What causes chronic adnexitis? Signs of adnexitis: determine the causes of the pathology, effective therapy. Indications for surgical treatment of adnexitis

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

Among young women, the disease is much more common and occurs for two reasons: infection entering the fallopian tubes and secondary infection during inflammatory processes in other organs (appendicitis, etc.). Bacteria of chlamydia, streptococci, E. coli, tuberculous mycobacteria, etc. provoke inflammation in the appendages. Typically, bacteria penetrate through the vagina, cervix, or less often they end up in the appendages through the blood or lymph flow (usually during the tuberculosis process). The infection can also occur during an abortion, diagnostic curettage, or other procedures inside the uterus. Usually, inflammation of the ovaries occurs in parallel with inflammation of the fallopian tubes and, therefore, gynecologists perceive inflammatory processes in the pelvis as one phenomenon.

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ICD-10 code

N70 Salpingitis and oophoritis

Causes of adnexitis

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

Experts divide adnexitis into several types, depending on which microorganisms provoked the inflammation:

• nonspecific, caused by sexually transmitted infections (mycoplasma, chlamydia, etc.) or opportunistic microorganisms (Escherichia coli, streptococci, etc.);
• specific, caused by diphtheria, gonococcal, tuberculosis bacteria.

The infection can enter through the circulatory or lymphatic systems, from the vagina (usually with sexually transmitted infections) or from other internal organs (lungs, kidneys). However, infection in the body does not always lead to inflammation of the appendages, since adnexitis requires the presence of predisposing factors.

Symptoms of adnexitis

Inflammation in the appendages leads to disruptions in the menstrual cycle. The discharge usually becomes more scanty, the interval between menstruation increases, but in some cases, menstruation takes on the character of prolonged and painful bleeding. Symptoms of adnexitis in chronic form manifest themselves in possible frequent exacerbations due to weakened immunity, infections, and secondary infection. With an exacerbation of the inflammatory process in the appendages, the woman’s general health may worsen, the temperature rises, pain in the lower abdomen intensifies, and purulent discharge from the vagina is also possible.

Pain with adnexitis

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

If such pain occurs, it is important to consult a doctor immediately, since the disease is better treated in its acute form.

Temperature with adnexitis

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

Discharge during adnexitis

Menstruation with adnexitis

Why is adnexitis dangerous?

Adnexitis can occur practically without pronounced symptoms, and therefore timely detection and treatment becomes difficult.

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

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

With systematically worsening chronic inflammatory processes in the fallopian tubes, a woman develops sexual function disorders, in particular pain during sexual intercourse, decreased desire, etc. If the acute form of adnexitis is treated incorrectly, in the vast majority of cases, infertility develops, and the risk of ectopic pregnancy also increases.

Forms

The abbreviation ICD is usually understood as 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 and mortality at different times and in different countries.

The tenth revision of the ICD is now in effect, in which alphanumeric coding systems have begun to be used. By introducing letters and numbers into the coding system, it became possible to more than double the coding structure.

According to the ICD, adnexitis belongs to class XIV (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.

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Chronic adnexitis

Adnexitis becomes chronic after improper or untreated acute inflammation. As the disease worsens, your health worsens, your temperature rises, and sexual dysfunction appears. Often, patients have impaired digestive or urinary function. With chronic adnexitis, frequent dull pain appears in the abdomen, which can become stronger during sexual intercourse, menstruation, and after exercise. With chronic inflammation of the appendages, menstruation is usually scanty and short-lived, but can also be heavy and long (up to two weeks). With prolonged chronic adnexitis, infertility develops, which, as a rule, occurs due to obstruction of the fallopian tubes caused by the adhesive process.

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Chronic bilateral adnexitis

Bilateral chronic adnexitis affects organs on both the left and right sides. Typically, 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 genitourinary organs.

Bilateral inflammation in the appendages is provoked by gonorrhea bacteria, mycobacterium tuberculosis, chlamydia, etc.

