Chronic adnexitis: symptoms and treatment
The proportion of diagnosed cases of adnexitis among other gynecological pathologies is very high. If the inflammatory process that has arisen in the reproductive system is not promptly eliminated, it provokes severe complications and serious negative consequences for the female body. It is very dangerous when the course of adnexitis becomes chronic, because in this case many women are at risk of infertility.
- Adnexitis - what is it in women?
- Symptoms of chronic adnexitis
- Causes of chronic adnexitis
- Chronic adnexitis and pregnancy
- Consequences and complications of chronic adnexitis
- Diagnostics of the chronic adnexitis
- Treatment of chronic adnexitis
- Prevention of chronic adnexitis
- Disease prognosis
Adnexitis - what is it in women?
Adnexitis, or salpingo-oophoritis, is an inflammation of the uterine appendages (ovaries, fallopian tubes and ligaments). The disease can be acute or chronic, occurring on one or both sides of the uterus.
Pathogenic bacteria with adnexitis are introduced into the mucous membrane of the fallopian tube, involving the muscular and serous layers of the organ in the inflammatory process. Further, the inflammation will spread to the peritoneum of the small pelvis, passes to the ovaries. The infection penetrates directly into the ovary after ovulation, getting there through the corpus luteum or a ruptured follicle.
Extensive inflammation with adnexitis contributes to the formation of a conglomerate from the ovary and fallopian tube, and then a tubo-ovarian abscess is formed. The permeability of the fallopian tubes as a result of adnexitis is sharply reduced due to the formation of numerous adhesions and strands. The outcome of the acute form of the disease can be rupture of the tubo-ovarian abscess.
Dangerous complications in the chronic form of inflammation of the appendages:
- Accession of anaerobic infection;
- Development of sepsis
- Perforation of the peritoneum.
Chronitization of adnexitis occurs as a result of incorrectly chosen tactics for treating acute salpingo-oophoritis. The characteristic features of the chronic form of the disease are a sluggish course with periodic exacerbations, the need for more complex and long-term treatment.
According to ICD-10, the chronic form of the disease has the code N70.1 (chronic salpingitis and oophoritis).
Symptoms of chronic adnexitis
There are acute and chronic forms of inflammation of the appendages, which have a different clinical picture. To differentiate the chronic form of adnexitis from the acute type of the disease, you need to know their characteristic features.
The clinical manifestations of acute inflammation of the fallopian tubes and ovaries are always very pronounced. From the very beginning of the process, the temperature rises significantly, its values reach 38-39 °, the woman feels chills. Sharp, sharp pains are felt in the lower abdomen. They are localized on one or both sides in the iliac part of the peritoneum. The painful sensations are given to the sacrum, to the rectum, to the leg.
Palpation of the abdomen diagnoses symptoms of irritation of the peritoneum, its soreness and tension. Urination may become frequent and accompanied by a burning sensation. The woman feels a headache, as a symptom of intoxication, there is no appetite.
During a gynecological examination, the release of serous-purulent or purulent secretions from the opening of the cervical canal is recorded in the mirrors. The size and shape of the appendages is very difficult to determine, they are enlarged, have limited mobility. When carrying out laboratory studies, an acceleration of ESR, an excess of the number of leukocytes, the amount of C-reactive protein is revealed.
With poor-quality treatment or in its absence, acute adnexitis becomes chronic. Its clinical manifestations are erased, exacerbations of the disease occur during the off-season. The introduction of the infectious component occurs in the mucous membrane of the fallopian tube. The process then spreads to the muscle tissue, causing swelling of one or both tubes.
The tube lengthens and increases in volume, it is easy to find it by palpation. Together with the tubal fluid, the infection spreads into the serous membrane and into the peritoneal tissue. The result of this is purulent inflammation in the appendages, there is a risk of developing peritonitis and the formation of a tubo-ovarian abscess.
With the development of the inflammatory process, the walls of the tubes stick together, fibrous strands are formed, exudation is observed, and a hydrosalpinx may appear. Ectopic pregnancy is often a consequence of tubal obstruction.
Chronic inflammation in the pelvic organs leads to the formation of a large number of adhesions not only in the reproductive system, but also in the intestines, including the appendix, and also in the peritoneum. Since the inflammatory process is sluggish, the clinical picture of chronic adnexitis is not pronounced, most of the symptoms are hidden, they appear only during relapses.
Symptoms of chronic adnexitis
- The woman experiences aching pains in the lower abdomen, radiating into the vagina and into the lumbar region.
- On palpation, the abdominal wall is moderately painful.
- Due to functional changes in the ovaries, expressed in a decrease in the production of estrogen and the absence of ovulation, the menstrual cycle is disrupted in women. Menstruation becomes too scarce, or, conversely, profuse, they proceed accompanied by pain syndrome (algomenorrhea).
- Sexual intercourse with chronic adnexitis is painful, sexual desire is reduced.
- The disease complicates the work of the digestive, endocrine, urinary and nervous systems, provoking the occurrence of colitis, enterocolitis, cystitis, pyelonephritis, depression. A woman cannot work fully, the quality of life suffers.
