginal examination, enlarged, painful uterine appendages are palpated (on one or both sides). Due to severe pain, sometimes it is not possible to clearly define their boundaries. In the blood there is leukocytosis, increased ESR, a shift to the left of the white blood count. The process may be accompanied by pelvioperitonitis.
In the subacute stage, the temperature decreases, pain decreases, general condition improves, and blood counts normalize. The disease does not always end in recovery; when salpingoophoritis transitions to the chronic stage, periodic exacerbations are observed, accompanied by pain, fever, menstrual dysfunction. Diagnosis is carried out on the basis of anamnesis and objective examination, taking into account all the above symptoms and the results of bacteriological examination of smears from the vagina, cervix and urethra channel.
Treatment of inflammatory diseases of nonspecific etiology. In the acute stage: rest, cold on the stomach, intravenous calcium chloride solution or calcium gluconate solution; Antibacterial therapy - penicillin intramuscularly, 300,000-500,000 units every 3 hours. Other antibiotics are also used (it is necessary to determine the sensitivity of the microflora to antibiotics). Semi-synthetic penicillins are especially effective: oxacillin, methicillin, ammicillin. In severe cases, broad-spectrum antibiotics (cephalosporins and aminoglycosides) are used. You should always remember about the scale of infection. Treatment should be comprehensive and carried out against the background of general restorative therapy, the prescription of vitamins, painkillers, and antihistamines. In the subacute and chronic stages, physiotherapy is used: electrophoresis of calcium chloride and potassium iodide, diathermy, mud therapy. In the presence of saccular tumor-like formations of the uterine appendages, surgical treatment is indicated.
Parsley in any form several times a day (roots and aerial parts);
Anise seeds, finely ground, with honey in equal quantities by weight. Take 3-4 times a day;
Drink a decoction of parsley, or a decoction of onion peels, or a decoction of the roots of stinging nettle instead of water. You can prepare a decoction of onion peels and cloves, pour one liter of boiling water, boil for 5 minutes, cool, strain.
Prevention
Monogamy, abstinence, or condom use protect against sexually transmitted diseases.
After minor gynecological procedures such as curettage, avoid showering, tampons, bathing, and sexual intercourse for at least seven days.
If you have symptoms of pelvic inflammatory disease, especially a high fever with severe pain in the lower abdomen, contact your doctor or gynecologist immediately.
Among gynecological diseases inflammatory diseases of the genital organs in women are the most common pathologies. Approximately 60% of women seek advice from gynecologists precisely because of the development of inflammation.
In addition, gynecologists argue that in fact the number of cases may be even higher, since the inflammation sometimes has an erased form. Consequently, the woman does not go to the doctor. It is generally accepted that the increase in inflammation of the genital organs in women is associated, first of all, with a decrease, deterioration of the environmental situation, and changes in the sexual behavior of young people.
Causes of inflammatory diseases of the female genital organs
Almost always, the inflammatory process in the genital organs occurs under the influence of a number of different factors - thermal , chemical , mechanical . But the main factor that directly affects the development of inflammation is the influence of infections. Depending on which pathogen provokes the development of inflammatory diseases of the female genital organs, they are usually divided into nonspecific And specific . The latter include,.
Nonspecific inflammatory diseases are provoked by a wide variety of pathogens: chlamydia , candida mushrooms , ureaplasma , mycoplasma , Trichomonas , coli , klebsiella , corynebacteria (gardnerella ), etc.
Opportunistic microorganisms also play a role in the occurrence of such diseases. Most often, transmission of pathogenic pathogens occurs during sexual contact; more rarely, household transmission occurs. In order for inflammation of the female genital organs to be provoked opportunistic microorganisms, certain conditions must be met. In particular, the vaginal microflora, which creates an acidic environment, prevents the entry and further activation of infection by opportunistic microorganisms.
In addition, the process of shedding the endometrial layer during menstruation is an obstacle to the spread of infection. Along with this layer, microorganisms are also rejected. And thanks to the plastic properties of the pelvic peritoneum, inflammation in a woman affects only the pelvic area.
A factor that protects against the risk of recurrent inflammation of the genital organs is also the use of certain oral contraceptives.