Escherichia coli, streptococcal, and staphylococcal bacteria most often provoke unilateral inflammation.

The infection often penetrates the appendages due to inflammation of the internal organs, both nearby (appendicitis) and distantly located (pneumonia, tonsillitis); unprotected sex can also become a source of infection. Quite often, the infection enters precisely from the lower genital organs (vagina), in particular Trichomonas, which can quickly penetrate the fallopian tubes. Sperm can also contribute to infection, especially with E. coli.

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

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Exacerbation of adnexitis

When the disease worsens, sharp and intense pain appears in the lower abdomen and lower back. In some cases, acute adnexitis occurs with bloating, nausea, and constipation. When palpating the abdomen, the patient feels a sharp pain, and sometimes there is tension in the abdominal muscles. In the acute form of the disease, the temperature will rise to 390C. When the process is neglected, inflammation can affect the peritoneum, which ultimately leads to peritonitis and abscess. When pus accumulates in the fallopian tube, the organ may rupture and purulent contents may enter the peritoneum.

Acute adnexitis

Subacute adnexitis

Adnexitis in subacute form is quite rare; it usually appears during inflammation of a tuberculous or mycotic nature. The symptoms of subacute adnexitis are similar to the manifestation of the acute form of the disease, only it has less intensity and frequency (pain, purulent discharge, temperature, etc.).

Purulent adnexitis

Purulent adnexitis is usually a complication of gonorrhea. The disease can be polymicrobial or specific. Also, the reasons for the development of purulent inflammation in the appendages can be childbirth, artificial termination of pregnancy, IVF, stress, excessive consumption of alcohol, drugs, various intrauterine operations, frequent changes of sexual partners, anal sex, sexual intercourse during menstruation, hormonal contraceptives. One of the characteristic signs of the disease is aching pain in the abdomen, fever, pain during urination, and discharge from the genitals.

In the case of a purulent form of the disease, the first thing to determine is whether the sexual partner (past or present) has gonorrhea, urethritis and other sexual pathologies.

Purulent adnexitis is manifested by pain in the lower abdomen and rectum, dry mouth, fever, high temperature, weakness, dizziness, rapid heartbeat, pain when urinating, purulent discharge.

Bilateral adnexitis

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

As with other inflammatory processes of the female genital organs, bilateral adnexitis is manifested by pain, fever, weakness and general malaise, digestive system disorder, and nausea.

As a result of untreated (or undertreated) bilateral adnexitis, painful menstruation and cycle disruption occur. With bilateral inflammation of the appendages, adhesions appear in the fallopian tubes, which prevent the movement of the egg; in addition, a fertilized egg can attach to the tube, which will lead to an ectopic pregnancy (the most common complication of adnexitis).

Right-sided adnexitis

With right-sided inflammation of the appendages, organs on the right side are affected. Symptoms have some features that depend on the nature of the disease. First of all, nagging pain appears in the lower abdomen and lower back, which can intensify during urination, physical exertion, and sexual intercourse. Like any other inflammation, adnexitis can occur with high fever. In addition, the disease causes rapid fatigue and deterioration in general well-being.

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

Since the appendix is ​​located on the right side of the peritoneum, 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 avoid serious and life-threatening complications.

A source of inflammation in neighboring organs can cause infection to spread throughout the body, for example, with appendicitis, the likelihood of pathogenic microflora entering the appendages increases. The risk of inflammation of the appendages is much higher during various surgical interventions in the uterus, for example, during the installation of an IUD or abortion. Some bacteria are found in a woman’s body and do not manifest themselves until a certain point, but under favorable conditions (decreased immunity), the microorganisms are activated and, when they enter the internal genital organs, cause inflammation.

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

Left-sided adnexitis

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

As a rule, the symptoms of left-sided adnexitis depend on the cause of the disease, usually expressed by pain in the lower abdomen, irritability, fever, painful menstruation, and sexual intercourse.