- Exacerbations are accompanied by hyperthermia up to 38 °, increased pain. During a gynecological examination, purulent discharge from the cervix, soreness of the fallopian tubes and ovaries, limitation of their mobility and tissue sclerosis (formation of cords, adhesions) are recorded in the mirrors.
The onset of relapse can be determined by the appearance of chills, lower abdominal pain at rest and during urination. On palpation, the appendages are not noticeable clearly enough, but soreness is noticeable in the area of their location. A laboratory blood test shows an acceleration of ESR and an increase in the number of leukocytes.
Symptoms of adnexitis outside of periods of exacerbations:
- Constant low-grade fever (about 37 °);
- Dull or weakly throbbing pain in the lower right or left of the navel, aggravated before menstruation and during the expected ovulation;
- Pain during sexual intercourse, after exercise, hypothermia or stress;
- Menstrual irregularities associated with the volume of menstrual flow and the duration of menstruation;
- Headache and weakness, as symptoms of intoxication.
The clinical picture of a disease that lasts for many years often has very few manifestations. The doctor finds out that a woman has chronic adnexitis when she complains about the inability to conceive a child.
Causes of chronic adnexitis
The onset of the disease is provoked by pathogenic and opportunistic microorganisms. The causative agents of specific adnexitis are tubercle bacillus, gonococci, diphtheria bacillus. Nonspecific adnexitis is triggered by the activity of chlamydia, mycoplasma, staphylococcus, streptococcus, E.coli, fungi and viruses, or their associations.
Ways of penetration of infection into the reproductive system:
- Ascending - from the cervix, from the vagina;
- Descending - from organs in which an inflammatory process occurs (for example, appendicitis);
- Lymphogenous - with lymph flow;
- Hematogenous - with blood flow (typical for tuberculous adnexitis).
Factors that increase the likelihood of developing the disease:
- Promiscuous unprotected sex;
- Violations of intimate hygiene;
- Intrauterine manipulations - termination of pregnancy, hysteroscopy, diagnostic curettage, removal and insertion of an intrauterine device, metrosalpingography;
- Complicated labor;
- Removal of the appendix;
- Decreased immunity due to an infectious or somatic illness, HIV infection.
The development of chronic adnexitis is based on untreated or not at all treated acute and subacute adnexitis.
Chronic adnexitis and pregnancy
Obstruction of the fallopian tubes is a frequent complication of this disease, therefore, when planning a pregnancy, you should get rid of chronic adnexitis. At the end of therapy, you need to undergo an examination to assess the patency of the fallopian tubes and the possibility of conceiving a healthy baby.
If the diagnosis of "chronic adnexitis" is made during pregnancy, the doctor prescribes therapy with drugs that are as harmless as possible for the unborn child. Antibiotic treatment for pregnant women is usually not practiced in order to avoid negative consequences for the child, the doctor chooses safe drugs from other pharmaceutical groups. Nevertheless, it is very dangerous to leave untreated a focus of inflammation in the reproductive system of a pregnant woman, because the risk of abortion or fetal freezing increases.
Consequences and complications of chronic adnexitis
As a result of a chronic inflammatory process in the ovaries, their functionality is impaired. In this case, conception becomes impossible, since the egg cell loses the ability to fertilize. Due to the dysfunction of the ovaries, menstrual cycles become irregular.
Infertility as a result of tubal obstruction is the most severe consequence of chronic adnexitis. The adherent tissues of the fallopian tubes completely block the sperm from reaching the egg. In addition, the inflammatory process disrupts the function of the ciliated epithelium to promote the fertilized egg to the uterus for implantation. Since in this case movement along the tube is difficult, implantation can occur directly in the fallopian tube. In this case, an ectopic pregnancy occurs - another serious complication of chronic adnexitis.
Inflammation of the appendages, or salpingo-oophoritis, causes the following complications:
- Infertility, as a result of adhesions, obstruction of the fallopian tubes, impaired ovulation;
- Transition to a chronic form;
- Increased risk of ectopic pregnancy;
- Development of tubo-ovarian formation (purulent fusion of the fallopian tube and ovary with the formation of an abscess).
Chronic pain directly affects a woman's libido, reducing it. Sexual intercourse becomes undesirable, a woman feels weak, irritable, her mood often changes.
When a child is conceived by a patient with a chronic form of adnexitis, she may develop an intrauterine infection, start a spontaneous abortion, and premature birth.
Diagnostics of the chronic adnexitis
To diagnose salpingo-oophoritis, you should contact your gynecologist. The doctor will study the history, conduct a gynecological examination, during which painful and inactive appendages are recorded.
What the doctor is interested in during the collection of anamnesis:
- Whether the patient had abortions and complicated labor;
- Was the uterine spiral once installed;
- Whether intrauterine procedures and salpingography were performed.