Distinguish active And passive spread of infection to the upper genital tract from the lower. The lymphogenous or hematogenous route is considered passive, as well as spread into the tubes and uterus, into the abdominal cavity through the cervical canal. Active spread of infection occurs with Trichomonas and sperm.
Factors that contribute to the spread of infection
In the genital tract of a woman, the infection spreads more actively under the influence of certain factors.
The intensive process is facilitated by various manipulations performed intrauterinely: curettage etc. With such procedures, an infection can enter the uterine cavity either from the vagina or from the external environment. Through the fallopian tubes it gradually spreads to the fallopian tubes. An ascending infection very often appears immediately after menstruation, the birth of a child, or surgical interventions performed on the pelvic and abdominal organs.
Also, its active spread is facilitated by the presence in a woman’s body of foci of chronic infection, endocrine disorders and metabolic processes in the body, poor nutrition, frequent emotional overload, hypothermia, etc.
Types of inflammatory diseases of the female genital organs
Depending on which area of the woman’s genital organs is affected by a nonspecific infection, the disease of the genital organs is determined. Subject to the development of inflammation of the vaginal mucosa, it manifests itself. This inflammation can be diffuse or focal, and can spread to the vulva and part of the cervix.
If the inflammation has affected the external genitalia, then we are talking about vulvitis
. This disease can develop in a woman as a consequence of trauma to the mucous membrane due to scratching, abrasions, etc. The injured surface becomes infected. Sometimes diagnosed secondary vulvitis
, which is a consequence of inflammation of the internal genital organs.
Inflammation of the cervix is called, and the large gland of the vestibule of the vagina is called.
If inflammation affects the inner lining of the cervical canal, then the patient is diagnosed with endocervicitis . – an inflammatory process in the inner lining of the uterus. The occurrence of acute endometritis is mainly observed after difficult childbirth, abortion, and curettage.
With inflammation of the uterine corpus, the patient develops salpingitis . Inflammatory process, affecting the ovaries, provokes the development oophoritis . Inflammation of the walls of the uterus is called myometritis , and the pelvic peritoneum - pelvioperitonitis .
Local therapy is carried out in the form of douching with acidic solutions in order to restore normal vaginal microflora. Also used for treatment, Trichomonas , representatives, candles.
Symptoms of inflammatory diseases of the female genital organs
Women's inflammatory diseases are characterized by the absence of a clear clinical picture, since they are characterized by a chronic course and periodic exacerbations.
Inflammation of the female genital organs is characterized by various symptoms, both local and general. In the inflammatory process of the female genital organs, the characteristic symptoms are edema
, redness
And itching
mucous membrane of the vagina and vulva, pain during sexual intercourse, periodic pain in the lower back, changes in the nature of vaginal discharge. There may be disruptions in the menstrual cycle and difficulty urinating.
In the acute course of the inflammatory disease, a pronounced general reaction of the body is observed: body temperature rises and chills are observed. A blood test determines changes in the blood picture. The woman notes intense leucorrhoea and pain in the lower abdomen. If the process occurs in a chronic form over a long period, lesions of the reproductive system become less pronounced, but there are signs of changes in other systems and organs.
Consequences of inflammatory diseases of the female genital organs
As such diseases progress, a woman experiences changes in the state of her reproductive system, as well as a general deterioration in the patient’s health. There are often disturbances in metabolic processes, changes in the vegetative-vascular nature, and shifts in the functioning of the endocrine system.
In addition, inflammatory diseases of the female genital organs provoke the formation of anatomical changes. A woman who has had inflammation of the genital organs may develop adhesions or develop fallopian tube obstruction . Blood flow in the tissues of the genital organs noticeably deteriorates, and the egg also matures with disturbances. Inflammatory diseases in gynecology sometimes lead to the formation of hemodynamic and trophic changes in the organs and tissues of the pelvis. The process may be disrupted in a woman ovulation , as well as transportation of the egg in case of obstruction of the tubes.
Due to inflammation of the genital organs, a woman also experiences menstrual dysfunction, and an ectopic pregnancy may develop. Sometimes changes in the uterus and appendages occur. Such serious pathologies in some cases provoke infertility. Therefore, inflammatory diseases in gynecology occupy a major place in the list of causes of infertility.
