Adhesions in the pelvis: symptoms, treatment, adhesionsafter cesarean section

Update: October 2018

Adhesions of the pelvic organs today received
fairly widespread. Especially this condition
concerns women who are not only responsible for development
infertility, but also causes extremely unpleasant sensations.

The prevalence of adhesive disease is associated with an increase in indications for
surgery, an increase in the percentage of hormonal
impairments and the number of people who have suffered or suffered from diseases
that are sexually transmitted. Therefore currently given
The problem is of such urgency.

Pelvic adhesions: what is it?

About pelvic spikes say when in it, on the peritoneum and
internal organs appear tyazh consisting of connective
tissue. Adhesive disease is a problem to be solved
very difficult, and treatment requires maximum patience, as a doctor,
and from the patient. Spikes overtighten and restrict movement
pelvic organs create obstacles to their normal
functioning, and, most importantly, often cause
женского infertility

Mechanism of occurrence of adhesions

As you know, all the internal organs of the abdominal cavity and small
the pelvis is covered with peritoneum (visceral), and the abdominal cavity themselves and
the pelvis is lined with a parietal peritoneum that covers them with
outside. Normally, the peritoneum has a smooth surface and
emits some amount of fluid (peritoneal) that
necessary for free bias relative to each other
pelvic organs.

For example, during pregnancy, the growing uterus is absolutely not
interferes with intestinal loops or filled bladder
freely “shifts” the uterus to the side. With возникновении
provoking factors of adhesive disease (for example, inflammation in
pelvic) tissues involved in the process swell, and on the visceral
the peritoneum is fibrin bloom.

Fibrin is a very sticky substance, therefore
соединяет друг с другом близлежащие tissue. It’s so peculiar
defensive response of the body to prevent the spread of
inflammation further. If the inflammatory process takes a long time or not
subjected to adequate treatment, then after the attenuation of the disease on
place glued surfaces occur adhesions.

If an infection penetrates the fallopian tubes,
inflammatory exudate is necessarily formed. With соответствующей
therapy, inflammation subsides even before its transition to exudative
stage with the formation of effusion and fibrin. If exudate occurred
stand out then it is able to dissolve without further consequences
(education adhesions) for the patient.

And only a small proportion of patients contribute to the process.
spread of infection, and, consequently, exudate (serous
either purulent) throughout the oviduct. Inflammatory secret is able
pour into the abdominal cavity, which causes fibrin to fall out,
which clog the abdominal opening of the tube, and later it
generally closes tightly (obliterated).

Thus, the fallopian tube is converted into a closed cavity.
If the process was purulent, then pyosalpinx (pyo-pus,
salpinks – pipe). In case of open uterine opening of the oviduct
pus can pour into the uterus and then out into the vagina. But
the danger lies in the fact that with purulent inflammation of the tube
infectious agents either with exudate or through the blood can
get into the ovary, which will lead to its purulent melting and
the formation of pyovar.

With этом по мере течения заболевания в трубе и яичнике
exudate accumulates, they significantly increase in size and
change their shape (the tube resembles a retort, and the ovary ball). AT
the oviduct mucosa is partially peeling epithelium
(desquamation) and opposite surfaces are glued together, and between
they arise partitions.

This leads to the formation of a multi-compartment sacculate.
education. If the exudate was serous, it forms
hydrosalpinx or sactosalpinx, and if purulent, then pyosalpinx.
AT дальнейшем склеиваются, а затем срастаются пиосальпинкс и пиовар,
in the places of their compounds the capsules melt, which is called
purulent tubo-ovarian formation. Hydro or pyosalpinx,
pyovar or tubo-ovarian tumor often have pelvic adhesions
from the healthy side of the walls, uterus, oviduct and ovary,
urea, stuffing box and intestines.

By the way, such inflammatory tumors are very difficult and
long to operate, in addition to removing the source of exudate is necessary
dissect spikes, highlight education without damaging attached to
them healthy organs and provide decent hemostasis. Operation
requires not only a thorough knowledge of the pelvic anatomy and the ability to
a surgeon, but also patience.

What leads to the formation of adhesions?

Withчины спаечного процесса обусловлены разнообразными факторами
and conditionally they can be divided into several groups:

Diseases caused by inflammation in organs
pelvic floor

This is the most frequent factor, such diseases include such
common diseases like endometritis, salpingo-oophoritis,
parametritis, and, of course, pelvioperitonitis (inflammation of the small peritoneum
pelvis). Prevent the spread of infection the following
conditions:

  • hidden genital infections (myco-and ureaplasmosis, chlamydia and
    other);
  • female genital tuberculosis (favorite localization –
    the fallopian tubes);
  • self-medication and inadequate treatment of inflammatory
    diseases;
  • intrauterine manipulation (curettage of the uterus and abortion,
    hysteroscopy and others);
  • use of intrauterine device.

