Chronic adnexitis - what is it? Symptoms and treatment

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Chronic adnexitis - what is it? Symptoms and treatment
Chronic adnexitis - what is it? Symptoms and treatment
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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 eliminated in a timely manner, 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 face infertility.

Adnexitis - what is it in women?

Adnexitis
Adnexitis

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 bursting follicle.

Extensive inflammation in adnexitis contributes to the formation of a conglomerate from the ovary and fallopian tube, and then there is the formation of a tubo-ovarian abscess. The patency 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 may be the rupture of the tubo-ovarian abscess.

Dangerous complications in chronic inflammation of the appendages:

  • Accession of anaerobic infection;
  • Development of sepsis,
  • Peritoneal perforation.

Chronitization of adnexitis occurs as a result of incorrectly chosen tactics for the treatment of acute salpingo-oophoritis. The characteristic features of the chronic form of the disease are a sluggish course with recurrent exacerbations, the need for more complex and prolonged treatment.

According to ICD-10, the chronic form of the disease has the code N70.1 (chronic salpingitis and oophoritis).

Symptoms of chronic adnexitis

Symptoms of chronic adnexitis
Symptoms of chronic adnexitis

Distinguish between 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.

Acute adnexitis

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 \u200b\u200breach 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. Pain is given to the sacrum, rectum, leg.

When palpation of the abdomen, symptoms of peritoneal irritation, its soreness and tension are diagnosed. Urination may become frequent and accompanied by a burning sensation. The woman feels a headache, as a symptom of intoxication, no appetite.

During a gynecological examination in the mirrors, serous-purulent or purulent secretion from the opening of the cervical canal is fixed. The size and shape of the appendages is very difficult to determine, they are enlarged, have limited mobility. When conducting laboratory tests, an acceleration of ESR, an excess of the number of leukocytes, the amount of C-reactive protein is revealed.

Chronic adnexitis

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 muscle tissue, causing swelling of one or both tubes.

The tube lengthens and increases in volume, it is easy to detect on palpation. Together with the tubal fluid, the infection spreads into the serous membrane and into the tissues of the peritoneum. 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 cords are formed, exudation is observed, and a hydrosalpinx may appear. A tubal obstruction often results in an ectopic pregnancy.

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

  • A woman experiences aching pains in the lower abdomen, radiating to the vagina and to the lumbar region.
  • On palpation, the abdominal wall is moderately painful.
  • Due to functional changes in the ovaries, expressed in a decrease in estrogen production and the absence of ovulation, the menstrual cycle is disturbed in women. Menstruation becomes too scarce, or, conversely, abundant, they proceed accompanied by pain syndrome (algomenorrhea).
  • Sexual intercourse with chronic adnexitis is painful, libido is reduced.
  • The disease complicates the work of the digestive, endocrine, urinary and nervous systems, causing 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 strands, adhesions) are recorded in the mirrors.

The beginning of a relapse can be determined by the appearance of chills, pain in the lower abdomen at rest and during urination. On palpation, the appendages are not felt clearly enough, but pain is noticeable in the area of \u200b\u200btheir location. A laboratory blood test shows an acceleration of ESR and an increase in the number of leukocytes.

Symptoms of adnexitis outside periods of exacerbations:

  • Constant subfebrile temperature (about 37°);
  • Dull or slightly throbbing pain in the lower right or left of the navel, aggravated before menstruation and during expected ovulation;
  • Pain during intercourse, after exercise, hypothermia or stress;
  • Disorders of the menstrual cycle associated with the volume of menstrual flow and the duration of menstruation;
  • Headache and weakness as symptoms of intoxication.

The clinical picture of the disease, lasting for many years, often has very poor manifestations. The fact that a woman has chronic adnexitis, the doctor finds out when she complains about the inability to conceive a child.

Causes of chronic adnexitis

Causes of chronic adnexitis
Causes of chronic adnexitis

The onset of the disease is provoked by pathogenic and opportunistic microorganisms. The causative agents of specific adnexitis are tuberculosis 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 infection into the reproductive system:

  • Ascending - from the cervix, from the vagina;
  • Descending - from the organs in which the inflammatory process occurs (for example, appendicitis);
  • Lymphogenic - with lymph flow;
  • Hematogenous - with blood flow (typical for tuberculous adnexitis).

Factors that increase the likelihood of developing the disease:

  • Hypothermia;
  • Stress;
  • Promiscuous unprotected sex;
  • Violations of intimate hygiene;
  • Intrauterine manipulations - abortion, hysteroscopy, diagnostic curettage, removal and insertion of the intrauterine device, metrosalpingography;
  • Complicated childbirth;
  • Removing the appendix;
  • Reduced immunity due to an infectious or somatic disease, HIV infection.

The development of chronic adnexitis is based on untreated or not treated acute and subacute adnexitis at all.

Chronic adnexitis and pregnancy

Chronic adnexitis and pregnancy
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 he althy baby.

If the diagnosis of "chronic adnexitis" was made during pregnancy, the doctor prescribes therapy with drugs that are as harmless as possible to the unborn child. Antibiotic treatment of pregnant women is usually not practiced in order to avoid negative consequences for the child, the doctor chooses safe drugs from other pharmaceutical groups. However, leaving a focus of inflammation in the reproductive system of a pregnant woman untreated is very dangerous, because the risk of abortion or fetal fading increases.