To determine the type of infectious agent that caused the inflammation and to assess its sensitivity to antibiotics, bacterioscopy and bacteriological examination of smears from the vagina, cervical canal and urethra are performed. A general blood test in this case is not informative enough - only an increase in ESR can indicate the presence of inflammation.
Instrumental research methods:
- Ultrasound of the vagina;
- CT, MRI of the reproductive system;
- Echography to determine the presence or absence of adhesions;
- X-ray of the uterus and ovaries;
- Hysterosalpingography to determine the patency of the fallopian tubes.
Treatment of chronic adnexitis
Treatment of this disease lasts for a long time, however, with the exact implementation of the doctor's recommendations, positive dynamics is most often recorded. After determining the sensitivity of the causative agent of the inflammatory process to antibacterial drugs, the doctor prescribes a treatment regimen. It is based on antibiotic therapy, the exception for which is pregnancy.
The best result is obtained in the treatment of adnexitis during an exacerbation, since active bacteria are more sensitive to the effects of antibacterial drugs. Treatment of chronic adnexitis is carried out in combination, using medication and physiotherapy.
Salpingo-oophoritis therapy is carried out in bed rest in a gynecological hospital. The woman is assigned a special diet with restriction of seasonings and carbohydrates. It is recommended to apply cold to the abdominal area to relieve pain and inflammation.
Drug therapy includes broad-spectrum antibiotics, a combination of two or more drugs:
- Clindamycin (2 g twice a day) + Gentamycin;
- Klaforan i / m (1-0.5 g twice a day) + Gentamicin i / m (80 mg three times a day);
- Lincomycin IM (0.6 g three times a day);
- Cephobid IM (1 g twice a day) + Gentamicin;
- Cefazolin IM (1 g twice a day) + Ciprofloxacin IV (100 ml twice a day).
At the same time, Metronidazole is administered orally, 0.5 g three times a day. If an anaerobic infection is suspected, a woman is given intravenous injections of Metrogyl (100 ml twice a day).
For detoxification, drip administration of glucose, Reopolyglyukin, Gemodez, salt solutions of 2-3 liters is prescribed.
NSAIDs are used as analgesics orally, in the form of rectal suppositories or in the form of injections:
- Ibuprofen (Nurofen, Faspik, Ibuklin);
- Ketorolac (Ketorol, Ketanov);
- Diclofenac (Voltaren, Ortofen, Diklak, Naklofen).
Additionally, antihistamines (Cetrin, Suprastin, Pipolfen) are prescribed for the prevention of allergic reactions, vitamin complexes.
For the treatment of adnexitis outside the period of exacerbations, physiotherapeutic procedures are used:
- Electrophoresis with iodine or lidase;
- Ultrasound treatment;
- Electrophoresis with copper and zinc in the phases of the menstrual cycle;
- Treatment with high frequency impulse currents.
To restore well-being, autohemotherapy, treatment with immunomodulators, injections of aloe, Longidase, FIBS are used. Excellent results are obtained by spa treatment with mud, paraffin baths, baths and douching.
Treatment of adnexitis with candles
Vaginal and rectal suppositories are extremely effective in treating this disease because they act in close proximity to the site of inflammation. Candles relieve pain, their components actively resist the action of bacteria.
The most commonly prescribed:
- Movalis - analgesic, used within 5-7 days;
- Fluomizin - applied once a day before bedtime, as an antibacterial agent;
- Polygynax - candles with anti-inflammatory effect, used for 10-14 days;
- Voltaren - have an analgesic effect;
- Geksikon - approved for use during pregnancy as an antibacterial and anti-inflammatory agent;
- Indomethacin - rectal suppositories with anti-inflammatory effect;
- Candles with belladonna extract are effective against pain.
You should not use candles without a doctor's prescription, who will take into account the peculiarities of the course of the disease and possible contraindications.
Prevention of chronic adnexitis
To prevent the acute form of the disease from transforming into chronic adnexitis, it is necessary to timely carry out a course of treatment under the guidance of the attending physician with strict adherence to his recommendations. To prevent exacerbations, it is recommended to periodically carry out courses of therapy with therapeutic mud, spa treatment. In order not to provoke the inflammatory process, you should avoid stressful situations, hypothermia.
Sexual relationships with a regular partner, the use of condoms will help to avoid infection of the reproductive system with sexually transmitted diseases.
You should not swim in cold water and sit on cool surfaces, give up warm underwear in winter.
Intimate hygiene rules must be strictly observed:
- It is recommended to wash with warm water daily;
- Shower regularly;
- Frequent change of sanitary napkins is required during menstruation;
- It is advisable to abandon the use of hygienic tampons during treatment.
At the first manifestations of diseases of the reproductive system, the appearance of pain and atypical discharge, you should immediately contact your doctor, without waiting for complications.
If the therapy of chronic adnexitis is carried out in a timely manner and in full under the guidance of a qualified doctor, the disease has a favorable prognosis and does not threaten the patient's life. Failure to comply with preventive measures and ignoring the recommendations of the gynecologist increases the risk of infertility, menstrual irregularities, and the appearance of an ectopic pregnancy.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.