Pelvic adhesions

Adhesions in the small pelvis are formations that often occur after surgical or invasive interventions in the pelvis, which can disrupt the topography of organs and cause severe pain. Structurally, adhesions are a product of the layering of fibrin and other connective tissue elements. The course of the adhesive process in the small pelvis can be of varying severity, from asymptomatic to a pronounced clinical picture, which requires proper diagnosis and correction of this process.

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Epidemiology

The epidemiology of the development of adhesions in the pelvis is such that more than 75% of surgical interventions are sooner or later complicated by the formation of adhesions, and this is every second woman who has undergone surgery. The number of adhesions after an open cesarean section is twice as high as after laparoscopic operations. More than 45% of cases of abdominal pain syndrome and ovariomenstrual cycle disorders are a consequence of the formation of adhesions in the pelvis. Given the prevalence of the problem, it is necessary to take primary preventive measures in relation to the adhesion process in the pelvis.

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Causes pelvic adhesions

Speaking about the causes of adhesions, it is necessary to first understand the pathogenesis of these elements. The mechanism of connective tissue regeneration is the same, regardless of the place of formation. When there is any tissue damage, the body tries to restore the structure of this damaged tissue. And normally, this regeneration process occurs due to the intensive division of cellular structures. If the process of cellular regeneration does not have time to recover, then the body thus replaces the tissue defect due to the intensive synthesis of fibroblasts and the formation of connective tissue. Connective tissue strands are strengthened by fibrin threads, which are formed as a result of vascular damage and the release of its degradation products. Thus, in order for the process of fibrin release and synthesis of connective structures to begin, vessel damage and the release of plasma elements are necessary. Therefore, the main condition for the onset of adhesion formation is damage to the peritoneum and vessel. The main reason for the formation of adhesions in the pelvis is any surgical intervention. In this case, cellular synthesis is activated in response to damage and regeneration is stimulated by attracting mediators, which in turn lead to the activation of fibroblasts. As a result of these processes, there is an increase in the synthesis of fibrin, which can accumulate in the regeneration sites and further deepening of these changes occurs. This is why postoperative adhesions in the small pelvis are so common.

Adhesions in the pelvis after a cesarean section are a very common occurrence, since this operation is very common, and it also leads to the processes described above. During this operation, intervention is performed on the pelvic organs with subsequent revision of the uterus and parauterine space, which is a factor of external intervention and this disrupts the processes of normal regeneration with the subsequent formation of connective tissue bridges. They can attach not only to the uterus, but also to the ovaries, rectum, bladder, which contributes to the development of certain clinical symptoms.

But surgical interventions are not the only reason for the development of this pathology. Chronic inflammatory processes of the pelvic organs are the second most common cause of the formation of adhesions. This creates very favorable conditions for maintaining a sluggish inflammatory process, which is maintained by constant proliferation. Thus, chronic inflammation in the ovary is accompanied by the constant presence of neutrophilic leukocytes, granulocytes, monocytes and fibroblasts - all these cells damage the normal structure of the peritoneum, which is a condition for the constant process of proliferation and regeneration of connective cells and fibrin. Therefore, there are favorable conditions for the development of adhesions.

Another, less common, cause of adhesions is a violation of the topography of the pelvic organs, which may be due to congenital defects in the structure and location of the genitourinary system. In this case, a violation of the normal location of the organs is a provoking factor for the onset of adhesion formation.

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Risk factors

Considering all possible causes of this pathology, it is necessary to identify a risk group of women who need to be monitored for the detection of adhesions. This will help reduce not only the problem with ovariomenstrual cycle disorders, but also reduce female infertility, which can still be cured at this stage of fibroplastic changes. This group includes:

1. women after cesarean section, which is the main factor in the development of processes of enhanced regeneration of the peritoneum;
2. women who have had an induced abortion;
3. inflammatory diseases of the ovaries – chronic or previous acute adnexitis, oophoritis, ovarian apoplexy, cyst, removal of the ovary or any surgical intervention on the uterus;
4. hypoplasia of the uterus or ovaries of congenital or acquired etiology;
5. external genital endometriosis;
6. previous surgeries on the bladder, rectum or other pelvic organs;

All these risk factors are a potential threat to the development of adhesions in the pelvis, so it is necessary to take these reasons into account and take preventive measures.

