The causative agent of tuberculosis is Koch's bacillus. Once in the body, it may remain inactive for some time. At the same time, nonspecific symptoms appear in the form of increased fatigue and weakness. Often they are attributed to overwork and do not pay due attention to them. Women learn about the presence of the disease when the first difficulties with conception appear. This is how uterine tuberculosis manifests itself. The first signs and symptoms of the disease will be discussed in today's article.
Medical certificate
Uterine tuberculosis is an infectious disease. It affects mainly the mucous membrane and myometrium. In rare cases, the pathological process extends to the cervix. It has several forms of flow: subacute, acute and chronic. It is generally accepted that infertility is considered a mandatory consequence of the disease. dangerousdisease for the fetus. Due to adhesions, the organ changes shape, which can provoke a stop in the development of the child inside the womb.
Classification of pathology
By the nature of the course, uterine tuberculosis can be subacute, acute and chronic. The acute form of the disease is detected extremely rarely and, as a rule, with the addition of a secondary infection. In 15-17% of cases, subacute tuberculosis is observed, when the inflammatory process is not so active. The chronic variant of the disease is most common.
Also distinguish different activity of Koch's rods in the genitals. For example, in the first 2 years, the bacterium is most active. The phase of remission can last from 2 to 4 years, after which the inactive form occurs. The last stage is also called the consequence of the disease. If in the first 4 years from the moment of infection, the signs of uterine tuberculosis become more pronounced, then there is an exacerbation. When such a phenomenon is diagnosed after the first 4 years, we are talking about a relapse.
Separately, it is necessary to consider the classification according to the localization of the pathological process. Tuberculosis of the uterine appendages occurs in 70% of cases. This is due to the fact that the fallopian tubes receive nutrition from two arteries - the uterine and ovarian. They, in turn, have an extensive network. The blood flow in such vessels is rather slow, which allows Koch's stick to settle in tissues fed by small diameter arteries.
Tuberculosis of the body of the uterus is recorded in 20% of cases. The disease can affect only the area of the inner shell of the organ, the entireendometrium and even spread to the muscle membrane. Inflammation of other structures (cervix, ovaries, vagina) is rare.
Depending on the histological picture of pathological foci, the disease is:
- Chronic with productive changes. Elements in the focus of inflammation are constantly growing and dividing. Therefore, characteristic tubercles or lupomas appear on the mucosa.
- Subacute. Cells not only actively divide, but also secrete an inflammatory fluid - exudate.
- Caseous. Dead tissue looks like a white curd mass.
- Finished. The foci of inflammation are impregnated with calcium s alts and are self-limited by the capsule.
Determination of the form of the disease helps to choose therapy and prevent the development of complications.
Main reasons
Tuberculosis is a secondary pathology. Bacteria enter the uterus from other foci, which can be the lungs and intestines. How is uterine tuberculosis transmitted? Koch's wand spreads through the air. Many people are immune to it, but 10% of the world's population survives the infection.
The uterus is a field for complications and the resumption of the pathological process. At first, Koch's wand does not show activity due to the increased work of the immune, endocrine and cardiac systems. However, when immunity is weakened, it rapidly spreads through the body through the blood and lymph.
Among the risk factors, doctors identify the following conditions:
- chronic diseases;
- surgical interventions on the organs of the reproductive system;
- functional disorders;
- frequent stress;
- hormonal changes.
When several factors are combined, the likelihood of developing the disease increases several times.
General clinical picture
In most cases, there are no pronounced symptoms of uterine tuberculosis. A woman may complain of general weakness, fever to subfebrile levels, excessive sweating. With significant changes in the uterine mucosa, amenorrhea occurs. This is a condition in which menstruation is absent.
Tuberculosis is characterized by prolonged and acyclic uterine bleeding. Infertility usually develops after the first childbirth or another abortion. However, it is primary. Its main cause is obstruction of the fallopian tubes.
In the case of an advanced form of the disease, deformation of the uterine cavity is observed against the background of adhesions, synechia or fibrosis. The organ can fill with curdled neoplasms.
The severity of symptoms of uterine tuberculosis depends on the general he alth of the woman, external factors and the stage of the disease. In total, there are three of them: subacute, acute and chronic. Each of them will be discussed in more detail below.
Acute disease
Pathology is manifested by severe pain in the lower abdomen. In addition, there is an increase in temperature and weakness.
Pain syndrome whentuberculosis of the uterus can be so severe that doctors do not always immediately make the correct diagnosis. Usually, appendicitis, ectopic pregnancy, or ovarian apoplexy are suspected, and surgery is prescribed. If during the surgical intervention the dying off of the uterus is detected, they are removed and sent for histological examination. Otherwise, tuberculosis may not be diagnosed for a long time.
Subacute variant of the disease
The first symptoms of subacute uterine tuberculosis are manifested in the form of pain above the pubis. It is associated with inflammatory processes. In addition, it becomes difficult for the intestines and other organs of the small pelvis to contract due to the large number of adhesions and scarring.
The temperature is usually maintained at subfebrile values or within the normal range. General weakness and loss of appetite alarm the woman. However, many simply do not notice these first signs and symptoms of uterine tuberculosis, so they do not see a doctor.
Chronic process
In the chronic course of the disease, a woman usually does not care about anything. Minor fatigue and fever are attributed to frequent stress and hectic rhythm of life. Only unsuccessful attempts to conceive a child can prompt you to see a doctor and undergo an examination. Usually the problem is preceded by several abortions or even childbirth.