Most often, such an inflammatory process causes disorders of sexual, as well as menstrual and generative function in women.
If the diagnosis is not established correctly and in a timely manner, the process may worsen and ultimately be difficult to treat. That is why a woman must be aware that the earliest possible diagnosis and an integrated approach to treatment are a very important measure for preventing infertility in the future.
– an inflammatory process in the pelvis, localized in the ovaries and tubes (appendages). The causes of the pathology are bacteria and viruses that penetrate the appendages, and the main provoking factors are hypothermia, as a result of which general and local immunity is reduced. The disease manifests itself with a variety of symptoms: from nagging pain in the lower abdomen and scanty discharge to irregularities in the menstrual cycle and acute inflammatory phenomena. Therefore, only a comprehensive diagnosis, including laboratory, differential and instrumental research methods, helps to make the correct diagnosis. The main element of treatment is specific etiotropic therapy; outside the acute stage, prevention plays an important role. The disease also has other medical designations - adnexitis, salpingoophoritis (from a combination of the terms “salpingitis” - inflammation of the fallopian (fallopian) tubes and “oophoritis” - inflammation of the ovaries).
Clinical signs of chronic inflammation of the appendages are nagging, sometimes intensifying, painful sensations in the lower abdomen, periodic slight or moderate rise in body temperature (up to 38 degrees), discharge of varying degrees of intensity and color. Signs appear and disappear cyclically, with relapses lasting up to seven days. In half of the cases, menstrual irregularities are diagnosed. Possible menorrhagia - menstruation with significant blood loss; metrorrhagia - bleeding outside the cycle, oligomenorrhea may develop.
Symptoms of inflammation of the appendages
Inflammation of the appendages has a staged course, both in acute and chronic forms of the disease. Symptoms and treatment at each stage are specific. The acute course, as a rule, gives a clear picture of inflammation, which can be tracked by the pathognomonic symptoms of the disease at each stage.
The toxic stage is characterized by symptoms of intoxication of the body. Characterized by moderately elevated, high, sometimes very high body temperature (up to 40-41 degrees). Chills, bloating and abdominal pain, dysuric disorders (impaired urination), and dyspeptic symptoms (diarrhea, vomiting) are observed. On the part of the reproductive system, there is abundant discharge, severe, localized or diffuse pain, and bleeding is possible. Symptoms persist for 1-1.5 weeks, then the disease may progress to the second (septic stage), complete recovery (with adequate treatment for inflammation of the appendages) or chronicity of the pathology (with partial activation of the internal immune defense mechanisms).
The septic stage is characterized by worsening symptoms, weakness, dizziness, and the addition of anaerobes with the formation of a purulent tubo-ovarian formation with the threat of perforation. It is possible that the inflammatory process may further spread to the pelvic organs and peritoneum with the occurrence of pelvioperitonitis, which threatens the patient’s life.
Symptoms of inflammation of the appendages in the chronic phase in some cases are unexpressed. Dull, intensifying pain occurs periodically and coincides with one or another phase of the cycle. There is a slight increase in temperature, menstrual dysfunction, problems in the sexual sphere (painful sexual intercourse, decreased libido, etc.), deterioration in general well-being and decreased ability to work. With long-term chronic inflammation of the appendages without treatment, diseases of the gastrointestinal tract (colitis, etc.) and excretory system (pyelonephritis, recurrent cystitis, etc.) can occur.
Complications of inflammation of the appendages
Peritonitis can become a serious complication of acute inflammation of the appendages if therapy is not started in a timely manner. Chronic inflammation of the appendages is often complicated by infertility. Infertility of mixed origin, which is also caused by inflammation of the appendages, is very difficult to cure. This is due to the fact that hormonal dysfunction due to damage to the ovaries is associated with a decrease in the physiological function of the fallopian tubes (contractility, disruption of the activity of the ciliary layer) or their complete obstruction. Disruptions in the menstrual cycle and lack of ovulation lead to serious functional and anatomical changes in the female reproductive system.