The chronic form of left-sided adnexitis is the result of untreated (undertreated) inflammation of the appendages in an acute form. Chronic adnexitis during periods of remission creates a feeling of complete recovery, however, during exacerbation, the disease can occur with greater intensity.

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

Adnexitis in girls

Adnexitis can develop not only in those women who are sexually active. Both little girls and teenage girls who do not have sexual intercourse are susceptible to this disease.

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 the disease, since the infection can enter any organ through the bloodstream. The disease is usually caused by E. coli and staphylococcus.

If a girl is already sexually active, then first of all adnexitis can develop due to infection of the genital organs, abortion, or sexually transmitted diseases.

Pregnancy and adnexitis

Pregnancy is almost impossible with diseased appendages. Adnexitis poses a threat when trying to conceive a child, primarily due to the increased risk of ectopic pregnancy, when it is impossible to do without medical help. In addition, the danger of an ectopic pregnancy is that it is practically no different from a normal one, and is often detected when the fallopian tube ruptures.

If the appendages become inflamed during pregnancy, a complication is possible. First of all, if the mother is infected, the risk of intrauterine infection of the child is extremely high. Even if the child is not infected in utero, he can become infected while passing through the birth canal. In addition, with inflammatory processes in the female genital organs, the risk of spontaneous termination of pregnancy (miscarriage) increases many times over. Also, pregnant women require special treatment, since antibiotics are not used in this condition due to the high risk of pathologies for the fetus.

Is it possible to get pregnant with adnexitis?

Most women who are diagnosed with adnexitis worry whether it is possible to become pregnant with diseased appendages. Only a gynecologist can answer this question 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, a woman’s immune strength weakens, so in the chronic form of adnexitis, an exacerbation may begin.

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Diagnosis of adnexitis

If adnexitis is suspected, the doctor, first of all, finds out the patient’s medical history (past abortions, childbirth with complications, intrauterine device, operations for therapeutic or diagnostic purposes, sexually transmitted diseases, frequent change of sexual partners, unprotected sex, insufficient personal hygiene, diseases of the genitourinary organs and etc.).

After the survey, the specialist begins the examination. If upon palpation the patient experiences sharp pain and tense abdominal muscles, then most likely the disease occurs in an acute form.

Laboratory tests are also required:

• bacterial culture of the vagina, analyzes of the cervical and urethra, PCR;
• General blood test.

With adnexitis, Gram staining of the smear 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 results, so sometimes they resort to provocative methods:

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

Ultrasound examination of internal organs in the pelvis allows you to obtain quite extensive information and assess the condition of the appendages, identify neoplasms during pregnancy (intrauterine or normal).

Ultrasound is used when, due to severe pain, the doctor cannot properly palpate and examine the woman.

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

Diagnosis of chronic adnexitis

In case of chronic adnexitis, during the examination, a specialist determines the inactivity of the appendages and muscle tension.

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

Diagnosis of acute adnexitis

Acute adnexitis has symptoms similar to appendicitis. Severe pain, temperature, fever, nausea - all these conditions can occur both with acute inflammation of the appendages and with appendicitis. The cause of the illness can only be determined in a hospital. Usually during a gynecological examination, upon palpation, severe sharp pain appears, which indicates an acute process of inflammation. In some cases, an ultrasound is prescribed to confirm the diagnosis and exclude other pathologies.

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Adnexitis on ultrasound

Ultrasound examines internal organs using a special device with ultrasonic waves. Current ultrasound machines have a special transvaginal sensor that allows you to scan the female genital organs and obtain more detailed information about the location and characteristics of the inflammatory process.

Transvaginal ultrasound is the most valuable diagnostic method. Using special sensors inserted into a woman’s vagina, a specialist can determine changes in the appendages and formations.

