In this article, consider the main symptoms of adnexitis. What is this pathology?
Adnexitis or salpingo-oophoritis is a pathological process of inflammation, which involves both the ovaries and fallopian tubes (uterine appendages). In the acute period, this disease is characterized by pain in the lower abdomen, which is most intense on the side where the inflammation is stronger, fever, intoxication. In addition, there may be a violation of the menstrual cycle.
In the chronic form, the clinical signs of the disease are less pronounced, but periodic relapses are possible. This pathology leads to the development of adhesions in the pelvic organs and adhesions in the lumen of the fallopian tubes, which significantly increases the likelihood of an ectopic pregnancy, as well as infertility. Symptoms and treatment of adnexitis are presented below.
Description of pathology
Adnexitis is called one-or bilateral inflammation of the ovaries and tubes, which are uterine appendages. In the general list of various inflammatory diseases of the female reproductive apparatus, this pathology occupies one of the main places. Inflammation of these organs can be caused by such pathogens as streptococci, gonococci, enterococci, staphylococci, fungi, mycobacterium tuberculosis, viruses, chlamydia, escherichia, etc. Microbial associations, for example, E. coli, become a very common cause of symptoms of adnexitis. As a rule, pathogens of this process are resistant to many modern antibiotics.
Tuberculosis bacillus and gonococcus most often cause bilateral inflammation of the appendages, and E. coli and staphylococci cause one-sided inflammation. The prerequisites for the occurrence of inflammation of the appendages or its recurrence are hypothermia, poor hygiene, infection with sexual infections, frequent stress, weakened immunity, promiscuity.
What are the symptoms? How is adnexitis treated in women? We will give answers to these questions in the article.
Mechanism of disease progression
The development of the pathological process begins, as a rule, with the introduction of an infectious agent on the mucous membrane of the fallopian tubes with the gradual involvement of the serous and muscular layers. Further, the inflammation begins to spread to the surrounding tissues - the surface epithelium of the ovary and the pelvic region. After ovulation, the infection affects the burst follicle and begins its development in the ovary. With suchpathologies, the ovary and fallopian tube are soldered together and form a single inflammatory conglomerate, and then a tubo-ovarian abscess. The outcome of such a disease is the development of adhesions that prevent the patency of the fallopian tubes. Treatment of symptoms of adnexitis with antibiotics will be discussed later.
Infection, which is the cause of the inflammatory process in adnexitis, enters the fallopian tubes in several ways:
- Hematogenous (with blood).
- Lymphogenic (with lymph).
- Descending (from the caecum or sigmoid colon through the peritoneum).
- Ascending (from the vagina, through the cervical canal, into the uterus, and from there - the fallopian tubes and ovaries).
The causes of symptoms of adnexitis in women are of interest to many.
The hematogenous route of infection of the uterine appendages with adnexitis is observed in cases of tuberculous lesions of the genital organs, lymphogenous and descending - in diseases of the rectum, as well as the appendix in the caecum. For E. coli, streptococcus and staphylococcus, by entering the fallopian tubes, anatomical canals are used - the vagina and the cervical canal. Chlamydia and gonococcus are able to penetrate through intact tissues. Often there is infection in the appendages at the same time in several ways. The course of the disease can be chronic, acute and subacute.
Before talking about the treatment of symptoms of adnexitis in women, consider the main methods of diagnosis.
Diagnosis of pathology
The main reason for making a diagnosis in this pathologyare history data, for example, the presence or absence of an intrauterine device, abortion, diagnostic hysteroscopy, difficult childbirth, as well as other factors that could lead to inflammation of the appendages. Patient complaints and research results are also taken into account. In a gynecological examination with this pathology, a painful increase in the uterus and its appendages is determined. To determine the type of causative agent of adnexitis, such studies as bacteriological culture and smears from the urethra for the presence of sexually transmitted infections, smears from the vagina and cervix.
Ultrasound with adnexitis allows you to identify other inflammatory processes occurring in the organs of the reproductive system - hydrosalpinx, pyosalpinx. Laparoscopy is used as a diagnostic method to identify purulent formations and examine the fallopian tubes in conjunction with intracavitary therapeutic procedures for inflammation.
In order to determine what is the patency of the tubes, as well as the causes of the symptoms of adnexitis in women and the severity of the pathological changes occurring in them, in chronic forms, the “hysterosalpingography” method is used - an x-ray examination with the introduction of a special contrast agent into the blood. With changes in the menstrual cycle, various functional tests are carried out to assess the work of the ovaries: indicators of rectal temperature, cervical mucus tension.
Consider the symptoms of acute adnexitis.