The formation of infiltrates is a common consequence of chronic inflammation of the appendages and can be complicated by the development of sclerosis processes in the fallopian tubes. This is the main cause of ectopic (ectopic) pregnancy, the formation of painful adhesions. The spread of pathology to neighboring organs often causes the development of cholecystitis (acute and chronic), colitis, and pyelonephritis.
Diagnosis of inflammation of the appendages
Instrumental methods for diagnosing inflammation of the appendages can be used: diagnostic laparoscopy helps to identify purulent formations in the fallopian tubes, exclude or confirm the presence of adhesions. The procedure allows you to combine a diagnostic study with therapeutic procedures. Using an X-ray examination of the uterus using contrast - hysterosalpingography - the presence of pathological changes in the tubes is determined and their patency is assessed.
Treatment of inflammation of the appendages
Inflammation of the appendages in the acute phase is treated in a hospital setting with the patient observing bed rest, physical and mental rest, a diet based on easily digestible food, adequate drinking regimen with an assessment of excretory function. The main treatment for adnexitis is antibacterial etiotropic therapy depending on the diagnosed causative agent of the disease: penicillins, tetracyclines, macrolides, aminoglycosides, fluoroquinolones. If there is a risk of anaerobic infection, a combination of different groups of antibiotics is prescribed, for example, metronidazole is added to the above drugs (intravenously, orally).
Conservative therapy also includes painkillers, drugs that relieve the effects and consequences of intoxication (infusion therapy). For purulent complications of inflammation of the appendages, surgical treatment is used. First of all, preference is given to low-traumatic gynecological surgery - laparoscopic manipulations, evacuation of the purulent contents of the saccular formation through puncture of the posterior vaginal fornix with the possible subsequent administration of medications. In case of advanced inflammation, when there is a risk of purulent melting, surgical removal of the appendages is indicated.
After eliminating acute signs of inflammation of the appendages, a course of physiotherapeutic procedures is prescribed: ultrasound, electrophoresis using Mg, K, Zn preparations, vibration massage. These same methods, along with etiotropic antibacterial therapy, are indicated in the treatment of chronic inflammation of the appendages. Sanatorium rehabilitation treatment is prescribed to promote the resorption of the adhesive process and prevent the formation of adhesions. Resorts that use mud therapy, paraffin therapy, medicinal baths and irrigation with sulfide and sodium chloride mineral waters as therapeutic procedures are preferred.
Forecast and prevention of inflammation of the appendages
With timely initial treatment of symptoms of acute inflammation of the appendages and adequate therapy, complete clinical recovery occurs in approximately 10 days. Adnexitis in the chronic stage requires regular examinations and supportive therapy, sanatorium and rehabilitation measures, and systematic monitoring of the patient’s condition.
In order to prevent relapses of inflammation of the appendages, especially for patients at risk (using IUDs, having unsuccessful pregnancies and abortions in history), it is necessary to exclude factors that provoke the disease - hypothermia, stress, sexually transmitted infections. It is recommended to use rational methods of contraception and promptly carry out complex adequate therapy for diseases of the pelvic organs, taking into account the causative agents of the pathology. A visit to the antenatal clinic at least once a year for a preventive examination by a gynecologist should become the norm for every woman who cares about her health.
Inflammation of the appendages in women: symptoms and treatment is a problem that worries a significant number of representatives of the fair sex of different ages.
This group of diseases includes a number of pathologies that can seriously undermine women’s health. When inflammation of the appendages occurs in women, treatment must begin as early as possible. It should be remembered that this process can cause dangerous complications and lead to infertility.
The essence of pathology
Inflammation of the appendages in women, or adnexitis (salpingoophoritis), is an inflammatory lesion of the main uterine appendages - fallopian (fallopian) tubes, ovaries and ligaments. This pathology occupies a leading place among gynecological diseases and is dangerous for its consequences - almost a quarter of women affected by this lesion subsequently suffer from infertility.
The disease is infectious in nature and is caused by the activation of pathogenic microorganisms under the influence of internal or external factors. Pathology can develop in both acute and chronic forms. In addition to combined damage to the appendages, diseases of individual organs are distinguished: inflammation of the epididymis - oophoritis and inflammation of the fallopian tubes - salpingitis. Taking into account that the uterine appendages have a paired structure, inflammatory pathologies can be unilateral or bilateral.