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Symptoms pelvic adhesions

Very often this pathology develops asymptomatically and changes progress to the extent of the absence of treatment measures. This is explained by the fact that for the formation of clinical symptoms it is necessary for a certain organ to be involved in the process. And this happens very slowly, until the moment when adhesions are significant and strands are formed from the walls of the small pelvis to the organs. This disrupts their topic and normal function, which subsequently leads to the appearance of complaints.

The first signs of the adhesion process in the pelvis most often manifest as pain syndrome. This is due to the fact that there are many nerve plexuses in the pelvis and a huge number of nerve endings on the peritoneum of the pelvis. Therefore, when the peritoneum is stretched, it is irritated, which manifests itself as pain and heaviness in the abdomen. Pain with adhesions in the pelvis has its own characteristics: the pain is dull, constant, localized in the lower abdomen. They can intensify due to menstruation, which may be due to compression of nerve endings when the uterus increases. Such pain syndrome is not intense and is poorly treated with antispasmodics. The peculiarity of such pain is that they are of the same type and do not intensify, do not have a progressive nature. If the nature of the pain has changed or if the localization has changed, then it is worth thinking about it, because this may be a sign of complications.

Adhesions in the pelvis and pregnancy are a very important issue, especially for women of reproductive age. The localization of adhesions is very important in terms of the normal ovariomenstrual cycle and the fertilization process. If connective tissue is formed on the ovary, it prevents the egg from leaving the follicle, so the ovulation process is defective. In this case, the egg simply does not reach the uterine cavity and fertilization does not occur. Therefore, adhesions on the ovaries can have clinical manifestations in the form of infertility. If adhesions are localized between the pelvic wall and the fallopian tube, then there is also an obstacle to the normal movement of the sperm, which complicates the fertilization process due to problems with the patency of the fallopian tubes. Symptoms of a chronic inflammatory process of the tubes or ovaries arise, which occurs due to the maintenance of a chronic source of infection. In this case, symptoms of a chronic intoxication process occur in the form of periodic or constant maintenance of subfebrile body temperature, lethargy and weakness, decreased performance, periodic or constant mild pain syndrome. These symptoms should also be paid attention to, since they may indicate such a pathology. Therefore, a frequent cause of infertility without obvious disruptions in the normal function of the uterus and ovaries can be adhesive processes in the small pelvis. If adhesions are localized on the wall of the uterus and the woman becomes pregnant, then during the enlargement of the uterus with the growth of the fetus, these adhesions can cause compression of organs and blood vessels, which can disrupt normal blood circulation. This should also be taken into account when planning a pregnancy.

Sometimes adhesions in the small pelvis localized on the ovaries can disrupt their normal functioning so much that the structure of the stroma and glandular structure of the organ changes and the function is disrupted. This is manifested primarily by disruptions of the ovariomenstrual cycle. Often these two pathologies are not linked, but it is necessary to remember that such reasons can also exist. In this case, disruptions in the form of ovarian insufficiency occur more often and this occurs as amenorrhea. Such delays can be up to two to three months, and then, when the amount of hormones is restored, normal menstruation can resume.

Symptoms of pelvic adhesions may also manifest as pathological discharges if the adhesions are the cause of a chronic inflammatory process. Such discharges may be green or yellow, in small quantities, with inflammation of the same ovary. There may also be bloody discharges if the adhesions are accompanied by a change in the topic of the fallopian tubes and secondary trauma. Then there may be minor bloody discharges after active physical exertion. But more often, discharges indicate secondary processes.

The diversity of clinical manifestations of the adhesive process in the pelvis indicates that it is necessary to conduct a very thorough diagnosis and differential diagnosis of the clinical symptoms of the disease for the correct treatment tactics.