The following factors provoke the above conditions:

  • frequent and indiscriminate change of sexual partners, the rejection of
    barrier contraception;
  • neglect of intimate hygiene rules;
  • hypothermia and malnutrition;
  • unfavorable housing conditions.

Endometriosis

Endometriosis характеризуется разрастанием ткани, похожей на
structure on the endometrium in places not typical for it. In the process
menstrual cycle endometrial foci undergo changes
how the endometrium and produce menstrual blood, which
pours not only into the affected organ, but also into the pelvis. Blood in
pelvic causes aseptic inflammation and contributes to the process
formation of adhesions.

Surgical interventions

Various operations performed on the pelvic organs and
abdominal cavity due to mechanical damage to the tissues and the discharge
in the pelvic cavity blood also contribute to the occurrence
aseptic inflammation and the formation of adhesions. And what
the longer and more traumatic the operation, the higher the risk of education
postoperative adhesions (contact of tissues with air and instruments,
bleeding during surgery, stitching on damaged
organs, tissue hypoxia and their drying). In addition,
injury mechanism also contributes to the adhesion mechanism.

Pouring blood into the pelvis and abdominal cavity

Speaking about this group of factors, it is necessary to mention such
diseases, when always blood enters the abdominal cavity:
ectopic pregnancy and ovarian apoplexy. Also possible
penetration of blood into the pelvis in a condition such as
retrograde blood request through the fallopian tube during
monthly

But it should be remembered that adhesions are not formed in all
listed cases. For example, there is an inflammatory disease.
heal promptly and adequately, then adhesions may not occur.
In addition, early activation of patients after abdominal operations
prevents the formation of adhesions, and the desire of surgeons to perform
the operation is faster, all the more.

Inflammatory diseases of organs located in the abdominal
areas

First of all, appendicitis refers to this group.

The clinical picture of adhesive disease

When the pelvic spikes, the intensity of the symptoms directly depends
on their number and extent of distribution. During adhesions
diseases there are 3 forms of the disease:

Acute form

This form of the disease is characterized by considerable intensity.
The patient complains of a progressively increasing pain syndrome, her
vomiting and nausea, fever, increased
pulse. Palpation of the abdomen is determined by a sharp pain.
Often develop acute intestinal obstruction, in which
condition worsens: fall in blood pressure,
the occurrence of weakness and drowsiness, reduced diuresis
(due to a violation of water-salt and protein metabolism).
This situation requires immediate operational
interventions.

Intermittent form

Spike pains are characterized by periodicity, often
there are intestinal disorders (diarrhea, alternating constipation).

Chronic form

The clinic is sufficiently hidden. Or it is not at all, or periodically
pains of a whining character appear in the lower abdomen and constipation occurs.
Gynecologists most often in women with pelvic adhesions face
with chronic form. It is usually associated either with not
diagnosed with endometriosis, or with hidden infections.
Patients usually go to a doctor for a long time.
absence of pregnancy, as for the remaining signs, if they
is, do not pay attention.

Diagnostics

It is quite difficult to diagnose spikes in the pelvis. With
initial treatment to the doctor, he can only suspect the disease,
based on anamnesis and typical complaints. With бимануальном
the study of the pelvic organs gynecologist can be determined or their
immobility (uterus and appendages are reliably “fixed”) or their
limited displaceability. In case of significant
adhesions palpation of the uterus and appendages is very painful.
To clarify the diagnosis are assigned additional studies:

  • smears on the vaginal microflora;
  • PCR diagnostics for hidden genital infections;
  • Gynecological ultrasound;
  • MRI of the pelvic organs.

Ultrasound and magnetic resonance imaging for the most part, but 100%
allow you to diagnose adhesions. Also assigned
hysterosalpingography to determine the patency of the pipes. With
detecting their obstruction can always talk about the presence of adhesions
in the pelvis, but when they passable to deny the presence of adhesions
process is impossible.

For reliable diagnosis used diagnostic
laparoscopy. With осмотре pelvic cavities reveal adhesions,
the degree of their distribution and massiveness. In laparoscopic
the picture has 3 stages of the prevalence of adhesions:

  • Stage 1 – adhesions are located around the oviduct, ovary, or in
    another area, but do not interfere with the capture of the egg;
  • Stage 2 – adhesions are located between the oviduct and the ovary or
    between these anatomical structures and other organs and
    cause difficulty in capturing the egg;
  • Stage 3 – the fallopian tube is twisted, the tube is blocked
    spikes that speaks of the absolute impossibility of capturing
    ovum.

Adhesions after abdominal delivery

The adhesions after cesarean section almost all
mandatory effects of the operation.