Differential diagnosis of adnexitis

Differential diagnosis allows you to separate adnexitis from diseases such as ovarian cyst, endometriosis, diseases of the genital organs, acute appendicitis, etc. It is important for a specialist to study the results of the tests, ultrasound data as best as possible, and consultation with a surgeon is also necessary.

Treatment of adnexitis

When treating inflammation in internal organs, the main emphasis is on suppressing infection in the body, preventing the likely severe consequences of the disease, and restoring the woman’s reproductive function.

With adnexitis, the main thing is to start treatment on time, to carry out step-by-step and complex therapy. Chronic adnexitis is quite difficult to treat, primarily due to the fact that the cause of the inflammatory process in most cases remains unknown.

The inflammatory process during pregnancy presents some difficulties in treatment, since many effective drugs are prohibited for use during pregnancy. In severe cases, treatment of adnexitis is carried out in a hospital setting. Mandatory hospitalization is required for girls under 20 years of age, inflammation in the appendages after intrauterine intervention, suspicion of purulent complications, immunodeficiency, long-term outpatient treatment that does not give positive results, as well as inflammation during pregnancy, since in this case there is a risk of infection of the fetus and complications of pregnancy (delivery activity) increases.

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

In case of a chronic process, combined antimicrobial treatment (drugs of different groups) is prescribed. When prescribing antibacterial drugs, the doctor must prescribe a test for the susceptibility of microorganisms.

In addition to antibacterial therapy, anti-inflammatory, immunomodulatory, and antiallergic agents are used in the treatment of adnexitis. In order for antibacterial drugs to act more effectively and to prevent adhesions in the pelvic organs, enzyme agents are prescribed.

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

During surgical treatment, they try to preserve the fallopian tubes as much as possible, while completely removing the source of inflammation. If necessary, an additional operation is performed to restore the patency of the fallopian tubes.

During the recovery period after surgery, physiotherapeutic procedures, spa treatment, and biological stimulants are used. Immunostimulating, absorbable, anti-inflammatory treatment continues. In some cases, taking into account the results of examinations and the patient’s condition, the doctor may prescribe hormonal drugs (oral contraceptives).

In addition to traditional methods of treatment, folk remedies for combating this disease are very effective. Relieves pain in the lower abdomen, inflammation, swelling - an enema of chamomile infusion (1 tbsp. boiling water, 1 tbsp. dried flowers). At the beginning, it is recommended to do a cleansing enema with clean boiled water, then do 2-3 enemas with chamomile infusion, after which you need to lie on your side. This treatment is carried out once a day, preferably before bedtime. In severe cases (severe inflammation, pain, etc.), it is recommended to repeat the procedure several times a day.

Vitamins for adnexitis

Adnexitis is a rather serious disease that requires an integrated approach to treatment. In addition to antibiotics, antimicrobials, and immunomodulators, taking vitamin kits is of great importance in treatment. Depending on the woman’s condition and susceptibility, vitamins are selected individually. Both tablets (capsules) and injections can be used.

Sports for adnexitis

It is recommended to play sports with inflamed appendages with caution. Exercises, especially those involving the abdominal muscles, are contraindicated for acute adnexitis.

Adnexitis is almost always painful, so physical exercise can negatively affect a woman’s health (increased pain, bleeding, etc.). In this regard, it is better to postpone sports activities until complete recovery.

Diet for adnexitis

In acute and subacute forms of adnexitis, it is extremely important to pay attention to proper nutrition and exclude any allergic foods from your diet. It is also necessary to control your calorie intake - no more than 2300 per day. The diet should consist of easily digestible foods, preferably stewed or boiled.

If you have adnexitis, you need to add foods rich in vitamin C to your diet, which will help increase the body's defenses and speed up the healing process (bell peppers, citrus fruits, cranberries, pomegranates, etc.). Malfunctions in the digestive system can provoke stagnation of feces and inflammatory processes. In addition, antibacterial therapy can further aggravate the situation. To avoid digestive disorders, you need to eat more vegetables (boiled or stewed) with a small amount of vegetable oil and fermented milk products. It is also important to drink enough liquid (at least 1.5 liters). It is better to drink still water, fresh juices, unsweetened compotes and green tea. You should also eat lean meats and fish, greens (parsley, spinach, onions, etc.) several times a week.