The localization and prevalence of the process are very important for clinical manifestations of pathology. Therefore, for better diagnostics and prognosis of clinical development, several stages are distinguished:

1. the adhesion process is limited to only one space without serious deformations of the tubes and ovaries;
2. adhesions cover the ovaries, tubes, uterus;
3. the adhesion process deforms the fallopian tube, changing the topic and spreading to surrounding organs - the bladder, rectum.

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Complications and consequences

The consequences and complications of adhesions in the pelvis depend on the stage of the disease. The most important complication of such adhesions in women of childbearing age is infertility. This happens if the process has spread to the fallopian tubes and caused a change in the topic of the organs. What is the danger of adhesions in the pelvis? A pronounced adhesive process can maintain chronic foci of infection in the ovary or tubes for a long time, which is important to consider during treatment. Then such chronic oophoritis and adnexitis are difficult to treat. Pronounced adhesions of the pelvis with significant progression of the process can lead to spread to the abdominal cavity and the development of intestinal obstruction.

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Diagnostics pelvic adhesions

Diagnosis of the adhesion process of the small pelvis is complicated by the fact that this process is difficult to determine without visual confirmation. Therefore, the variety of complaints in this pathology should be brought to a preliminary diagnosis and, using additional methods, establish a final diagnosis. Therefore, it is very important to establish and detail the complaints, as well as find out the patient's life history.

It is necessary to find out about the nature of the pain, its localization, duration, reaction to analgesics, as well as to find out the dynamics of the symptoms and whether they have changed recently. Such detailing of complaints is also necessary for further differential diagnostics. From the anamnesis data, it is necessary to find out what surgeries the woman has had, whether there were any pregnancies and how the birth went, as well as the presence of ovarian and uterine diseases. It is important to find out the time of the last menstruation, their regularity and nature. Further, during the examination, it is possible to identify indirect signs of the adhesion process. During bimanual palpation of the uterus, its insufficient mobility can be determined, and with large adhesions, a unilateral infiltrate can be determined that is not painful or moderately painful. But this process should not be excluded if there are no specific changes during the examination of the woman in the mirrors, because the process is difficult to diagnose.

Tests that can be carried out for the purpose of differential diagnostics, since there are no specific laboratory signs of this pathology. In case of chronic inflammatory process in the ovary due to formation of adhesions, it is possible to determine changes in the general blood test - leukocytosis with neutrophilic shift of the formula to the left, acceleration of ESR. This should prompt the idea of a chronic inflammatory process. It is also necessary to conduct a study of a vaginal smear for bacterial flora - this will make it possible to identify the causative agent of this chronic infection. But the underlying cause of the inflammatory process, such as adhesions, should always be kept in mind. Therefore, instrumental diagnostic methods are important.

There are no specific symptoms when conducting instrumental diagnostics, and the nature of the changes depends on the size of the adhesive conglomerates. Adhesions during ultrasound examination look like heterogeneous echo signals of varying intensity, which are located in the form of strands from the walls of the small pelvis to the organs. But it is very difficult to differentiate and confirm these changes, so preference is given to more informative methods.

Hysterosalpingography is a method in which the uterine cavity and tubes are filled with a contrast agent and an X-ray examination is performed. In this case, any defects in the filling of the tubes in the ampullar part and the degree of filling with contrast can be seen, which can be used as a basis for diagnosing the adhesion process. It is possible to determine the degree of disruption of the topic of the uterus, fallopian tube and ovary in connection with the development of connective tissue and establish the stage of the disease.

But the main method of diagnosing and confirming adhesions in the pelvis is laparoscopy. This is a visual diagnostic method, which consists of inserting a camera through a special conductor into the pelvic cavity, which allows one to directly see the nature of the changes and their prevalence. The diagnostic value of this method increases due to the fact that it is possible to simultaneously perform surgical intervention, during which the pelvic cavity is revised. This is an accessible and minimally invasive method, which can also be used for differential diagnostics of a volumetric process in the pelvis, adhesions, and congenital disorders of the pelvic organs.

