Adnexitis

In gynecology, inflammation in the appendages (ovaries, fallopian tubes) occupy one of the first positions among diseases of the female reproductive system. Among doctors, inflammation in the fallopian tubes is commonly called adnexitis (salpingoophoritis).

Among young women, the disease is much more common and occurs for two reasons: infection in the fallopian tubes and secondary infection in inflammatory processes in other organs (appendicitis, etc.). Provoke inflammation in the appendages of chlamydia bacteria, streptococci, Escherichia coli, tuberculosis mycobacteria, and the like. Usually bacteria penetrate the vagina, the cervix, rarely they end up in the appendages with blood or lymph flow (usually in the tuberculosis process). Also, the infection can get during abortion, diagnostic curettage or other procedures inside the uterus. Usually, the inflammation of the ovaries proceeds in parallel with the inflammation of the fallopian tubes and, therefore, gynecologists, inflammatory processes in the small pelvis are perceived as one phenomenon.

[1], [2]

Causes of the adnexitis

Infection in the fallopian tubes is the main cause of the development of adnexitis.

Experts divide adnexitis into several species, depending on which microorganisms triggered the inflammation:

• nonspecific, caused by sexual infections (mycoplasma, chlamydia, etc.) or conditionally pathogenic microorganisms (E. Coli, streptococci, etc.);
• specific, caused by diphtheria, gonococcal, tuberculous bacteria.

Infection can get through the circulatory or lymphatic system, from the vagina (usually with genital infections) or from other internal organs (lungs, kidneys). However, infection in the body does not always lead to inflammation of the appendages, as for adnexitis, predisposing factors are necessary.

[3]

Symptoms of the adnexitis

Inflammation in the appendages leads to malfunctions of the menstrual cycle. Discharge usually becomes more scarce, the interval between menstruations increases, but in some cases, menstruation takes the form of prolonged and painful bleeding. Symptoms of adnexitis in chronic form are manifested in possible frequent exacerbations due to weakened immunity, infections, secondary infection. When the inflammation in the appendages worsens, the general well-being of a woman can worsen, the temperature rises, the pain in the lower abdomen increases, and purulent discharge from the vagina may also appear.

Pain with adnexitis

Adnexitis usually occurs with pulling pains in the lower abdomen, but the disease can be characterized by acute intense pain, giving back to the back or coccyx, nausea (vomiting), constipation. When pressing on the abdomen, the woman feels a sharp pain, sometimes with the tension of the abdominal muscles.

When such pains appear, it is important to immediately consult a doctor, because the disease is better treatable in acute form.

Temperature at adnexitis

High body temperature indicates an inflammatory process in the body. Adnexitis in acute form usually occurs with an increase in body temperature to 39 ^o C, in chronic course of the disease the temperature is usually normal or within 37 ^o C.

Discharge with adnexitis

Inflammation of the appendages leads to the appearance of secretions from the genital organs of a greenish or milky color, with an unpleasant odor. It is these secretions that cause irritation, burning and itching of the vagina. In color, you can identify an infection that provoked adnexitis (with gonorrhea, yellowish discharge, purulent, with trichomoniasis - greenish-yellow and bubble).

[4], [5]

Monthly for adnexitis

Adnexitis leads to a violation of the menstrual cycle, which is associated with dysfunction of the ovaries. With adnexitis, female sex hormones are produced in a reduced amount. Usually the monthly abundant, very painful, often clots appear. The disease leads to a malfunction of the menstrual cycle, the duration of excreta can become larger. However, in some cases, it may be all the opposite: the allocation is meager and lasts a couple of days.

Bleeding at adnexitis

Adnexitis is often accompanied by prolonged bleeding, which is associated with a violation of the menstrual cycle. In this case, the cycle decreases, and the allocation becomes more abundant.

[6]

What is the danger of adnexitis?

Adnexitis can occur with little or no obvious symptoms, and therefore, timely detection and treatment becomes difficult.