Prevention

To prevent adnexitis, women are advised to take care of personal hygiene and use underwear made of cotton materials. Adnexitis can also be prevented if you dress appropriately for the weather and do not freeze. Also, good prevention of inflammatory diseases is strengthening the immune system, regular exercise, systematically taking vitamin complexes, maintaining a healthy lifestyle and proper nutrition.

In the acute stage, as well as for a month after the main symptoms subside, you should not use tampons.

Adnexitis often develops after an infection enters a woman’s genitals (after casual relationships, artificial termination of pregnancy or natural childbirth, etc.), so it is extremely important to monitor your hygiene and follow the doctor’s recommendations after surgical interventions in the uterus.

Forecast

In most cases, with timely diagnosis and effective treatment, adnexitis goes away with virtually no consequences. But if the disease is caused by an infection (gonorrhea, tuberculosis), as well as with chronic advanced inflammation, there can be quite serious complications, for example, infertility.

Adnexitis can be triggered by a variety of bacteria, which usually penetrate the vagina during sexual intercourse. Poor hygiene and decreased immunity also contribute to the disease. At risk are women who are sexually active, and have also had infectious diseases in the past (trichomoniasis, chlamydia) or have had frequent intrauterine interventions (abortions, diagnostic curettages, etc.).

Inflammation of the ovaries, or adnexitis, occupies a leading place among gynecological diseases. The inflammatory process not only negatively affects a woman’s quality of life, but can also disrupt her reproductive functions. Most often the disease occurs among young women. According to medical statistics, every fifth patient suffering from chronic adnexitis is diagnosed with infertility.

The primary development of the disease is usually associated with the negative influence of opportunistic microflora, which penetrates the ovaries against the background of a general decrease in immune defense or when using an IUD ().

According to research in the field of gynecology, it is the IUD that often causes purulent inflammation of the ovaries. But infectious agents can also cause ovarian adnexitis if the woman’s medical history includes surgical interventions - therapeutic and diagnostic interventions, postpartum salpingoophoritis.

Also, the causes of adnexitis can be:

• promiscuous sex life;
• sexual intercourse during menstruation without;
• hypothermia of the body against the background of weak immunity;
• inflammatory diseases of the female genital area suffered in the past.

The secondary development of adnexitis is caused by inflammatory diseases of the abdominal organs, for example, appendicitis, colitis, etc. Sometimes the causes of symptoms of adnexitis are specific infections, such as syphilis, tuberculosis, gonorrheal infection and much more.

Classification

Depending on the location of the infectious-inflammatory process, one- and two-sided adnexitis occurs. According to the course - acute, chronic and subacute adnexitis. According to the infectious agent - specific and nonspecific. According to the presence of complications - complicated and uncomplicated.

Let us consider the features of the acute form of the disease.

Inflammatory phenomena in the appendages have 4 stages of development:

• salpingitis without signs of abdominal irritation;
• salpingitis with signs of peritoneal irritation;
• the formation of a purulent-inflammatory infiltrate and its asphalt formation;
• spontaneous process of breakthrough of the tubo-ovarian abscess.

Two phases of the disease:

• toxic phase, which is characterized by the prevalence of aerobic flora in the infectious process and moderate signs of intoxication;
• septic phase, caused by the activity of anaerobic flora, increased intoxication, and the development of complications.

The chronic form of the disease can occur in two directions:

• infectious-toxic, which is characterized by the occurrence and increase of the exudative process in the ovaries, an increase in their sensitivity and pain during and without palpation, the appearance of uncharacteristic discharge from the genital tract and an increase in leukocytosis;
• neuro-vegetative, in which there is a general disturbance of well-being, psycho-emotional lability, disturbances in the functioning of the endocrine and vascular systems.