  • First, a cesarean section is abdominal surgery and
    It is performed with a high traumatic tissue.
  • Secondly, massive blood loss during surgery (from 600 to
    1000 ml) is also an important factor in
    spike formation.
  • In addition, often caesarean section is performed by emergency
    indications that is one of the reasons for the development
    postoperative metroendometrita and further contributes
    the formation of adhesions.

Treatment

Of course, in the topic of adhesive disease the question: “How to treat adhesions
in the pelvis? ”remains the main. There are 2 methods of therapy
connective tissue strands: conservative and operative. Treatmentм
adhesions in the pelvis should be dealt with even at the “pre-articular” stage, then
eat prophylactically or proactively. This implies early
the appointment of absorbable therapy immediately after detection
significant inflammatory process or during
operations. But it is important to note that most often doctors combine both
treatment method, as they complement each other.

Conservative therapy after surgery

After abdominal surgery, patients are immediately recommended.
normalize nutrition and lifestyle, given that development
adhesive disease takes 3 to 6 months, when the first
the signs. After surgery of patients, in the absence of
contraindications, activate in the first day. Getting up early
out of bed and slight physical exertion not only activates
intestinal motility, but also prevent the formation of adhesions. at once
and in the future such patients will be given split meals up to 5 – 6
once a day in small portions so as not to overload the stomach and
small intestine and do not provoke the last adhesion
on intestinal obstruction.

In addition, patients with the threat of adhesions or
diagnosed with adhesive disease should refuse to rise
weights and heavy physical exertion. At runtime
surgery and after it is the so-called adjuvant therapy,
which includes an introduction to the pelvic cavity of fluids that
act as a barrier between organs and prevents
spike formation: dextran, mineral oils and other in
together with glucocorticoids, and also immerse the fallopian tubes
in the polymer absorbable film to prevent pipe
infertility

Then, in the postoperative period shown fibrinolytic
facilities:

  • Trypsin, chymotrypsin, streptokinase and others in injections
  • Physiotherapy (electrophoresis with lidazy)
  • The drug Longidase (candles,
    injections).

Also shown in the postoperative period are anticoagulants and
antiplatelet agents (chimes, trental, heparin) that thin the blood
and reduce the risk of adhesions.

Genital infections

  • In case of detection of urogenital infections shows the appointment
    antibacterial drugs in adequate dosage and
    anti-inflammatory drugs (glucocorticoids, NSAIDs).
  • If genital endometriosis is detected, hormone replacement is prescribed.
    therapy.

Chronic adhesive disease

  • If a chronic form of adhesive disease is diagnosed,
    treatment also includes physiotherapy with enzymes –
    fibrinolytics, physical therapy and massage, hirudotherapy
    (treatment with leeches).
  • A good absorbing effect has the introduction
    Intravaginal tampons with Vishnevsky ointment (up to 20 – 30 times) and
    sodium thiopental injections.
  • With возникновении болей показан прием спазмолитиков (но-шпа,
    papaverine) and NSAIDs (ketonal, indomethacin, voltaren).

With хронической спаечной болезни, если нет противопоказаний,
Very effective are yoga or bodyflex (breathing and pose
gymnastics). Bodyflex has a healing effect on the whole
organism, massage of internal organs takes place (especially organs
pelvic), which contributes to the resorption of spec, many women with
Problem conception become moms, starting daily classes.
Gymnastics is not complicated, does not require the services of a coach, you can perform
at home, just 15 minutes a day.

Surgery

Almost necessarily, pelvic adhesions occur after surgery,
Of course, other mechanisms for the development of the disease are not excluded. AND,
as a rule, conservative treatment alone remains
ineffective. It is mandatory shown surgical
intervention in the development of acute adhesive disease. As
surgical treatment is applied laparoscopy adhesions followed
the appointment of conservative therapy, since even gentle
laparoscopic surgery does not preclude the formation of new
connective tissue cords. How exactly to dissect and remove adhesions,
The gynecologist decides already during the operation. There are 3 types
separating them:

  • laser therapy – cords are cut using a laser;
  • aquadissection – separation of cords is carried out with the help of water,
    supplied under pressure;
  • electrosurgery – dissection is performed by an electrocautery.

Folk therapy

Folk treatment of adhesions is possible, and sometimes gives good
results, only it should be applied under the supervision of a physician and in
combined with other conservative therapies. Alone
folk remedies to get rid of adhesions is impossible, as well, and
from other diseases, and a long, and especially unsystematic reception
those or other decoctions, crust and other things at best
turn out to be useless, and at worst provoke a deterioration of the condition.
As a folk treatment, infusions of flowers or
plantain seeds, parsley and dill seeds, etc.

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