Adhesions In The Pelvis - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Adhesions in the small pelvis: symptoms and treatment

Adhesions in the small pelvis are found very often, especially this problem is relevant for women. For them, adhesions pose a serious threat in the form of the development of infertility, not to mention the severe discomfort and pain they cause.

The explanation that pelvic adhesive disease is very common lies in several reasons: the systematically increasing number of diseases requiring surgical intervention, the growth of various hormonal pathologies, the coverage of the population with sexually transmitted diseases. In this regard, the urgency of the problem of pelvic adhesions is simply impossible to ignore.

Pelvic adhesions are connective tissue cords that are located on the peritoneum and on internal organs. Adhesion therapy requires a professional approach and close interaction between the doctor and the patient. They should not be left unattended, since they disrupt the functioning of internal organs, limit their mobility, provoke pain and often cause the impossibility of fertilization.

Content:

• The mechanism of adhesions in the small pelvis
• Reasons for the formation of adhesions in the small pelvis
• Symptoms of adhesions in the small pelvis
• Diagnosis of adhesions in the small pelvis
• Adhesions in the small pelvis after cesarean section
• Treatment of adhesions in the small pelvis

• Answers to popular questions:

  • Is it possible to get pregnant with adhesions of the fallopian tubes?
  • Is it possible to see small pelvic adhesions on ultrasound?
  • Can adhesions resolve on their own?
  • Is it possible to have sex with pelvic adhesions?

The mechanism of adhesions in the small pelvis

The inner side of the peritoneum and small pelvis is covered with parietal tissue, and the organs located in them are lined with visceral tissue. If no pathological processes and changes occur, then these tissues have a smooth and even surface. Both the visceral and parietal sheets produce peritoneal fluid, which allows the internal organs to move freely relative to each other.

This movement mechanism is very important. For example, as the uterus grows during pregnancy, it does not interfere with the intestines, or during the filling of the bladder, it easily shifts the uterus to the side. If any pathological processes are triggered in the small pelvis, then the tissues lining the internal organs are involved in them. In addition to the fact that they become edematous, fibrin plaque appears on them. Fibrin is designed to prevent inflammation from spreading to other organs. It has an adhesive structure and therefore bonds adjacent fabrics. However, such a protective reaction of the body is not always useful. If the inflammation is present for a long time, then after its completion, connecting cords are formed at this place.

If the infection enters the fallopian tubes, the inflammatory fluid does not always form. In the event that therapy is carried out quickly, inflammation can be eliminated to the exudative stage. This means that fibrin will not appear. However, when the exudate had time to form in large quantities, it, like a cork, will block the abdominal opening of the tube. Over time, this hole will be plugged in tightly. This process is called obliteration.

As a result, the fallopian tube continues to secrete exudate, which now has nowhere to go, and it begins to accumulate in its cavity. The ovary and the tube expand, lose their shape, the epithelium of the oviduct undergoes a desquamation process, the opposite surfaces stick together to form partitions between them.

If the exudate contains pus, then until the fallopian tube is blocked, it can pour into the uterine cavity, and from it into the vagina and go outside. Nevertheless, there remains a high risk that the infection will be carried into the ovary and it will melt, forming a pyovar. Purulent inflammation of only the pipe is called pyosalpinx, and non-purulent saktosalpinx or hydrosalpinx.

At first, only the fallopian tube is glued, then the ovary melted by pus is involved in the pathological process. In the place where they close, the capsule melts and a tubo-ovarian purulent formation occurs. Tubo-ovarian tumor, pyovar, pyosalpinx (hydrosalpinx) grow together with adhesions with the walls of the pelvis, with the uterus, with an intact ovary and tube, with an omentum, intestines, and bladder.

A tumor of this kind is very difficult to remove from the body. The operation requires a lot of time and effort on the part of the surgeon. Indeed, in addition to the very source of inflammation, you need to carefully dissect the adhesions without damaging the healthy organs attached to them. At the same time, it is necessary not to disrupt their blood supply.

Reasons for the formation of adhesions in the small pelvis

The reasons for the formation of adhesions in the small pelvis are varied, so it would be advisable to distribute them into five large groups:

1. Inflammation of the pelvic organs. It is the inflammatory processes that most often lead to the formation of connective tissue cords. It can be salpingo-oophoritis, endometritis, pelvioperitonitis, parametritis.

   The infection manifests itself against the background of the following provoking factors:

   • Infection with a genital infection. It can be chlamydia, ureaplasmosis, gonorrhea, etc.
   • Infection with Koch's stick. It has been established that the appendages of the uterus are a favorite site for localization of the tuberculosis bacteria.
   • Prolonged lack of treatment for pelvic inflammatory disease, or self-medication.
   • Surgical interventions on the uterus. This can be hysteroscopy, curettage, abortion, etc.
   • Installation of an intrauterine device.