Etiological features of the disease
The pathology under consideration develops in 2 stages. At the first stage, pathogenic microorganisms penetrate and become established in the vagina and cervix. At the next stage, they spread to the uterus, its appendages and surrounding areas of the peritoneum, provoking an inflammatory reaction of the mucous membrane.
The causative agents of the disease can be both pathogenic and conditionally pathogenic microorganisms that previously penetrated the body under the influence of certain factors that reduce immune defense. The main pathogens: gonococci, staphylococci, streptococci, chlamydia, gardnerella, mycoplasma, ureaplasma, coli, diphtheria and tuberculosis infection, genital herpes, trichomonas, peptococci, cytomegalovirus, etc. Most often, there is a joint effect of several different pathogens.
Infection can occur in several ways: ascending (from the vagina); descending route - from internal foci of infection (intestines, appendix, etc.); lymphatic route - together with lymph and hematogenous route through the blood.
An important factor in the development of adnexitis is considered to be a change in the properties of the cervical fluid due to hormonal imbalance (especially during ovulation and menstruation). Cervical mucus should physiologically create a barrier to the spread of infection, but if its composition is disrupted, this function is lost, which leads to infection of the appendages. During pregnancy, when there is an increase in mucus production, adnexitis occurs much less frequently.
Activation of microorganisms is possible only when immunity deteriorates. This requires the presence of favorable conditions, which are ensured by the following provoking reasons: ignoring hygiene standards; promiscuous sex with frequent changes of partners and unprotected contact; stress; hypothermia; physical fatigue; poor nutrition and reckless fasting; injuries; gynecological procedures (abortion, curettage, hysteroscopy, etc.); diseases leading to immune deficiency (diabetes mellitus, infectious diseases, HIV infection); endocrine disorders; sexually transmitted diseases; appendix surgery; use of intrauterine contraceptives; uncontrolled douching.
Symptoms of pathology
Inflammation of the appendages can develop in the form of oophoritis, salpingitis or adnexitis. However, the symptoms of inflammation of the appendages in a woman, when inflammation of the appendages - ovaries or appendages - fallopian tubes develops, manifest themselves in exactly the same way, and therefore the primary diagnosis of adnexitis is made in the presence of both oophoritis and salpingitis. There is nothing critical about this, since the treatment of these types of pathology is carried out identically.
When inflammation of the appendages occurs, the symptoms have a fairly characteristic manifestation. The first sign is the appearance of pain in the lower abdomen. Further development of the inflammatory reaction causes the following symptoms: fever, chills, tachycardia, vaginal bleeding, profuse vaginal discharge of serous or purulent-serous type, increased pain during sexual intercourse, urinary disturbances, nausea and vomiting, pain in the right hypochondrium, itching of the genitals organs, menstrual irregularities.
Features of the manifestation of various forms of pathology
Most often, the acute form of the disease is caused by the activation of gonococci, but can also be caused by other pathogens. This pathology develops rapidly and is clearly expressed. Almost immediately, the body temperature rises above 38.2 degrees, and during the purulent process, chills are added. An intense pain syndrome of a sharp, piercing nature appears in the lower abdomen. The main pain is localized in the iliac region. Irradiation of pain is found in the rectum, in the lumbar region, and sometimes radiates to the legs.
The initial stage of the acute form is characterized by a symptom of muscle protection - tension in the abdominal wall in front. There are signs of general intoxication: headache, nausea, vomiting, loss of appetite. Gynecological examinations reveal an increase in the size of the appendages. A lot of leukocytes and abnormal ESR are detected in the blood.
In the absence of the necessary treatment, after 10-15 days the acute form can turn into chronic inflammation of the appendages. During this period, the pain syndrome noticeably subsides, and the inflammatory reaction becomes a sluggish process. The chronic form is characterized by alternating periods of remission with exacerbations (most often this occurs in the off-season - autumn and spring). During remission, there is a slight fever and mild painful sensations of a tedious nature. The pain can intensify with physical activity, sexual intercourse, and also during menstruation. Quite often, a symptom such as vaginal discharge that causes itching is detected. The menstrual cycle is disrupted.