First of all, the disease is dangerous by various complications, in particular, spikes between the fallopian tubes and neighboring organs (bladder, uterus, omentum, intestine, etc.). When spikes appear purulent formations, which eventually lead to an ovarian abscess.

With suppurative adnexitis in the fallopian tubes, pus begins to accumulate, "pouches" are formed, filled with serous or purulent fluid (saktosalpinks). Also, the disease can be complicated by a tubovarial abscess, when the infection enters the peritoneum, inflammation, peritonitis and abscesses (rectovaginal, intercusine, etc.) begin.

With systematically exacerbated chronic inflammatory processes in the fallopian tubes, a woman develops disorders of sexual function, in particular pain during sexual intercourse, decreased desire, etc. With incorrect treatment of the acute form of adnexitis, in most cases, infertility develops, and the risk of ectopic pregnancy increases.

Forms

Under the abbreviation of the ICD it is customary to understand a special reference book with the classification of diseases. This manual was developed by the World Health Organization to systematize, analyze and compare data on diseases, mortality at different times and in different countries.

Now the ICD of the tenth revision is operating, in which alphanumeric coding systems began to be used. Due to the introduction of letters and numbers into the coding system, it became possible to increase coding structures more than twice.

According to the ICD, adnexitis belongs to the XIV class (diseases of the female genitourinary system) and has code N70. This encoding includes three subsections:

• N70.0 - acute oophoritis and salpingitis.
• N70.1 - chronic oophoritis and salpingitis.
• N70.9 - oophoritis and salpingitis, unspecified.

[7], [8], [9], [10]

Chronic adnexitis

Adnexitis becomes chronic after an incorrect or incomplete acute inflammation. When the disease worsens, the state of health worsens, the temperature rises, sexual dysfunction appears. Often in patients, digestive or urinary function is impaired. With chronic adnexitis in the abdomen there are frequent dull pains, which during sexual intercourse, menstruation, after exercise can become stronger. In chronic inflammation, the appendages of menstruation are usually meager and short, but can also be copious and prolonged (up to two weeks). With prolonged chronic adnexitis, infertility develops, which, as a rule, arises from the obstruction of the fallopian tubes caused by the adhesive process.

[11], [12], [13]

Chronic bilateral adnexitis

Bilateral chronic adnexitis affects the organs on both the left and right side. Usually, the onset of the disease affects only the fallopian tubes, then inflammation develops in the ovaries. Adnexitis quite often develops together with other diseases of the genito-urinary organs.

Two-sided inflammation in the appendages is provoked by bacteria of gonorrhea, tuberculosis mycobacteria, chlamydia, etc.

Escherichia coli, streptococcal, staphylococcus bacteria often provoke one-sided inflammation.

Infection often penetrates into the appendages with inflammation of the internal organs both located nearby (appendicitis) and located remotely (with pneumonia, angina), and unprotected sex can also become a source of infection. Quite often, the infection comes from the lower genital organs (the vagina), in particular Trichomonas, which can quickly enter the fallopian tubes. Sperm can also contribute to infection, especially with E. Coli.

With bilateral inflammation, there are abdominal pain, weakness, and fever. With prolonged inflammation in the tubes, the risk of ectopic pregnancy or infertility increases, due to the formation of adhesions.

[14], [15], [16]

Exacerbation of adnexitis

When the disease worsens in the lower abdomen, as well as the lower back, there are sharp and intense pains. In some cases, acute adnexitis occurs with bloating, nausea, constipation. When probing the abdomen, the patient feels a sharp pain, sometimes there is a tension in the abdominal muscles. With an acute form of the disease, the temperature rises to 390C. With the process running, inflammation can affect the peritoneum, which eventually leads to peritonitis and an abscess. With the accumulation of pus in the fallopian tube, a rupture of the organ and the entry of purulent contents into the peritoneum can occur.

