Chronic adnexitis
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms of chronic adnexitis
- Diagnostics
- Treatment of chronic adnexitis
- Treatment of chronic adnexitis during pregnancy
- Possible complications and consequences
- Forecast
- Prevention
Chronic adnexitis (inflammation of the appendages, salpingo-oophoritis) is a long-term inflammatory disease of the fallopian tubes and ovaries, which are the uterine appendages. Salpingitis (an inflammatory process in the fallopian tubes) and oophoritis (inflammation of the ovaries) are usually not divided into separate pathologies, since they almost never proceed in isolation - the inflammation in one of them quickly turns into another. Adnexitis is one of the most common gynecological diseases - according to statistics, 8 out of 10 women have experienced it at least once during their life. Most often, pathology is diagnosed in women aged 20-40 years.
Adnexitis is characterized by a protracted course with periodic exacerbations, followed by remission
The pathological process usually begins with the introduction of an infectious agent into the mucous membrane of the uterine (fallopian) tube. Further, the inflammation spreads to the muscle and serous layers, as well as the surrounding tissues - the integumentary epithelium (mesothelium) of the ovary, the pelvic peritoneum. During ovulation, the bursting follicle is affected, the infectious and inflammatory process continues to progress in the ovary and fallopian tube, which, in the absence of treatment, eventually leads to the formation of adhesions, adhesions and obstruction of the fallopian tubes. Experts call the obstruction of the fallopian tubes due to the transferred inflammatory process the main cause of the secondary, i.e., acquired infertility.
Causes and risk factors
The infectious agent can penetrate into the uterine appendages ascending, descending, as well as hematogenous or lymphogenous. As a rule, pathogens penetrate from the vagina (ascending route of infection). The disease is caused by pathogenic or opportunistic microorganisms: strepto- and staphylococci, chlamydia, gonococci, lactococci, E. coli, fungi of the genus Candida, etc.
Chronic adnexitis develops against the background of improper treatment of an acute or subacute form of the disease.
The factors contributing to the onset of exacerbation of chronic adnexitis include:
- resumption of sexual activity soon after childbirth, underwent surgical operations, abortion;
- re-infection (for example, in the case of a change of sexual partner);
- infectious and inflammatory processes in the body;
- the presence of an intrauterine device;
- frequent constipation;
- decreased immunity, severe overwork;
- hypothermia of the body;
- stressful situations;
- avitaminosis;
- poor nutrition.
Hypothermia - a risk factor for chronic adnexitis
Forms of the disease
Adnexitis is divided into acute (specific and non-specific), subacute and chronic.
Depending on the characteristics of the course of exacerbations of chronic adnexitis, the following forms are distinguished:
- infectious-toxic (exudative processes in the fallopian tubes and ovaries, rather intense pain sensations are characteristic, changes in the blood formula are noted);
- neuro-vegetative (deterioration in general well-being, rapid mood changes, decreased ability to work, endocrine and vascular disorders, neuralgia of the pelvic nerves).
Thus, in the infectious-toxic form of exacerbation, the clinical picture of the disease is similar to that in acute adnexitis, only slightly less pronounced. In the case of the neuro-vegetative form, the manifestations of the inflammatory process are insignificant, and pain sensations are typical for a neurological disease.
Depending on the localization of the pathological process, chronic adnexitis is unilateral and bilateral. One-sided, in turn, is left- or right-sided.
Symptoms of chronic adnexitis
Adnexitis is characterized by a protracted course with periodic exacerbations, followed by remission.
With the transition of adnexitis to the chronic form, the symptoms of the disease characteristic of the acute form are dulled or disappear altogether, remission occurs. In some cases, there is occasional moderate aching or dull pain from the affected appendage (appendages).
With an exacerbation of chronic adnexitis, the patient complains of rather intense pain in the lower abdomen. The pain can radiate to the lumbar region, rectum, thigh. It intensifies in a stressful situation, hypothermia, with intense physical activity, before or after menstruation, during bowel movements or intercourse. The general state of health is somewhat reduced, weakness, increased fatigue, irritability, and sleep disturbances are noted. Body temperature, as a rule, does not rise, or rises slightly (37-37.5 ˚С). Other symptoms of chronic adnexitis include mucopurulent vaginal discharge. About half of the patients with chronic adnexitis have some kind of menstrual irregularity (algomenorrhea, menorrhagia, metrorrhagia, oligomenorrhea, premenstrual syndrome). Sexual function is also impaired (soreness during intercourse, decreased libido).
With an exacerbation of chronic adnexitis, women complain of intense pain in the lower abdomen
With frequent relapses of chronic adnexitis, the vascular, endocrine and nervous systems are gradually involved in the pathological process.
Diagnostics
Outside of exacerbations of chronic adnexitis, diagnostic studies are not very informative.
Diagnosis of chronic adnexitis is based on data obtained as a result of collecting anamnesis and complaints of the patient, as well as instrumental and laboratory research. When collecting anamnesis, first of all, attention is paid to the signs of a previously transferred acute adnexitis, as well as to factors that could provoke an exacerbation: the installation of an intrauterine device, abortion, diagnostic curettage, transferred stress, etc.