   The risk that a woman will develop this or that provoking factor increases under the following conditions:

   • The absence of a permanent sexual partner, their frequent change. Refusal of condom contraception is of particular importance.
   • Violation of the rules of personal hygiene.
   • Power supply errors.
   • Hypothermia.
   • Low social status, resulting in poor living conditions.
2. Endometriosis Endometriosis is a disease that manifests itself in the proliferation of tissue similar to the endometrium in places where this should not occur. During your period, these overgrown areas also begin to secrete blood. It falls not only into the cavity of the diseased organ, but also into the cavity of the small pelvis. As a result, aseptic type inflammation begins there and the process of adhesion formation starts.

3. Operational interventions. Adhesions very often begin to form after a person has undergone surgery on the pelvic organs. During any surgical procedures, blood is poured out, the more there is, the higher the risk of developing aseptic inflammation with the subsequent formation of cords.

   The duration and severity of the operation are also important, since for the subsequent process of adhesion formation, favorable conditions are prolonged contact of internal organs with air, an abundance of superimposed sutures, oxygen starvation of tissues, drying out of the peritoneal sheets. A special place in the formation of adhesions is occupied by various injuries of the pelvic organs.

4. Blood entering the abdominal cavity and small pelvis. This always happens with pathologies such as ectopic pregnancy and ovarian apoplexy. Another condition in which blood enters the pelvis is its retrograde flow during the menstrual cycle. It is cast through the fallopian tube.
5. Appendicitis, as the most common inflammatory disease that requires surgery on the intestines. (Read also: Appendicitis in women and men - the first signs and symptoms)

However, the presence of any of the above reasons is not a prerequisite for a woman to form adhesions. If therapy is carried out on time and it is selected correctly, then it is quite possible to avoid the development of adhesive disease. The sooner a person begins to actively move (naturally within the limits permitted by the doctor) after undergoing operations on the pelvic organs, the less the risk of adhesions formation. The speed of the operation has a positive effect on the prevention of the formation of adhesions, if the speed of the doctor's actions does not harm the patient's health as a whole.

Symptoms of adhesions in the small pelvis

The more cords in the cavity, the wider the areas they occupy, the brighter the symptoms of pelvic adhesions will be.

It is customary to distinguish three forms of this pathological process:

• Acute form. For the acute stage of the adhesive process, severe pain is characteristic. Women complain of their constant increase, nausea and vomiting. The body temperature rises, the heartbeat speeds up. If the abdomen is palpated, then it gives off painful sensations. Acute intestinal obstruction often becomes a symptom of adhesive disease. This worsens overall health, a drop in pressure occurs, weakness, drowsiness develops, the amount of urine excreted decreases, and stool disappears. This condition requires emergency medical care, which often ends with surgery.
• Intermittent form. This form of adhesion is characterized by pain that occurs at regular intervals, possibly an intestinal disorder.
• Chronic form. Symptoms in this case may be completely absent, or very mild. They are expressed in recurrent pain in the lower abdomen, constipation. It is this form of the adhesive process that is the most common. Most often, the cause of their formation is either endometriosis or a latent genital infection. As a rule, a woman comes to an appointment with a gynecologist because she cannot conceive a child, and because of their low intensity, they simply do not pay attention to other symptoms.

Diagnosis of adhesions in the small pelvis

Diagnosis of adhesions in the small pelvis is rather difficult. The doctor cannot indicate their presence only on the basis of a standard examination, he is only able to put forward an assumption. In this case, it will be based on anamnesis data and characteristic symptoms. During a gynecological examination, the doctor establishes that the uterus or appendages have poor mobility, or are completely fixed. If there are a lot of adhesions, then painful sensations may occur during standard palpation.

To make sure that straps are present, it is necessary to conduct studies such as:

• Take a smear on the flora;
• Carry out PCR for latent genital infections;
• Conduct gynecological ultrasound examination;
• Perform an MRI of the pelvic organs.

Ultrasound and MRI data in terms of detecting pelvic adhesions are the most informative studies. In order to determine the patency of the uterine appendages, hysterosalpingoscopy can be performed. If it is broken, then this clearly indicates the presence of adhesions. However, even with normal patency of the appendages, it is impossible to deny the presence of strands.

Diagnostic laparoscopy is the most reliable method for detecting adhesions.

This technique is invasive, but provides the following information:

• Detection of adhesions of the first stage, when they are localized near the ovary, oviduct, uterus or near other organs, but the progression of the egg does not interfere.
• Detection of adhesions of the second stage, when the cords are located between the ovary and the oviduct, or between them and other organs, while the adhesions interfere with the passage of the egg.
• Adhesions of the third stage with torsion of the uterus, blockage of the tubes and their obstruction.