[17]

Acute adnexitis

Acute adnexitis develops with a general inflammatory process, due to a decrease in protective forces and infection. Bacteria that provoke the disease fall into the organs of the small pelvis from the source of infection, in the role of which can be even a sore throat or sinusitis. Also, infection can occur during intercourse, menstruation, after interventions in the uterus, in particular abortion or diagnostic operations.

With exacerbation of adnexitis, the temperature rises, there are pains in the muscles, headaches, the waist, abdomen (lower part) also becomes quite sick, urination is impaired. The gynecologist on examination determines the enlarged and painful appendages. During inflammation of the uterus, a woman may have purulent discharge from the genitals.

[18], [19], [20]

Subacute adnexitis

Adnexitis in subacute form is rare, usually it occurs with inflammation of tuberculous or mycotic nature. Symptoms of subacute adnexitis are similar to the manifestation of an acute form of the disease, but it has a lower intensity and frequency (pain, purulent discharge, temperature, etc.).

Purulent adnexitis

Purulent adnexitis is usually a complication of gonorrhea. The disease can be of a polymicrobial or a specific nature. Also, the causes of purulent inflammation in the appendages can be labor, artificial termination of pregnancy, IVF, stress, excessive use of alcohol, drugs, various intrauterine operations, frequent changes in sexual partners, anal sex, intercourse during menstruation, hormonal contraceptives. One of the characteristic signs of the disease - aching pain in the abdomen, temperature, rubbing during urination, discharge from the genitals.

With a purulent form of the disease, the presence of gonorrhea, urethritis and other sexual pathologies is primarily determined in the sexual partner (in the past or in the present).

Purulent adnexitis is manifested by the soreness of the lower abdomen and rectum, dry mouth, fever, fever, weakness, dizziness, palpitations, cuts during urination, purulent discharge.

Two-sided adnexitis

Bilateral adnexitis develops as a result of an infectious disease, with the infection can penetrate into the fallopian tubes from almost any inflamed organ. With a general inflammation, the immunity decreases and the infection can progress unhindered to other organs. With frequent sexual contacts with different partners, intrauterine spirals, operations on the uterus, the risk of developing adnexitis increases.

As well as in other inflammatory processes of female genital organs, bilateral adnexitis is manifested by pain, temperature, weakness and general malaise, digestive system disorder, nausea.

As a result of untreated (or untreated) bilateral adnexitis, painful menstruation appears, a violation of the cycle. With bilateral inflammation of the appendages in the fallopian tubes, adhesions appear that impede the movement of the oocyte; in addition, a fertilized egg can attach itself to the tube, leading to an ectopic pregnancy (the most common complication of adnexitis).

Right-side adnexitis

With right-sided inflammation of the appendages, organs on the right side are affected. Symptoms have some characteristics that depend on the nature of the disease. First of all, there are pulling pains in the lower abdomen, lower back, which can increase during urination, physical stress, sexual contact. Like any other inflammation, adnexitis can occur with a high fever. In addition, with the disease there is a rapid fatigue, a deterioration in overall well-being.

The chronic form of right adnexitis provokes malfunctions of the menstrual cycle, a slight increase in temperature, constant pain of the lower abdomen.

Since there is an appendix on the right side of the peritoneum, the inflammation of which can occur with similar symptoms, it is necessary to seek the help of a specialist if any symptoms appear, which will help to avoid a serious and life-threatening complication.

The focus of inflammation in neighboring organs can cause the spread of infection through the body, for example, with appendicitis the probability of getting pathogenic microflora in the appendages increases. The risk of inflammation of the appendages is much higher with various surgical interventions in the uterus, for example, during the installation of a spiral or abortion. Some bacteria are in the body of a woman and up to a certain point they do not manifest themselves at all, but under favorable conditions (a decrease in immunity) microorganisms are activated and, getting into internal genital organs, cause inflammation.

If the treatment of adnexitis is started in acute or subacute form, the process of recovery will be much faster, a number of negative consequences of the disease can be avoided.

