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Adhesions in the pelvis are found very often, especially this problem is relevant for women. For them, adhesions pose a serious threat in the form of the development of infertility, not to mention the pronounced discomfort and pain that they cause.
The explanation that adhesive disease of the small pelvis is very common lies in several reasons: a systematically increasing number of diseases requiring surgical intervention, the growth of various hormonal pathologies, the coverage of the population with sexually transmitted diseases. In this regard, the relevance of the problem of pelvic adhesions is simply impossible to ignore.
Pelvic adhesions – These are connective tissue strands that are located on the peritoneum and on the internal organs. Therapy of adhesive disease requires a professional approach and close interaction between the doctor and the patient. They should not be left unattended, as they disrupt the functioning of internal organs, limit their mobility, provoke pain and often cause impossibility of fertilization.
The mechanism of occurrence of adhesions in the pelvis
The inner side of the peritoneum and small pelvis is covered with parietal tissue, and the organs located in them are lined with visceral tissue. If no pathological processes and changes occur, then these tissues have a smooth and even surface. Both visceral and parietal sheets produce peritoneal fluid, which allows the internal organs to move freely relative to each other.
This movement mechanism is very important. For example, as the uterus grows during pregnancy, it does not interfere with the intestines, or during the filling of the bladder, it moves the uterus to the side without any problems. If any pathological processes are triggered in the small pelvis, then the tissues lining the internal organs are involved in them. In addition to the fact that they become edematous, fibrin plaque appears on them. Fibrin is designed to prevent inflammation from spreading to other organs. It has an adhesive structure and therefore connects adjacent tissues. However, such a protective reaction of the body is not always useful. If inflammation is present for a long time, then after its completion, connecting cords form at this place.
If the infection enters the fallopian tubes, then the inflammatory fluid is not always formed. In the event that the therapy is carried out quickly, the inflammation can be eliminated to the exudative stage. So, fibrin will not appear. However, when the exudate managed to form in large quantities, it, like a cork, will block the abdominal opening of the tube. Over time, this hole will clog tightly. This process is called obliteration.
As a result, the fallopian tube continues to secrete exudate, which now has nowhere to go, and it begins to accumulate in its cavity. The ovary and tube expand, lose their shape, the epithelium of the oviduct undergoes a process of desquamation, the surfaces opposite each other stick together with the formation of partitions between them.
If the exudate contains pus, then until the fallopian tube is blocked, it can pour into the uterine cavity, and out of it into the vagina and out. However, there remains a high risk that the infection will be introduced into the ovary and it will melt, forming a pyovar. Purulent inflammation of only the tubes is called pyosalpinx, and non-purulent sactosalpinx or hydrosalpinx.
At first, only the fallopian tube undergoes gluing, then the ovary melted with pus is involved in the pathological process. In the place where they close, the capsule melts and a tubo-ovarian purulent formation occurs. Tuboovarian tumor, pyovar, pyosalpinx (hydrosalpinx) grow together with adhesions with the walls of the pelvis, with the uterus, with an intact ovary and tube, with the omentum, intestines, and bladder.
A tumor of this kind is very difficult to remove from the body. The operation requires a lot of time and effort on the part of the surgeon. After all, in addition to the very source of inflammation, you need to carefully cut the adhesions without damaging the healthy organs attached to them. At the same time, their blood supply must not be interrupted.
Reasons for the formation of adhesions in the pelvis
The reasons for the formation of adhesions in the pelvis are diverse, so it would be advisable to distribute them into five large groups:
Inflammation of the pelvic organs. It is inflammatory processes that most often lead to the formation of connective tissue strands. It can be salpingoophoritis, endometritis, pelvioperitonitis, parametritis.
The infection manifests against the background of the following provoking factors:
Sexual infection. It can be chlamydia, ureaplasmosis, gonorrhea, etc.
Infection with Koch’s wand. It has been established that the uterine appendages are a favorite place for the localization of tuberculosis bacteria.
Prolonged lack of treatment for pelvic inflammatory disease, or self-medication.
Operative interventions on the uterus. It can be hysteroscopy, curettage, abortion, etc.
Installation of an intrauterine device.
The risk that a woman will have one or another provoking factor increases under the following conditions:
The absence of a permanent sexual partner, their frequent change. Of particular importance is the refusal of contraception using a condom.
Violation of the rules of personal hygiene.
Nutritional errors.