Adhesions in the small pelvis after cesarean section

Adhesions in the small pelvis after cesarean section are formed very often, due to the following factors:

• This operation is highly traumatic.
• Blood loss during the procedure is significant and can reach a volume of 1 liter.
• Caesarean section is often performed on an emergency basis, which is also an additional risk in the formation of adhesions.

Treatment of adhesions in the small pelvis

Treatment of adhesions in the small pelvis can be both conservative and surgical. It is necessary to deal with this issue even at the stage when the bands did not begin to form. Prevention is reduced to the appointment of absorbable therapy directly during the treatment of the detected inflammation, or immediately after the operation.

Conservative treatment of adhesions in the small pelvis after surgery

The sooner a person returns to normal life, the sooner power is restored, the better the prognosis for the development of adhesive disease. It is known that the formation of strands takes from 3 months to six months. Therefore, if there are no contraindications, then the patient is raised in the first hours after the performed abdominal operation. Dosed physical activity, early getting out of bed has a positive effect on the normalization of intestinal motility, and prevents the formation of adhesions.

It is important to normalize the patient's nutrition as soon as possible. It should be fractional, you need to eat at least 5 times a day. Serve small portions to avoid overloading the digestive tract.

If adhesive disease is already present, then one should be careful with respect to weight lifting and physical exertion. During and after surgery, fluids are injected into the pelvic cavity, which become an obstacle between the organs and prevent the formation of strands. These are liquids such as mineral oils, dextran in combination with glucocorticoids. The appendages of the uterus are immersed in an absorbable polymer film to prevent tubal infertility. This therapy is called adjuvant therapy.

The next stage of treatment is the appointment of fibrinolytic drugs, including:

• Sterptokinase, Trypsin, Chymotrypsin and other injectable drugs.
• Longidza in injectable form and in the form of suppositories.
• Physiotherapy, for example, electrophoresis with Lidase.

Antiplatelet agents (Trental, Heparin, Curantil) and anticoagulants are needed to thin the blood.

STD treatment

If a woman has genital infections, then she is prescribed antibiotics and anti-inflammatory drugs.

The appointment of hormonal drugs requires genital endometriosis.

Treatment of adhesions in the small pelvis of a chronic course

To get rid of the chronic form of the disease, it is necessary to use physiotherapy with fibrinolytics. The effect can be provided by the implementation of complexes of exercise therapy, massage, treatment with leeches. Perhaps intervaginal introduction of tampons with Vishnevsky ointment, intramuscular injections of Thiopental sodium.

If a woman is in pain, then she is prescribed antispasmodics - No-shpu, or Papavrin, as well as anti-inflammatory drugs, for example, Indomethacin, Ketonal, Voltaren.

You can, after consulting a doctor, practice yoga or body flex. Respiratory-posture gymnastics heals the body as a whole, while deep massage of internal organs is carried out in parallel, which helps to prevent adhesions. Often it is gymnastics that makes it possible to activate the inner potential and women who suffer from infertility become mothers. At the same time, the classes are not difficult, and they will take no more than 15 minutes a day to complete.

Surgical treatment of adhesions in the small pelvis

Often, to prevent adhesions, only conservative treatment is not enough and surgical intervention is required. It is carried out in case of acute development of adhesive disease. Laparoscopic technique is widely used for this purpose; after the operation, the patient is prescribed medications aimed at preventing the formation of adhesions. Indeed, even despite the fact that laparoscopy is a minimally invasive technique, it does not guarantee that the bands will not grow again.

How exactly to remove adhesions will be decided by the surgeon during the intervention. It is possible to eliminate them using a laser (laser therapy), using water (aquadissection) and using an electric knife (electrosurgery).

Answers to popular questions:

• Is it possible to get pregnant with adhesions of the fallopian tubes? In about 25% of cases, adhesions of the fallopian tubes lead to the development of infertility. If the damage to the tubes is not too pronounced, then after laparoscopy it is possible to conceive a child in 50-60% of cases. If, even after the laparoscopy, pregnancy does not occur, then it is advisable to think about IVF. So, the answer to this question is yes, with adhesions of the fallopian tubes, you can get pregnant, but most often this requires the help of specialists.
• Is it possible to see small pelvic adhesions on ultrasound? On ultrasound, only old, multiple adhesions will be clearly visible. In the early stages, it is almost impossible to detect them using ultrasound.
• Can adhesions resolve on their own? Sometimes, after childbirth, adhesions disappear on their own. The fact is that during pregnancy, the uterus is strongly stretched, which leads to the rupture of thin strands. However, this often leads to pain, which requires hospital treatment or pain relievers. In any case, this process must be supervised by medical personnel.
• Is it possible to have sex with pelvic adhesions? You can engage in sex with pelvic adhesions.

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.