Left-side adnexitis

With left adnexitis, inflammation of the appendages occurs on the left side. Left-sided adnexitis, as in other cases, occurs after infection in the uterus and fallopian tubes as a result of abortions, childbirth, sexual intercourse, etc. And also under hypothermia, installation of the IUD, stress.

As a rule, the symptoms of left adnexitis depend on the cause of the disease, usually it is expressed by pains in the lower abdomen, irritability, fever, painful menstruation, sexual intercourse.

The chronic form of the left adnexitis is the result of untreated (not treated) inflammation of the appendages in an acute form. Chronic adnexitis during the periods of remission creates a feeling of full recovery, however, with an exacerbation the disease can proceed with greater intensity.

Left-sided adnexitis leads to dysfunction of the left ovary, the left fallopian tube becomes impassable for the ovule as a result of multiple adhesions.

Adnexitis in girls

Adnexitis can develop not only in women who have sex. This disease affects both young girls and teenage girls who do not have sexual intercourse.

Intestinal infections, purulent appendicitis, urinary tract infections - all this and much more can cause inflammation of the appendages. Also, chronic foci of inflammation (tonsillitis, otitis, tonsillitis, caries, etc.) can cause disease, since the infection can get into any organ with a blood stream. Usually, the disease causes E. Coli and staphylococcus.

If a girl already lives sexually, then in the first place adnexitis can develop due to infection of the genitals, abortion, sexually transmitted diseases.

[21], [22]

Pregnancy and adnexitis

Pregnancy is almost impossible with diseased appendages. Adnexitis is a threat when trying to conceive a child, primarily because of the increased risk of ectopic pregnancy, when it is impossible to avoid medical care. In addition, the risk of ectopic pregnancy is that it is practically no different from normal pregnancy, and is often detected even when the fallopian tube is ruptured.

With inflammation of the appendages during pregnancy, a complication is possible. First of all, with the infection of the mother, the risk of intrauterine infection of the child is extremely high. Even if the child has not contracted in utero, he can seize the infection while passing through the birth canal. In addition, with inflammatory processes in the female genitalia, the risk of spontaneous abortion (miscarriage) increases manifold. Also, pregnant women require special treatment, since antibiotics are not used in this state because of the high risk of pathologies for the fetus.

Can I get pregnant with adnexitis?

The majority of women who are diagnosed with adnexitis are experiencing whether it is possible to become pregnant with diseased appendages. This question can be answered only by a gynecologist, after a complete examination of the fallopian tubes. In the absence of adhesions, pregnancy is possible, but pregnancy with diseased appendages occurs with complications and often ends unfavorably (high risk of miscarriage or ectopic pregnancy).

During pregnancy, the immune forces of a woman are weakened, so if chronic form of adnexitis can begin to exacerbate.

[23], [24], [25]

Diagnostics of the adnexitis

In case of suspected adnexitis, the doctor first of all recognizes the patient's anamnesis (abortion in the past, complications with birth, intrauterine device, surgery with diagnostic or therapeutic purpose, sexually transmitted diseases, frequent change of sexual partners, unprotected sex, insufficient personal hygiene, genitourinary diseases and etc.).

After the survey, the specialist begins to inspect. If, during palpation, the patient experiences severe pain, strained abdominal muscles, then most likely the disease proceeds in acute form.

Laboratory studies are also required:

• bacterial sowing of the vagina, analyzes of the cervical and urethra, PCR;
• the analysis of a blood general.

With adnexitis, the color of the Gram stain is widespread, which requires the mucous contents of the cervix. This diagnosis allows you to identify gonococci. But with chronic adnexitis this test does not show any results, therefore sometimes resort to provocative methods:

• analysis of menstrual blood from 2 to 4 days, when there is more chance to identify pathogenic microorganisms, which live on other days deep in the appendages;
• food factor (alcohol, spicy, food, etc.);
• biological, chemical, physiotherapeutic provocation (use of special substances or procedures);
• use of several methods.