The pathogenesis of infertility is quite simple. Due to the peculiarities of local circulation, Koch's wand first enters the fallopian tubes, provoking inflammation. It causes constriction of the oviducts. As a result, the ovumcan enter the uterine cavity and attach. Pregnancy also does not occur if the disease contributed to partial or complete infection, scarring of this cavity.
Cervical tuberculosis is considered a complication of inflammation of the organ body. The disease develops mainly in older women. It does not have specific symptoms, but is diagnosed during a colposcopy.
Diagnostic Methods
Diagnosis of this disease is very difficult due to low awareness of the population about the first signs and symptoms of uterine tuberculosis in women. In addition, it is rarely detected by standard vaginal cultures.
It is possible to suspect an ailment only after a long observation of the patient's he alth, studying her history and contacts. The following instrumental and laboratory diagnostic methods also help:
- examination on a gynecological chair;
- X-ray or CT of lungs;
- tuberculin test;
- hysterosalpingography;
- diagnostic curettage of the endometrium;
- laparoscopy.
After receiving the results of a comprehensive examination, a consultation with a TB specialist may be required.
Conservative Therapy
Uterine tuberculosis is treated in a specialized dispensary. This is a rather insidious disease. Koch's wand withstands the effects of many drugs. Therefore, complex therapy is selected to destroy it.with the use of several drugs at the same time. Usually preference is given to "Isoniazid", "Streptomycin", "Rifampicin" and "Ethambutol". If the listed drugs are ineffective, a new generation of drugs (Kanamycin, Ofloxacin, Amikacin) is prescribed.
Chemotherapy is carried out using at least three named drugs. Its duration can vary from 6 months to 2 years. It all depends on the severity of the pathology, the presence of concomitant he alth problems and the state of the immune system.
Given the negative impact of chemotherapy on the liver, hepatoprotectors and vitamin complexes are additionally prescribed. In case of menstrual irregularities, the help of hormonal drugs may be required. To eliminate adhesions and scars that form against the background of tuberculosis in the uterus and ovaries, absorbable drugs are prescribed.
To consolidate the results of ongoing therapy, a spa vacation is useful, where, depending on the initial diagnosis, specialists select a set of physiotherapy.
Surgery
If conservative treatment does not give the desired result, caseous areas or purulent formations, adhesions appear in the uterine cavity, surgical intervention is indicated. The operation can be carried out in two ways:
- total hysterectomy;
- excision of the affected area with preservation of the organ.
The technology of the operation may also vary. In each case, the doctor determines the volumeintervention. In modern medical practice, the following options for eliminating pathology are used:
- Blind surgery. Its help is resorted to in case of extensive damage to the organ, when a good overview is required to identify pathological areas. Performed under general anesthesia.
- Laparoscopy. This is a minimally invasive technique, during which the doctor performs several punctures on the skin in the affected area. Through them, he introduces tools for subsequent manipulations and a video probe. The image from the latter is continuously fed to the computer monitor. Thus, the doctor can constantly monitor his work. After excision of the pathological areas, sterile dressings are applied to the punctures. Recovery after laparoscopy is fast and the risk of complications is minimal.
- Endoscopic intervention. It implies the use of a hysteroscope with a camera. The procedure is performed for minor lesions of the endometrium, for the purpose of diagnostic curettage or to stop bleeding.
Removal of the uterine cavity can also be complete or partial. If a woman has not yet given birth and is planning a pregnancy in the future, the doctor tries to preserve the reproductive organ.
Possible Complications
Lack of timely treatment of uterine tuberculosis often leads to complications. Among them, the most common are the following:
- bleeding;
- spread of infection to adjacent organs;
- formation of abscesses in the chest cavity;
- formation of fistulas and adhesions;
- transition of the disease into genital tuberculosis.
Tuberculosis treatment is a long and complicated process. However, full recovery does not always occur. Often Koch's wand is insensitive to prescribed antibiotics. As a result, the reproductive organs completely lose their ability to bear children.
In the presence of such complications, only a few can try on the role of a mother. Therefore, you should consult a doctor if you suspect uterine tuberculosis. Suspicion can often literally save a woman's life.
Tuberculosis often shows up too late. Therefore, doctors advise to undergo fluorography annually and visit a gynecologist for preventive purposes.
Prevention Methods
To avoid uterine tuberculosis, you should avoid contact with sick people, do not use their personal hygiene products. In addition, as a preventive measure, doctors advise adhering to the following recommendations:
- Eat properly and fully, take vitamin complexes.
- It is necessary to observe the regime of work and rest. Eight hours of daily sleep is helpful.
- Timely treat respiratory diseases, get an annual flu vaccination.
- It is important to maintain a high level of immunity. To this end, it is necessary to temper the body and give up bad habits.
- To avoid chronic gynecological diseases that create a favorable environment for the reproduction of pathogenic flora, you need to visit a gynecologist annually.
- Parents should monitor their child's vaccinations to maintain a high resistance to disease. Against tuberculosis, the vaccine is given immediately after the baby is born, then at 7, 12 and 17 years. Mantoux test must be done annually.
Uterine tuberculosis is a very serious disease. It is dangerous because for a long time it can be almost asymptomatic. Even with timely detection and proper treatment, the disease often leaves behind unpleasant complications. Among them, the most common problem is infertility. Relapses occur in every tenth woman. If the patient retains the ability to conceive, the pregnancy itself is very difficult for her. Spontaneous miscarriages often occur, miscarriages are diagnosed, and premature births occur. Therefore, even at the planning stage of conception, all women, without exception, must undergo a comprehensive examination of the body.