Subcooling.
Low social status resulting in poor living conditions.
Endometriosis. Endometriosis is a disease that manifests itself in the growth of tissue similar to the endometrium in places where it should not occur. During menstruation, these overgrown areas also begin to secrete blood. It gets not only into the cavity of the diseased organ, but also into the cavity of the small pelvis. As a result, inflammation of the aseptic type begins there and the process of formation of adhesions starts.
Operational interventions. Adhesions very often begin to form after a person has undergone surgery on the pelvic organs. During any surgical procedures, blood is poured out, the more it is, the higher the risk of developing aseptic inflammation with the subsequent formation of strands.
The duration and severity of the operation is also important, since for the subsequent process of adhesion formation, favorable conditions are prolonged contact of internal organs with air, an abundance of sutures, oxygen starvation of tissues, and drying of the peritoneum sheets. A separate place in the formation of adhesions is occupied by a variety of injuries of the pelvic organs.
Entry of blood into the abdominal cavity and small pelvis. This always happens with pathologies such as ectopic pregnancy and ovarian apoplexy. Another condition in which blood enters the small pelvis is its retrograde reflux during the menstrual cycle. Throwing occurs through the fallopian tube.
appendicitis, as the most common inflammatory disease requiring surgical intervention on the intestines. (See also: Appendicitis in women and men – the first signs and symptoms)
However, the presence of any of the above reasons is not a prerequisite for a woman to form adhesions. If therapy is carried out on time and it is chosen correctly, then it is quite possible to avoid the development of adhesive disease. The sooner a person begins to actively move (of course, within the limits allowed by the doctor) after undergoing operations on the pelvic organs, the lower the risk of adhesion formation. The speed of the operation has a positive effect on the prevention of the formation of adhesions, if the speed of the doctor’s actions does not harm the patient’s health as a whole.
Symptoms of adhesions in the pelvis
The more strands in the cavity, the larger the area they occupy, the brighter the symptoms of pelvic adhesions.
It is customary to distinguish three forms of this pathological process:
Sharp form. For the acute stage of the adhesive process, severe pain is characteristic. Women complain of their constant strengthening, nausea and vomiting. Body temperature rises, heart rate accelerates. If the abdomen is palpated, then it is given by painful sensations. Acute intestinal obstruction often becomes a symptom of adhesive disease. This worsens the general state of health, there is a drop in pressure, weakness, drowsiness develops, the amount of urine excreted decreases, the stool disappears. This condition requires emergency medical care, which often ends with surgery.
Intermittent the form. This form of adhesive process is characterized by pain that occurs with a certain frequency, possibly intestinal upset.
Chronic form. Symptoms in this case may be absent completely, or manifest very weakly. They are expressed in recurrent pains in the lower abdomen, in constipation. It is this form of adhesive process that is the most common. Most often, the cause of their formation is either endometriosis or a latent sexual infection. As a rule, a woman comes to an appointment with a gynecologist because she cannot conceive a child, and they simply do not pay attention to other symptoms due to their low intensity.
Diagnosis of adhesions in the pelvis
Diagnosis of adhesions in the pelvis is quite difficult. The doctor cannot indicate their presence only on the basis of a standard examination, he is only able to put forward an assumption. In this case, it will be based on the data of the anamnesis and characteristic symptoms. During a gynecological examination, the doctor determines that the uterus or appendages have little mobility, or are completely securely fixed. If there are a lot of adhesions, then painful sensations may occur during standard palpation.
To verify the presence of strands, it is necessary to conduct such studies as:
Take a smear on the flora;
Carry out PCR for the presence of latent genital infections;
Conduct a gynecological ultrasound examination;
Perform MRI of the pelvic organs.
Ultrasound and MRI data in terms of detecting pelvic adhesions are the most informative studies. In order to determine the patency of the uterine appendages, hysterosalpingoscopy can be performed. If it is broken, then this clearly indicates the presence of adhesions. However, even with normal patency of the appendages, it is impossible to deny the presence of strands.
Diagnostic laparoscopy is the most reliable method for detecting adhesions.
This technique is invasive, but it provides the following information:
Detection of adhesions of the first stage, when they are localized near the ovary, oviduct, uterus, or near other organs, but the advancement of the egg is not hindered.
Detection of adhesions of the second stage, when the strands are located between the ovary and the oviduct, or between them and other organs, while the adhesions interfere with the passage of the egg.