Ultrasound examination of the internal organs in the small pelvis allows to obtain rather extensive information and assess the condition of the appendages, to reveal new growths in pregnancy (intrauterine or normal).

Ultrasound is used when, due to severe pain, the doctor can not normally feel and examine the woman.

Also, if necessary, laparoscopy, MRI, computer diagnostics can be prescribed.

[26]

Diagnosis of chronic adnexitis

With chronic adnexitis specialist during the examination determines the lack of mobility of appendages, muscle tension.

One of the diagnostic methods for suspicion of chronic adnexitis is hysterosalpingography, which helps to determine the patency of the fallopian tubes. This diagnosis consists in carrying out an X-ray examination of the uterus, as well as adjacent organs.

[27]

Diagnosis of acute adnexitis

Acute adnexitis has symptoms similar to appendicitis. Severe pain, fever, fever, nausea - all these conditions can occur with acute inflammation of the appendages, and with appendicitis. Determine the cause of malaise can only be in the hospital. Usually during gynecological examination, when palpation there is a strong sharp pain, which indicates an acute process of inflammation. In some cases, ultrasound is assigned to confirm the diagnosis and exclude other pathologies.

[28], [29], [30], [31]

Adnexitis on ultrasound

Ultrasound examines the internal organs with a special device with ultrasonic waves. Current ultrasound devices have a special transvaginal sensor that allows you to scan the female genitalia and get more detailed information about the location and features of the inflammatory process.

Transvaginal ultrasound is the most valuable method of diagnosis. With the help of special sensors inserted into the vagina of a woman, a specialist can identify changes in the appendages and have education.

[32], [33]

Differential diagnosis of adnexitis

Differential diagnostics allows to separate adnexitis from such diseases as ovarian cyst, endometriosis, genital organs diseases, acute appendicitis, etc. It is important for a specialist to study the received analyzes, ultrasound data as well as possible, and also the surgeon's consultation is necessary.

[34], [35], [36]

Treatment of the adnexitis

During the treatment of inflammation in the internal organs, the main emphasis is on suppressing the infection in the body, preventing the likely serious consequences of the disease, restoring the reproductive function of the woman.

With adnexitis, the main thing is to start treatment in time, to conduct stage-by-stage and complex therapy. Chronic adnexitis is difficult to treat, in the first place, because the cause of inflammation in most cases remains unknown.

The inflammatory process during pregnancy presents some difficulties in the treatment, since many effective drugs are forbidden to use during pregnancy. In severe cases, adnexitis treatment is performed under steady-state conditions. Obligatory hospitalization is required for girls under the age of 20, inflammation in the appendages after intrauterine intervention, suspected purulent complications, immunodeficiency, long-term outpatient treatment, with no positive results, and inflammation during pregnancy, because in this case the risk of infection of the fetus and the complication of pregnancy activity) is increasing.

At the beginning of the disease, antibacterial therapy is started (preferably intravenously or intramuscularly) - amoxiclav, azithromycin, ofloxacin, etc. When the symptoms and inflammatory processes abate in the appendages, antibiotics are administered orally.

In the chronic process, a combined antimicrobial treatment is prescribed (preparations of different groups). When prescribing antibacterial drugs, the doctor must necessarily assign an analysis to the susceptibility of microorganisms.

In addition to antibiotic therapy in the treatment of adnexitis, anti-inflammatory, immunomodulating, anti-allergic agents are used. To antibacterial drugs acted more efficiently and for the prevention of adhesions in the organs of the small pelvis are assigned enzyme means.

Surgical treatment is prescribed only when drug treatment does not have a positive effect, the general condition of the patient is extremely severe or a purulent complication has begun.

When surgical treatment, try to keep the uterine tubes as much as possible, while completely removing the focus of inflammation. If there is a need, an additional operation is performed to restore the patency of the fallopian tubes.