Sharp shape
This disease in an acute form proceeds with a specific clinical picture. The patient's condition is accompanied by intense, sharp pains in the lower abdomen, which can radiate to the anus and lower back. They are usually more pronounced in terms of inflammation. The temperature rises, accompanied by chills, mucous or purulent discharge, weakness, dysuric disorders, flatulence appear. On palpation, there are signs of peritoneal irritation. In the blood, leukocytosis and an increase in ESR are observed. The symptoms of adnexitis are quite unpleasant.
Often there is a development of bilateral inflammation of the appendages, which is combined with inflammation of the body of the uterus. A disease of this nature may be accompanied by such phenomena as algomenorrhea and menorrhagia. With an increase in inflammatory - tubo-ovarian abscess. In this case, there is a high risk of rupture of the tube with the ingress of purulent contents into the peritoneal cavity, which entails the development of pelvioperitonitis. With severe intoxication in the acute phase of adnexitis, disorders of the vascular system often occur.
Severe symptoms of adnexitis in uncomplicated forms can persist for a week or a little longer, then the pain syndrome gradually weakens, the blood normalizes, the body temperature decreases. The outcome of such an inflammatory process in the area of the appendages can be a complete clinical recovery, subject to timely treatment, or the transition of the process to a chronic stage with a long course.
Stagesacute form of adnexitis
With the development of this form of the pathological process, four stages are noted:
- Acute endometritis and salpingitis without symptoms of pelvic peritoneal irritation.
- Acute endometritis and salpingitis with symptoms of irritation of the pelvic peritoneum.
- Acute adnexitis, which is accompanied by the formation of an inflammatory conglomerate and an abscess.
- Rupture of an abscess.
The course of the disease usually goes through two phases:
- Toxic when aerobic flora predominates and symptoms of intoxication.
- Septic, when the anaerobic flora joins, the symptoms of adnexitis intensify and the process of development of complications begins. In this phase of adnexitis, a purulent tubo-ovarian formation is formed with the threat of its perforation.
As already noted, the symptoms and treatment of adnexitis are closely related.
Treatment of pathology
In the acute stage of inflammation of the appendages, the pathology is subject to treatment in a hospital with the creation of rest conditions for the patient, the appointment of a light diet, plenty of liquid, and monitoring of excretory functions. In acute adnexitis, as a rule, antibacterial drugs with a wide spectrum of effects are prescribed, as well as painkillers, anti-inflammatory, desensitizing drugs.
The main means of treating adnexitis are antibiotics with the determination of the sensitivity of an infectious agent to a particular drug. Doses in this case should provide the maximum concentration of substancesat the site of inflammation. In the treatment of this pathology, antibacterial medicines of the following groups are widely used:
- Penicillins (Ampicillin, Oxacillin).
- Tetracyclines ("Doxycycline", "Tetracycline").
- Fluoroquinolones ("Ofloxacin" and others).
- Macrolides (Azithromycin, Erythromycin, Roxithromycin).
- Aminoglycosides ("Kanamycin", "Gentamicin").
- Nitroimidazoles ("Metronidazole").
- Lincosamides (Clindamycin).
When carrying out antibiotic therapy of the disease, preference is given to antibacterial drugs with a long half-life and excretion, and in severe forms of inflammation of the appendages, as well as when there is a risk of developing septic consequences, antibiotics can be prescribed in various combinations. Metronidazole, which is administered intravenously and orally, has a bactericidal effect on anaerobic microorganisms. In order to remove intoxication with adnexitis, infusion therapy is used by the method of intravenous administration of solutions of dextran, glucose, water-s alt solutions, protein preparations, etc., with a total volume of up to 2.5 liters per day.
Often used in the treatment of symptoms of suppository adnexitis.
As part of complex therapy, Fluomizin suppositories are prescribed. The main active ingredient of this drug is dequalinium chloride. It has a fairly broad spectrum of antimicrobial activity.
As an aid, it is used for adnexitis "Hexicon" in the form of candles. The main operatingThe substance in this preparation is chlorhexidine bigluconate. Its activity is manifested in relation to bacteria, protozoa and viruses, but the functional activity of lactobacilli is not disturbed.
Rectal suppositories, which are used for adnexitis, usually consist of anti-inflammatory and analgesic substances. Below are the most popular:
- Movalis.
- Indomethacin suppositories.
- Voltaren.
- Candles with belladonna.
In the event of purulent forms of the inflammatory process, surgical treatment of adnexitis is indicated. Today, in operative gynecology, low-traumatic methods of performing operations are widely used, including in the treatment of adnexitis. For example, laparoscopy, through which a purulent formation is removed and the focus of inflammation is treated with antiseptics and antibacterial agents. In addition, a method is used to evacuate the contents of the saccular formation during punctures of the vaginal vaults, with local administration of antibiotics. With the development of purulent inflammation in the appendages and the risk of damage to neighboring organs, specialists can resort to complete surgical removal of the fallopian tube, ovary, or separately, depending on how much the inflammatory-purulent process is running. This happens, as a rule, when kidney failure occurs, the threat of rupture of the abscess, generalization of the septic process, etc.