Transition of adnexitis to chronic form is fraught with serious complications if the issue of how to treat inflammation of the appendages is not resolved. As a result of the formation of adhesions and obstruction of the fallopian tubes, female infertility may develop. There is a significant risk of ectopic pregnancy. The most dangerous complications are associated with the development of purulent processes. In some cases, tubo-ovarian formations are observed, expressed by purulent melting in the ovaries and tubes with the development of an abscess. The transition of the inflammatory reaction into the abdominal cavity with the provocation of peritonitis is fraught with big problems. Characteristic signs of complications are a sharp jump in body temperature and severe pain, painful bloating.
When inflammation of the appendages is suspected, treatment is prescribed after an accurate diagnosis has been made. Primary detection of the disease is carried out through a gynecological examination and medical history. A pregnancy test is required. Through a gynecological examination and palpation, the condition of the uterus, its cervix and appendages is examined. Changes in size, shape and mobility are determined.
The next diagnostic step is laboratory tests. These include blood and urine tests, microscopy, bacterial culture of vaginal smears and discharge. PCR is performed to identify the type of pathogen. One of the most informative methods is transvaginal ultrasound. The diagnosis is clarified based on the results of computed tomography and MRI. As additional studies, hysterosalpingoscopy and laparoscopy are performed to clarify the condition of the appendages.
Principles of pathology treatment
Treatment of adnexitis or its local varieties is complex and carried out according to an individual scheme. The treatment regimen depends on the form of the pathology, the degree of development of the pathology, the woman’s age and the characteristics of her body. Acute and chronic phases during remission require different approaches to therapy.
Basic therapy for acute adnexitis or exacerbation of the chronic form is based on the administration of antibiotics to destroy the pathogen. In the chronic course of the disease, antibiotics are used as needed, but the basis of treatment is immunomodulators, anti-inflammatory and strengthening drugs. The emphasis in this case is on physical therapy. It is important to maintain a gentle diet with the exception of spicy seasonings, limiting the consumption of salt and carbohydrates. If serious complications occur in the form of abscesses or peritonitis, surgical treatment is indicated.
Therapy of the acute phase of pathology
In case of acute manifestation of the pathology, bed rest is provided, and treatment is often carried out in a hospital under the supervision of a doctor. To relieve pain, a cold compress on the lower abdomen is recommended. Antibiotics for inflammation of the appendages form the basis of treatment of the acute stage. The specific type of drug is determined based on the results of identifying the pathogen. Most often, drugs are prescribed in various combinations for a complex effect.
As a rule, the following drug regimens are used: Claforan with Gentamicin; Cephobid with Gentamicin; Clindamycin with Gentamicin; Cefazolin with Ciprofloxacin; Lincomycin. In the presence of an anaerobic type infection, Metronidazole or Metrogyl are prescribed. To carry out a complex effect on various types of pathogenic microorganisms, the following groups of antibiotics are used: protected penicillins such as Amoxiclav; Latest generation cephalosporins, in particular Ceftriaxone; macrolides; antimycotic agents – Diflucan, Nystatin.
The second important area of therapy is the removal of toxins formed as a result of metabolic processes. For this purpose, droppers with saline solutions, hemodez, and rheopolyglucin are prescribed. To eliminate the inflammatory reaction and relieve pain, non-steroidal drugs are administered - Ibuprofen, Nurofen, Ketarol, Ortofen, Voltaren, etc. Protection against allergic reactions is carried out with antihistamines.
In the chronic form of the disease, physiotherapy is widely used, as well as anti-inflammatory suppositories for inflammation of the appendages. The following effective physiotherapeutic methods are used: electrophoresis of copper and zinc; electrophoresis with lidase and iodine; ultrasonic influence; high frequency currents. For general strengthening of the body, vitamin complexes based on vitamins B and C are used. As vaginal products - suppositories based on paracetamol, indomethacin, diclofenac or natural substances: propolis, oak bark or walnut.
Inflammation of the appendages in a woman is a dangerous pathology, fraught with its consequences. This disease must be identified before it enters the chronic phase and treated effectively. Treatment of the disease should be carried out only as prescribed by a doctor.