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Differential diagnosis

Differential diagnostics of adhesions in the pelvis is very broad due to the fact that complaints and symptoms can be very different. If the main complaint of a woman is infertility with a full examination and exclusion of other causes, then it is necessary to differentiate a possible adhesion process and ovulation disorders. With luteal phase insufficiency, ovulation may not occur, which must be taken into account in the differential diagnostics of adhesions, which can be accompanied by a violation of the release of the egg. Therefore, to exclude hormonal causes of ovulation disorders, it is necessary to conduct hormonal screening, and only then think about mechanical factors.

When a significant conglomerate of adhesive etiology is detected on the ovary or uterus during palpation, differential diagnostics with tumor processes should be performed. In this case, an ovarian tumor is often painless, does not move and does not have clear contours. A tumor or uterine myoma leads to deformation of the uterus itself, and it is localized in the thickness of the organ. Sometimes, in order to differentiate the tumor process, magnetic resonance imaging is necessary.

It often happens that there is a need to differentiate ovarian adhesions with a cyst. In this case, the main thing is ultrasound, which can accurately determine the changes characteristic of a cyst in the form of a cavity with clear edges and echo-negative contents.

Careful differentiation of complaints and additional diagnostics are very important for establishing a diagnosis and choosing treatment tactics.

Treatment pelvic adhesions

Treatment of adhesions in the pelvis is necessary only if they cause any symptoms. Medicinal methods in this case should be used during exacerbation of processes, and if the process is not expressed, then physiotherapeutic and folk methods have priority.

If there is a pronounced inflammatory process against the background of pelvic adhesions, then it is necessary to carry out etiological treatment. Therefore, in the treatment it is necessary to use a complex of antibiotics and anti-inflammatory agents. The advantage belongs to the antibiotic to which the flora isolated from the vagina is sensitive. Suppositories for adhesions in the pelvis have a good effect due to their local effect.

1. Neotrizol is a combination product that contains two antibacterial drugs (neomycin and ornidazole), an antifungal drug (miconazole) and a hormonal drug (prednisolone). Due to this composition, it has a broad spectrum of action and, due to its local action, helps to get rid of chronic inflammation. The drug is available in tablet pharmacological form and the dosage is one tablet at night for an eight-day course. How to use the drug - one vaginal tablet must be inserted into the applicator and inserted into the vagina with the applicator at night. After this, you need to lie down for some time in a horizontal position for better action of the drug. Precautions - during pregnancy, treatment with this drug is not recommended due to the hormonal agent it contains. Side effects are rare due to the predominantly local action of the drug, but dizziness and headache may occur, as well as local burning and itching in the vagina.
2. Dicloberl is an anti-inflammatory drug used in combination therapy with an antibacterial drug for severe pain syndrome, as well as to accelerate the resorption of adhesions. This is achieved by activating immune defense cells in the inflammation site and reducing the severity of edema. The active ingredient of this drug is diclofenac (a non-steroidal non-narcotic anti-inflammatory drug). The drug is available in the form of rectal suppositories, the dosage of the drug is 500 milligrams of the active substance in one suppository. Method of administration - one suppository per day should be used rectally. Side effects are possible with damage to the mucous membrane of the stomach, esophagus, duodenum, which can be detected by epigastric pain syndrome. The effect of the drug on the blood system causes inhibition of the formation of formed elements with a decrease in all peripheral forms of blood cells. This can cause symptoms of dizziness, fainting, palpitations, decreased blood pressure, and edema syndrome. Precautions: Do not use during early pregnancy.
3. Longidaza is an enzyme preparation that can be used at the second stage of treatment, when the inflammatory process has been treated. Lidase for adhesions in the pelvis has a targeted effect on connective tissue, since it breaks down glycopeptide bonds. Due to this, the targeted action helps to carry out specific proteolytic therapy. The active substance of the drug is hyaluronidase (a natural proteolytic enzyme). The drug is available in ampoules for intramuscular administration and the dosage of the drug is 1500 and 3000 international units. The method of administration of the drug is intramuscular, 3000 units of the drug per day, the course of treatment is from ten days to three weeks. The course of treatment can be repeated if necessary. Side effects are possible only in the form of allergic reactions and irritation at the injection site. Precautions - it is undesirable to use the drug during pregnancy and breastfeeding.
4. Terrilitin is a drug that contains proteolytic proteins. This drug has proteolytic activity in relation to connective tissue, so it can be successfully used to improve the dynamics of resorption of adhesions on the ovaries as a combination therapy. The drug is available in the form of vaginal suppositories, which improves their effect when used locally. The method of using the drug is one suppository vaginally twice a day. Side effects can be in the form of local symptoms of itching in the vagina. Systemic side effects include increased heartbeat and a feeling of a rush of heat to the face. Precautions - do not use tampons with the drug in case of damage to the uterine cavity or after recent surgeries.