Consequences and complications of chronic adnexitis

Consequences and complications
Consequences and complications

As a result of the chronic inflammatory process in the ovaries, their functionality is disrupted. In this case, conception becomes impossible, as the egg loses its ability to fertilize. Due to ovarian dysfunction, menstrual cycles become irregular.

Infertility due to tubal obstruction is the most severe consequence of chronic adnexitis. Clumped tissues of the fallopian tubes completely block the ability for the sperm to reach 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 the movement through 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, ovulation disorders;
  • Transition to 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 patient with a chronic form of adnexitis conceives a child, she may develop intrauterine infection, spontaneous abortion, premature birth.

Diagnosis of chronic adnexitis

Diagnosis of chronic adnexitis
Diagnosis of chronic adnexitis

To diagnose salpingo-oophoritis, you should consult a gynecologist. The doctor will study the history, conduct a gynecological examination, during which painful and inactive appendages are fixed.

What interests the doctor during the history taking:

  • Did the patient have an abortion or complicated delivery;
  • Was the IUD ever inserted;
  • Have you had intrauterine procedures and salpingography.

To determine the type of infectious agent that caused inflammation and 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:

  • Vaginal ultrasound;
  • CT, MRI of the reproductive system;
  • Echography to determine the presence or absence of adhesive process;
  • X-ray of the uterus and ovaries;
  • Hysterosalpingography to determine the patency of the fallopian tubes.

Treatment of chronic adnexitis

Treatment of chronic adnexitis
Treatment of chronic adnexitis

Treatment of this disease takes a long time, however, with the exact implementation of the doctor's recommendations, positive dynamics are 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, with the exception of 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 a complex, using medical and physiotherapeutic methods.

Therapy of salpingo-oophoritis is carried out in bed rest in a gynecological hospital. A woman is prescribed a special diet with restriction of seasonings and carbohydrates. It is recommended to apply cold to the abdomen to relieve pain and inflammation.

Drug therapy includes broad-spectrum antibiotics, a combination of two or more drugs:

  • Clindamycin (2 g twice a day) + Gentamicin;
  • Klaforan IM (1-0.5 g twice a day) + Gentamicin IM (80 mg three times a day);
  • Lincomycin IM (0.6 g three times a day);
  • Cefobid IM (1 g twice a day) + Gentamicin;
  • Cefazolin IM (1 g twice daily) + Ciprofloxacin IV (100 ml twice daily).

Metronidazole is administered orally at the same time, 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, Reopoliglyukin, Hemodez, saline solutions with a volume of 2-3 liters is prescribed.

NSAIDs used as pain relievers by mouth, rectal suppositories or injections:

  • Ibuprofen (Nurofen, Faspik, Ibuklin);
  • Ketorolac (Ketorol, Ketanov);
  • Diclofenac (Voltaren, Ortofen, Diclak, Naklofen).

Additionally prescribe antihistamines (Cetrin, Suprastin, Pipolfen) to prevent an allergic reaction, vitamin complexes.

For the treatment of adnexitis outside the period of exacerbations, physiotherapy procedures are used:

  • Electrophoresis with iodine or lidase;
  • Ultrasound treatment;
  • Electrophoresis with copper and zinc by phases of the menstrual cycle;
  • Treatment with high frequency impulse currents.

To restore well-being, they use autohemotherapy, treatment with immunomodulators, injections of aloe, Longidase, FIBS. Excellent results are obtained by spa treatment with mud, paraffin baths, baths and douches.

Treatment of adnexitis with candles

Vaginal and rectal suppositories are extremely effective in the treatment of this disease, because they act in close proximity to the site of inflammation. Candles relieve pain, their components actively resist the action of bacteria.

Most frequently assigned:

  • Movalis - analgesic, used for 5-7 days;
  • Fluomizin - used once a day before bed as an antibacterial agent;
  • Polygynax - suppositories with anti-inflammatory effect, used for 10-14 days;
  • Voltaren - have an analgesic effect;
  • Hexicon - approved for use during pregnancy as an antibacterial and anti-inflammatory agent;
  • Indomethacin - rectal suppositories with anti-inflammatory effect;
  • Suppositories with belladonna extract - effective against pain.

Do not use suppositories without a doctor's prescription, which will take into account the characteristics of the course of the disease and possible contraindications.

Prevention of chronic adnexitis

Prevention of chronic adnexitis
Prevention of chronic adnexitis

To prevent the acute form of the disease from transforming into chronic adnexitis, it is necessary to carry out a course of treatment in a timely manner under the guidance of the attending physician with strict observance of his recommendations. To prevent exacerbations, it is recommended to periodically conduct courses of therapy with therapeutic mud, spa treatment. In order not to provoke an inflammatory process, stressful situations and hypothermia should be avoided.

Sexual relations with a regular partner, the use of condoms will avoid infection of the reproductive system with sexually transmitted diseases.

Don't swim in cold water and sit on cool surfaces, refuse warm underwear in winter.

Intimate hygiene rules must be strictly observed:

  • It is recommended to wash daily with warm water;
  • Shower regularly;
  • Required frequent change of sanitary pads during menstruation;
  • It is advisable to stop using hygienic tampons for the duration of 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.

Disease prognosis

If chronic adnexitis is treated 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 a gynecologist increases the risk of infertility, menstrual irregularities, and ectopic pregnancy.

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