After eliminating the acute manifestations of adnexitis, physiotherapy is prescribed with the help ofultrasound, electrophoresis with potassium, magnesium, zinc on the lower abdomen, various types of vibration massage and biostimulation. In the absence of therapeutic measures, this disease can turn into a chronic form of inflammation of the appendages, which occurs in the form of periodic exacerbations.
Chronic form of adnexitis
Chronic adnexitis is considered, as a rule, the result of an untreated acute process, and proceeds in the form of relapses resulting from the influence of certain negative factors, which can be stressful situations, severe hypothermia, overwork, STIs, etc. Consider the symptoms chronic adnexitis.
At the stages of exacerbation, there is a deterioration in the general well-being of the patient, weakness, the appearance or intensification of pain in the lower abdomen, a temperature of 38 degrees, the appearance of mucopurulent discharge. After a few days, these symptoms gradually subside, after which only a moderately pronounced aching or dull pain in the lower abdomen persists. Symptoms of adnexitis are important to identify in a timely manner.
Approximately half of patients with a chronic form of adnexitis have a short-term or persistent violation of the cycle of menstruation by the type of menorrhagia, algomenorrhea, oligomenorrhea. Approximately 40% of women in this case have a disorder of sexual functions in the form of pain during intercourse, a decrease or absence of libido, etc.
Not everyone knows the symptoms and treatment of chronic adnexitis.
In a chronic inflammatory process in the area of the appendages, there is a violation of the functions of the digestive organs, for example, in the formcolitis, as well as the functioning of the urinary system, for example, cystitis, bacteriuria, inflammation of the kidneys, etc. Frequent recurrence of adnexitis can lead to the development of nervous pathologies and a decrease in the patient's ability to work, the occurrence of depressive conditions and symptoms of increased anxiety. Symptoms of adnexitis in women in the chronic form manifest themselves in different ways.
Current chronic process
Exacerbation of chronic adnexitis occurs, as a rule, in two ways:
- Infectious-toxic - with an increase in exudative processes in the appendages, an increase in their soreness, changes in the blood.
- Neurovegetative - with symptoms of deterioration in he alth, decreased ability to work, mood instability, endocrine and vascular disorders.
Complications of adnexitis
Chronic recurrent adnexitis often leads to a pathological outcome of pregnancy (spontaneous miscarriage, ectopic pregnancy), as well as secondary infertility, which in the chronic form of adnexitis can be not only the result of pathological changes in the fallopian tubes. This process often entails disruption of the ovaries in the form of menstrual disorders, etc. Such forms of infertility are very difficult to treat.
With the development of the chronic form of this pathology, the formation of infiltrates, the occurrence of sclerotic processes in the pipes, as well as their obstruction, are noted. Adhesions also form around the ovaries.phenomena. From a chronic focus, the infection can spread to neighboring organs and provoke the development of chronic colitis, pyelonephritis, cholecystitis.
Therapeutic methods to combat chronic inflammation of the appendages
At the stage of exacerbation of the chronic form of adnexitis, as a rule, such therapeutic measures are carried out that correspond to the acute process - in the form of hospitalization, antibacterial, infusion, desensitizing and vitamin therapy. After the exacerbation period subsides with inflammation of the appendages, the patient may be recommended to perform autohemotherapy, aloe injections, physiotherapy procedures - electrophoresis with the use of drugs (lidase, potassium, iodine, magnesium, zinc), ultrasound therapy and vibration massage. This is done under the control of clinical and laboratory parameters.
Physiotherapy, which is used for inflammation of the appendages, helps reduce tissue exudation, has analgesic and absorbable effects, and reduces the formation of adhesions. In addition, ozokerite, paraffin therapy, and vaginal irrigation with sodium chloride and sulfide mineral water are very effective in inflammation of the appendages. In the stage of remission, patients are shown spa treatment. We reviewed the signs and symptoms of adnexitis.
Disease prevention
The risk group for the occurrence of this disease includes women who suffer from sexually transmitted infections and use intrauterine contraceptives, as well as those who have undergoneoperations on the internal genital organs and abortions. The threat of pathological complications indicates the need for special preventive measures:
- Exclusion of factors that can provoke the development of adnexitis and its relapses - hypothermia, stress, infections, etc.
- Use rational methods of contraception.
- Timely complex therapy of inflammatory diseases affecting the pelvic organs.
- Systematic follow-up with a specialist.
Only if all the recommendations are followed, the symptoms of adnexitis in women will not appear.