These are the main medications that should be used in certain situations as prescribed by a doctor.

Vitamins do not have a specific effect in the treatment of adhesions, but as part of complex therapy they improve blood circulation and normalize the immune status, including local.

Vishnevsky ointment for adhesions in the pelvis does not have a specific effect on adhesions, but can be used in the complex treatment of the inflammatory process.

Traditional treatment of pelvic adhesions

Traditional methods of treating this pathology are aimed at improving blood circulation, lymph flow in the pelvis, which improves the processes of cell proliferation and the amount of connective tissue decreases. This can be used at any stage of the disease, since these methods are not so harmful and can be used for a long time. The main traditional recipes are as follows:

1. Leeches are used for adhesions in the pelvis due to their ability to improve blood circulation due to the increased effect on the blood coagulation system. The extract that leeches secrete has the ability to thin the blood, which improves blood circulation in the pelvis and enhances the process of adhesion resorption. For such treatment, it is necessary to contact specialists who are engaged in this treatment and know the exact technique, which can be done in many private clinics.
2. Compresses from medicinal herbs are very useful and effective in the treatment of adhesions of the pelvic organs. For such compresses, you need to take yarrow and morinda leaves, pour hot water over them and make a compress from gauze. Such a compress should be placed on the lower abdomen and covered with a warm woolen cloth on top. The duration of such a compress should be at least two days. The course of treatment is ten days.
3. Compresses using Kalanchoe are very useful, as this plant contains many vitamins and proteolytic agents that activate polysaccharides and promote the breakdown of their bonds. This helps to more effectively dissolve adhesions. For a compress, you can use Kalanchoe juice and add a few drops of Longidaza from an ampoule to it - this enhances the beneficial properties of such a compress.

Herbal treatment also has its advantages, as they can be used instead of tea, which not only helps treat adhesions, but also normalizes the work of female hormones and the function of the genitals.

1. St. John's wort for adhesions in the pelvis is highly effective, since it improves the trophism of all organs and normalizes the proliferative activity of cells. For a medicinal solution, you need to take a liter of hot water and pour five tablespoons of dried St. John's wort leaves with this water. This solution is infused for three hours, and then you need to douche. It is better to do this at night with a small pear. The course of treatment is three weeks.
2. Orthilia secunda is a plant that is widely used in gynecology, as it has many properties - antitumor, resorption, anti-inflammatory. For treatment, use a water infusion of this herb, which is prepared according to standard rules - for three tablespoons of dry herb you need to take a liter of boiled water. You need to use half a glass of this tea twice a day, the course of treatment is seven days.
3. A solution of oak bark helps to normalize metabolic processes in cells and reduce the number of fibroblasts in places where adhesions form. To prepare it, take one hundred grams of dry oak bark, pour boiling water over it and boil for half an hour. Then, when the solution has cooled, take 100 grams of this infusion instead of tea twice a day.