Adhesions of the third stage with torsion of the uterus, blockage of the tubes and their obstruction.
Adhesions in the pelvis after caesarean section
Adhesions in the pelvis after cesarean section are formed very often, due to the following factors:
This operation is highly traumatic.
Blood loss during the procedure is significant and can reach a volume of 1 liter.
Caesarean section is often performed on an emergency basis, which is also an additional risk in the formation of adhesions.
Treatment of adhesions in the pelvis
Treatment of adhesions in the pelvis can be both conservative and surgical. It is necessary to deal with this issue even at the stage when the strands have not begun to form. Prevention is reduced to the appointment of resolving therapy directly during the treatment of the detected inflammation, or immediately after surgery.
Conservative treatment
The sooner a person returns to normal life, the sooner he restores nutrition, the better the prognosis for the development of adhesive disease. It is known that the formation of strands takes from 3 months to six months. Therefore, if there are no contraindications, then the patient is raised in the first hours after the performed abdominal operation. Dosed physical activity, early rise from bed has a positive effect on the normalization of intestinal motility, prevents the formation of adhesions.
It is important to normalize the nutrition of the patient as soon as possible. It should be fractional, you need to eat at least 5 times a day. Portions should be given out small, which will not overload the digestive tract.
If adhesive disease is already present, then one should be careful about lifting weights and physical activity. During surgery and after its completion, fluids are injected into the pelvic cavity, which become an obstacle between the organs and prevent the formation of strands. These are liquids such as mineral oils, dextran in combination with glucocorticoids. The uterine appendages are immersed in an absorbable polymer film to prevent tubal infertility from developing. This therapy is called adjuvant therapy.
The next stage of treatment is the appointment of fibrinolytic drugs, performing physiotherapy, taking antiplatelet agents and anticoagulants.
STD treatment
If a woman has genital infections, then she is prescribed antibiotics and anti-inflammatory drugs.
The appointment of hormonal drugs requires genital endometriosis.
Treatment of adhesions in the pelvis of a chronic course
To get rid of the chronic form of the disease, it is necessary to use physiotherapy with fibrinolytics. The effect can be provided by the implementation of exercise therapy complexes, massage, treatment with leeches. Perhaps intervaginal administration of tampons with Vishnevsky ointment, intramuscular injections of sodium thiopental.
If a woman experiences pain, then she is prescribed antispasmodics and anti-inflammatory drugs.
You can, after consulting a doctor, practice yoga or body flex. Respiratory-postural gymnastics heals the body as a whole, in parallel, a deep massage of internal organs is carried out, which contributes to the prevention of adhesions. Often it is gymnastics that allows you to activate your inner potential and women who suffer from infertility become mothers. At the same time, the classes are not difficult, and it will take no more than 15 minutes a day to complete them.
Operative therapy
Often, conservative treatment alone is not enough to prevent adhesions and surgery is required. It is carried out in case of acute development of adhesive disease. The laparoscopic technique is widely used for this purpose; after the operation, the patient is prescribed medication to prevent the formation of adhesions. After all, even though laparoscopy is a minimally invasive technique, it does not guarantee that the strands will not grow again.
The surgeon will decide how to remove the adhesions during the intervention. It is possible to eliminate them with a laser (laser therapy), with water (aquadissection) and with an electric knife (electrosurgery).
Answers to popular questions:
Is it possible to get pregnant with adhesions of the fallopian tubes? In about 25% of cases, adhesions of the fallopian tubes lead to the development of infertility. If the damage to the pipes is not too pronounced, then after laparoscopy it is possible to conceive a child in 50-60% of cases. If even after the laparoscopy, pregnancy does not occur, then it is advisable to think about IVF. So, the answer to this question is yes, you can get pregnant with adhesions of the fallopian tubes, but most often this requires the help of specialists.
Can pelvic adhesions be seen on ultrasound? On ultrasound, only chronic, multiple adhesions will be clearly visible. In the early stages, they are almost impossible to detect using ultrasound.
Can adhesions dissolve on their own? Sometimes, after childbirth, adhesions disappear on their own. The fact is that during pregnancy, the uterus is greatly stretched, which leads to rupture of thin strands. However, this often leads to pain, which requires hospital treatment or pain medication. In any case, this process must be supervised by medical personnel.
Is it possible to have sex with pelvic adhesions? You can have sex with pelvic adhesions.