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Adnexitis is a topic that is best explained by starting with the proverbial two words on anatomy. Normally, the appendages (ovary and fallopian tube) lie symmetrically in the smaller pelvis, on the right and left sides of the uterus. They are located very close to each other, and even partially touching each other, so if inflammation occurs in the fallopian tube, and this is where it usually begins, the process will also include the ovary.
Where does adnexitis come from?
Why does inflammation usually begin in the fallopian tube? Two things must be clarified here. First, the most common is so-called ascending infection. We will talk about other possibilities of spreading inflammation further. Secondly, in order to name the path one by one, we have to go back to anatomy again. Namely, in a typical case, the ascending path leads through the vagina, cervix, uterine cavity and fallopian tube + ovary. More specifically, the inflammation of the cervical mucosa spreads to the lining of the uterine cavity and further to the lining of the fallopian tubes which communicate with the uterine cavity. From the fallopian tube there is an easy way to the ovary and, unfortunately, even worse, also to the peritoneum of the pelvis, the lining of the pelvis from the inside.
The second ascending path also leads through the lymph vessels. Conditions conducive to ascending infection of the appendages are menstruation, miscarriage, childbirth and puerperium, intrauterine devices. In contrast, descending infection occurs either through the blood (i.e. the inflammatory process takes place in a completely different place in the body, and bacteria travel with the blood and settle in the ovary) or through the continuity of inflamed organs adjacent to the appendages (less frequently). Of course, there is a huge amount of possibility of infecting individual tissues and the degree of changes in adnexitis beyond the scope of this work.
Inflammation of the appendages – consequences
The increasing inflammatory process has a systemic significance, extremely dangerous, but also causes local consequences in the affected organ. Let’s start with the fallopian tubes. The easiest way is to define their role as a transporter for eggs from the ovary to the uterine cavity, where, if the egg is fertilized, it is to implant properly and pregnancy continues. In the event of post-inflammatory changes, it leads to the formation of local adhesions, preventing the free movement of the egg. As a result of healing, the fallopian tube wall may change its structure, which irreversibly interferes with its proper functioning. In women of childbearing age, this can lead to a serious threat, which is tubal pregnancy, which not only cannot develop properly, but can be very dangerous to a woman’s health and life.
Another scenario that can occur with adnexitis is the closure of the opening of the fallopian tube (one or both ends). The consequences are manifold. A barrier is clinically created that limits the spread of the inflammation further. On the other hand, when inflammatory secretion is difficult to flow out of the fallopian tube, it accumulates in it, causing distension and enlargement, resulting in pain symptoms. The long-term complication of obstruction of both fallopian tubes is female infertility.
The numerous adhesions in the area of the appendages can cause discomfort and a feeling of pulling. Then there are menstrual disorders or painful menstruation. In addition, discomfort during sexual intercourse contributes to sexual problems with a partner. Summing up the issue of possible complications, the list is long, and often ends with the patient’s mental state and depression, exhausted by relapses.
For diagnostic purposes, a stationary visit to the gynecologist is necessary. If you are unable to do so, speak to your doctor during your online visit. Register now and you will receive an e-Prescription and e-Referral without leaving your home.
Inflammation of the appendages – symptoms
The conditions conducive to adnexitis, already mentioned above, require increased attention of every woman to possible complications. Symptoms that something “bad” is starting to happen include acute abdominal pain and fever. They often start right after your period or a miscarriage. The appearing cramp pains in the lower abdomen are in some cases so strong that the woman literally squirms in pain, and in others the pain is severe, but dull and long-lasting. If there is no sudden increase in pain, vigilance should arouse fever or low-grade fever with a significant deterioration in well-being.
It should be emphasized once again that the most vulnerable women are after menstruation, miscarriage, intrauterine procedures (e.g. curettage of the uterine cavity) and, very importantly, postpartum women! In any case of discharge from the vagina with purulent or disturbing-smelling contents, fluid, or abnormal bleeding (too much and for too long), see your gynecologist for examination. In the aforementioned group of patients, we must not underestimate any abnormal, new symptoms, from worsening of well-being with low-grade fever, to severe pains in the lower abdomen, fever or foul-smelling faeces. There are also accompanying symptoms from neighboring organs, such as constipation, diarrhea, nausea, vomiting, and intestinal colic.
Adnexitis is a recurrent disease. In the case of a chronic condition, symptoms may worsen again, even after a long period of no symptoms. The triggering stimulus may be an apparently innocent hygiene error or a cold, infection. Examples include lying in a wet swimsuit instead of drying off and changing clothes, excessive physical exertion, severe runny nose, especially in the perimenial period.
Treatment of adnexitis
If disturbing symptoms appear, visit a gynecologist, as a gynecological examination is necessary. The examination itself will help to differentiate to a large extent other causes of similar pain in the lower abdomen. In addition, the gynecologist will take bacteriological swabs from the genital tract (from the cervical canal and from the vagina) with an antibiogram to determine if and with what microorganism we are dealing. This will help you determine which antibiotics are right for your situation. Another confirmation of the ongoing inflammation are blood tests such as the number of leukocytes, ESR or C-reactive protein. Ultrasound examination of the reproductive organ provides a lot of important information. The most common symptom is enlargement of the ovary / entire appendages.
It is also worth performing an ultrasound of the abdominal cavity, especially if the doctor is not sure about the symptoms described by the patient.
Visualization of other lesions enables a more accurate diagnosis and degree of lesion. Remembering that it is a recurrent disease, the patients themselves are often able to accurately recognize another relapse in themselves.
Nevertheless, whether this is the first case or the next, it is necessary to see a doctor, not only for treatment, but above all to make sure that it is inflammation of the appendages and not to overlook another disease with similar symptoms but more serious consequences (most often inflammation). appendicitis, tubal pregnancy).
Treatment is conservative in most cases, with first-line antibiotics that are causal. There are many preparations available on the market that should be selected individually for the patient, always in combination with the protection of the digestive tract. The treatment usually lasts for a minimum of 7-14 days. Supportive care includes painkillers, anti-inflammatory drugs and steroid therapy and is used only in consultation with the doctor. It is recommended to lie down, rest and a slightly digestible diet during the treatment. In the case of treatment of complications, hospitalization and surgical treatment, most often laparoscopy, are required.
Inflammation of the appendages is most common in young, active women. It is a frequently recurring disease, which is why it is so important to limit its occurrence. When it occurs, treat it according to the doctor’s recommendations, if it is absent, use prophylaxis to reduce the risk of its appearance. Intimate hygiene, warm clothes, treatment of inflammations throughout the body (including the genital tract, urinary tract, respiratory tract, teeth) are so important, not forgetting about the hygiene of sexual life.
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