Homeopathic methods of treating adhesions are also widely used:

1. Adonis vernalis is a homeopathic remedy of plant origin, which is effective in concomitant inflammatory diseases of the ovary. Dosage and method of administration of the drug - seven granules three times a day, keep in the mouth until completely dissolved. Side effects are possible in the form of a cough, which has a dry character. Precautions - patients with bronchial asthma should use the drug with caution.
2. Calcarea carbonica is a homeopathic remedy based on inorganic material. It is used to treat adhesions in patients with a pronounced exudative component. Method of application - under the tongue, dosage - ten drops of solution three times a day. Side effects are rare, allergic reactions are possible.
3. Ratanya is a single-component homeopathic preparation, the main active ingredient of which is a plant. The drug is recommended for the treatment of adhesions, which are accompanied by bloody discharge and disrupted ovariomenstrual cycle. The drug is released in the form of standard homeopathic granules and its dosage is ten granules three times a day. Method of application - under the tongue after meals after half an hour. Precautions - do not use if you are allergic to conifers. Side effects can be in the form of menstrual irregularities, which disappear after dose adjustment.
4. Calendula is a homeopathic remedy based on calendula infusion, diluted according to certain methods. The drug is available in the form of an infusion, which is used as a compress. Method of application - gauze should be soaked in the solution and placed on the lower abdomen overnight. Precautions - with severe itching, the drug can cause increased symptoms.

Surgical treatment of adhesions is used in the second and third stages of the disease, when neighboring organs are involved in the process. In this case, surgical intervention is recommended for women who are planning a pregnancy. The most accessible method is cutting adhesions with a scalpel. But such surgical intervention has a drawback, since after this, adhesions often form again. There are also alternative methods - this is the use of an electric knife or laser excision. In this case, in addition to removing adhesions, there is a parallel "cauterization" of connective tissue cells, so the process of further synthesis is not so significant. This is the advantage of laser surgery - adhesions form again very slowly, but this method is not available everywhere. During such surgical intervention, special absorbable agents can be applied to the ovaries, which can prevent further changes for a long time.

Laparoscopy of adhesions in the pelvis can be used as the most accessible and effective method in the absence of an alternative, since the intervention is minimal, and the excision of adhesions can be carried out very effectively.

Physiotherapeutic treatment of adhesions is carried out in the absence of acute and chronic inflammation during the remission period. The most common method of physiotherapeutic treatment is electrophoresis with enzymes - lidase, trypsin, chymotrypsin. These enzymes, with the help of ions, are able to penetrate deep into adhesions and better break down their bonds. A course of seven to ten electrophoresis sessions is recommended. Magnetic therapy also has a good effect, which enhances cell ionization and also reduces the severity of the process.

Gymnastics for adhesions in the pelvis helps to normalize blood circulation and stretches the adhesions that form, thus normalizing the normal position of the organs in the pelvis. The exercises should not be abrupt, with an emphasis on working out the muscles of the pelvis and the press. Massage of adhesions in the pelvis can also be used in complex treatment.

Bodyflex for adhesions in the pelvis, according to many patient reviews, helps in the resorption of the adhesion process and normalizes the function of all organs. This is a method that is a type of aerobics using the technique of proper breathing, which saturates all cells with oxygen. This has a general tonic and strengthening effect on the body, and also makes the cells renew themselves with a sufficient amount of oxygen, which is very important for the active resorption of adhesions. Therefore, this method can be recommended, which is useful for the whole body.

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Prevention

Prevention of adhesions in the pelvis is non-specific and includes timely diagnosis and treatment of inflammatory processes, avoidance of unscheduled surgical interventions and artificial termination of pregnancy, as well as timely consultation with a doctor and pregnancy planning.

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Forecast

The prognosis for life of this pathology is favorable, but if such a problem occurs in a young woman and in case of untimely treatment, pregnancy complications can be expected, given that this process is irreversible. Therefore, it is necessary to engage not only in primary prevention, but also in secondary prevention - it is better to treat adhesions at the first stage.

Adhesions in the pelvis are a problem that is not diagnosed as often as it can be the cause of ovariomenstrual cycle disorders, pain syndrome and other pathologies of the female reproductive system. Therefore, the importance of this problem regarding diagnosis and timely treatment comes to the fore, which is very important in preventing complications.

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