In the recovery period after the operation, physiotherapy procedures, spa treatment, biological stimulants are used. Immunostimulating, resorptive, anti-inflammatory treatment continues. In some cases, considering the results of the examinations and the patient's condition, the doctor can prescribe hormonal drugs (oral contraceptives).

Good means in addition to traditional methods of treatment are folk remedies for fighting this disease. Eliminates the painful sensations in the lower abdomen, inflammation, swelling - an enema of chamomile infusion (1 item of boiling water, 1 item of a spoon of dried flowers). In the beginning it is recommended to make a cleansing enema with pure boiled water, then 2-3 enemas with chamomile infusion are made, after which it is necessary to lie on one side. Such treatment is performed once a day, preferably before bedtime. In severe cases (severe inflammation, pain, etc.), the procedure is recommended to be repeated several times a day.

Vitamins with adnexitis

Adnexitis is a fairly serious disease that requires an integrated approach to treatment. In addition to antibiotics, antimicrobials, immunomodulators in the treatment of vitamins is very important. Depending on the condition of women, receptivity, vitamins are selected individually. Can use both tablets (capsules) and injections.

Sports with adnexitis

It is recommended to exercise with care when inflamed appendages. Contraindicated exercises, especially involving the abdominal muscles, with adnexitis in acute form.

Adnexitis is almost always painful, so physical exercise can adversely affect a woman's health (pain, bleeding, etc.). In this regard, exercise is better to postpone until complete recovery.

Diet with adnexitis

In acute and subacute form of adnexitis, it is extremely important to pay attention to proper nutrition and to exclude from the diet any allergic products. It is also necessary to control the consumption of calories - no more than 2300 per day. The diet should consist of easily digestible products, preferably be stewed or boiled.

With adnexitis, it is necessary to add foods rich in vitamin C to the diet, which will help to increase the defenses of the body and speed up the healing process (bell peppers, citrus fruits, cranberries, pomegranates, etc.). Failures in the work of the digestive system can provoke congestion and inflammation. In addition, antibiotic therapy can further exacerbate the situation. To avoid digestive disorders, it is necessary to consume more vegetables (in boiled or stewed) with a small amount of vegetable oil, fermented milk products. It is also important to drink a sufficient amount of liquid (not less than 1.5 liters). Drink better non-carbonated water, fresh, juices, unsweetened compotes and green tea. You should also eat a few times a week, low-fat varieties of meat and fish, greens (parsley, spinach, onions, etc.).

When the disease worsens, you need less to eat salty foods, sweets, foods high in carbohydrates. During the adnexitis coffee, cocoa, muffins, sweets, salty, smoked, spicy foods, canned goods, carbonated sweet drinks and factory-made juices are completely excluded.

[37], [38]

Prevention

To prevent adnexitis, women are advised to follow personal hygiene, use linen from cotton materials. Also, adnexitis can be prevented if dressing according to the weather, do not freeze. Also good prevention of inflammatory diseases is strengthening of immunity, regular exercise, systematic intake of vitamin complexes, adherence to a healthy lifestyle and proper nutrition.

In a more acute stage, and also during the month after the main symptoms abate, tampons should not be used.

Adnexitis often develops after infection in the sexual organs of a woman (after accidental connections, artificial termination of pregnancy or natural childbirth, etc.), so it is extremely important to monitor your hygiene and follow the doctor's recommendations after surgery in the uterus.

[39], [40], [41], [42], [43], [44]

Forecast

In most cases, with the timely delivery of a diagnosis and effective treatment, adnexitis passes almost without consequences. But in the event that the disease is caused by infection (gonorrhea, tuberculosis), as well as with chronic neglected inflammation, there can be quite serious complications, for example, infertility.

Adnexitis can be triggered by a variety of bacteria, which usually enter the vagina during intercourse. Also the disease contributes to poor hygiene, reduced immunity. At risk are women who have an active sex life, and in the past have had infectious diseases (trichomoniasis, chlamydia) or suffered frequent intrauterine interventions (abortions, diagnostic curettage, etc.).