To determine the infectious agent, bacteriological culture with an antibioticogram and microscopic examination of smears from the cervix, urethra and vagina are performed, and if a viral nature of the disease is suspected, a polymerase chain reaction study is performed. A general analysis of blood and urine, a biochemical blood test, a cytological examination of a smear (PAP test), an ultrasound of the pelvic organs are prescribed. If your period is delayed, a pregnancy test is prescribed. In case of menstrual irregularities, in order to determine the function of the ovaries, the determination of the tension of cervical mucus, a symptom of the pupil, and measurement of rectal temperature are shown. To determine the patency of the fallopian tubes and the severity of pathological changes, an x-ray examination of the uterus and uterine appendages is performed with the introduction of a contrast agent (hysterosalpingography). In the case of minor manifestations and an extensive process in the small pelvis, a tuberculin test is indicated. In severe cases, diagnostic laparoscopy may be required.
Diagnosis of chronic adnexitis allows pelvic ultrasound, blood and urine tests, PAP test
Differential diagnosis with endometriosis, tumors and ovarian cysts, pelvic plexitis, colitis is required.
Treatment of chronic adnexitis
Frequent exacerbations of chronic adnexitis with a high probability can lead to the development of complications. For this reason, therapy is recommended to be carried out in full.
Treatment of exacerbations of chronic adnexitis consists of anti-infectious, anti-inflammatory and restorative therapy. The choice of the treatment regimen depends on the etiological factor, the clinical picture of the disease, and the presence of complications. In severe cases, hospitalization may be required, with the relief of acute events, the therapy of chronic adnexitis can be continued on an outpatient basis under the supervision of the attending physician. However, more often the treatment of chronic adnexitis is carried out on an outpatient basis.
Treatment of chronic adnexitis consists in taking anti-inflammatory and anti-infectious drugs
Etiotropic therapy consists in taking anti-infectious drugs, selected taking into account the sensitivity of the pathogen. Anti-inflammatory, pain relievers are also prescribed. After the removal of the acute process, chronic adnexitis is treated with physiotherapy methods:
- electrophoresis of drugs in the area of the uterine appendages;
- ozokerite and mud applications;
- paraffin therapy;
- irrigation of the vagina with sulfide and sodium chloride mineral waters;
- hirudotherapy;
- oxygenobarotherapy;
- vibration massage;
- ultrasound therapy;
- high-frequency magnetotherapy.
In order to activate the immune system during the period of remission of chronic adnexitis, patients can be prescribed autohemotherapy (injecting the patient's own venous blood subcutaneously or intramuscularly), aloe injections.
The general scheme of treatment of the disease can be supplemented with herbal medicine under the supervision of the attending physician. In chronic adnexitis, infusions of medicinal plants with anti-inflammatory effects are used (St. John's wort, chamomile, viburnum, wormwood, etc.).
With a prolonged inflammatory process and the development of a syndrome of endogenous intoxication, violations of micro- and macrocirculation, blood circulation, acid-base balance, metabolism, plasmapheresis is shown. Plasmapheresis is carried out in the follicular phase of the menstrual cycle in a course that consists of several sessions.
In addition, gynecological massage, remedial gymnastics, and a balanced diet are recommended. Patients in the stage of stable remission are shown sanitary-resort treatment.
Sanatorium treatment is indicated for women who have achieved a stable remission of adnexitis
Surgical interventions for chronic adnexitis are rare. An indication for surgical treatment may be the ineffectiveness of several courses of conservative therapy and a high risk of complications.
Treatment of chronic adnexitis during pregnancy
Chronic adnexitis during pregnancy carries many risks. If therapy is not started on time, the pathological process can negatively affect the course of pregnancy, up to its spontaneous interruption. On the other hand, antibiotic therapy during pregnancy can adversely affect the condition of the fetus. If antibiotic therapy is necessary, it is carried out in the ll trimester, the choice of drugs is carried out taking into account the possible toxic effect. If a woman has a sexually transmitted infection that caused the development of the disease, it is recommended to terminate the pregnancy.
Possible complications and consequences
Chronic adnexitis can be complicated by the following pathologies:
- infertility;
- ectopic pregnancy;
- spontaneous miscarriage (including habitual);
- tubo-ovarian abscess;
- inflammation of the peritoneum in the pelvic area (pelvioperitonitis);
- chronic colitis;
- pyelonephritis;
- cholecystitis;
- disorders of the menstrual cycle;
- sexual dysfunction.
Forecast
Subject to timely diagnosis, properly selected treatment and further fulfillment of the doctor's prescriptions, the prognosis is favorable.
Prevention
In order to prevent the development of chronic adnexitis, it is recommended:
- timely treatment of diseases of the pelvic organs;
- undergoing regular preventive examinations with a gynecologist;
- refusal of casual unprotected sex;
- refusal of sexual intercourse during menstruation;
- avoiding violation of the timing of the use of intrauterine contraceptives;
- in case of an unplanned pregnancy - preference for the medical method of terminating it;
- avoidance of general hypothermia of the body and local, in the pelvic area, lower back;
- rejection of bad habits;
- compliance with the rules of personal hygiene;
- refusal to wear tight underwear, as well as underwear made of synthetic materials:
- lifestyle modification: a full night's sleep, moderate physical activity, balanced nutrition, regular sex life with one partner.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