Symptoms

Symptoms of acute adnexitis appear suddenly and severely. The disease begins with a sharp rise in temperature to 39 degrees and chills, which means that the process of suppuration has begun in the ovarian tissues.

Soon sharp abdominal pain occurs, the localization of which depends on whether the adnexitis is unilateral or bilateral. That is, pain can occur on one side of the iliac region or on both. In this case, pain can radiate to the lower extremities, sacrum or rectum.

At the early stage of the disease, symptoms of adnexitis in women (acute salpingitis) are characterized by tension in the abdominal wall, sharp pain, and urinary disturbance (painful and frequent). General well-being is also affected.

During a gynecological examination, discharge of purulent contents is noted from the cervical canal with adnexitis. The ovaries are painful on palpation, enlarged, and their mobility is limited. In the blood there is leukocytosis, an increase in ESR and C-reactive protein.

The symptoms of chronic adnexitis are erased, the pathology is characterized by periodic exacerbations during the cold season. Chronic signs of inflammation in the appendages are manifested by dull aching pain in the lower abdomen, radiating to the sacrum and vagina. On palpation, pain with chronic adnexitis is moderate.

Unilateral or bilateral chronic adnexitis manifests itself (polymenorrhea, oligomenorrhea, algomenorrhea, etc.), in turn, this process may be associated with the absence of adnexitis that has arisen against the background of structural and functional changes in the appendages. In this regard, the question arises - is it possible to get pregnant with chronic adnexitis?

With an exacerbation of chronic adnexitis, a subacute process develops, in which the body temperature rises to 38 degrees and the pain intensifies. During a gynecological examination, mucopurulent discharge will be detected from the os of the uterus. The ovaries are painful on palpation and limited in movement due to the developed adhesive process due to adnexitis.

Features of the course of the disease

What is adnexitis in women, why does it occur and is it possible to get pregnant due to it? Unfortunately, sooner or later, many patients of childbearing age ask these questions. The most dangerous is the chronic form of salpingo-oopharitis, which can occur latently, that is, without any signs of adnexitis for a long period of time - more than 2 years.

The disease develops extremely slowly. During the development of pathology, infectious agents wedge into the epithelium of the appendages and fallopian tubes, disrupting the structural structure of the mucosa. This leads to negative changes in the functioning of the reproductive organs: the egg begins to mature with difficulty, local and hormonal disruptions interfere with this, and its movement through the fallopian tubes is extremely difficult.

Against the background of degenerative changes in the epithelial tissue, a narrowing of the normal lumen of the blood vessels occurs, which are responsible for the blood supply to the pelvic organs, in particular the ovaries and fallopian tubes. These pathological changes cause the process of formation of adhesions, which entails obstruction of the fallopian tubes.

Adnexitis and pregnancy, in this case, become difficult to combine concepts, that is, in women who suffer from a chronic form of adnexitis, the diagnosis of infertility is made in 50% of cases. Patients who would like to become pregnant against the background of the disease should know that salpingoophoritis cannot be an absolute contraindication to pregnancy, but before starting conception, it is necessary to visit a doctor and treat any infectious diseases present in the body.

Acute adnexitis, which was diagnosed and treated in full and in a timely manner, in most cases does not have a negative effect on the condition of the woman’s reproductive system.

If, for some reason, diagnostic and therapeutic measures are absent, and the disease develops into a complicated purulent form of the inflammatory process in the ovaries, such serious consequences as necrosis of the tissues of the affected organs and general septic changes (blood poisoning) may occur. All this can cause not only irreversible infertility, but also death.

Diagnostics

The diagnosis of adnexitis or salpingoophoritis is made on the basis of medical history: abortions, the presence of an IUD, the consequences of a complicated birth, the patient’s complaints and the results of laboratory and instrumental examinations.

Diagnosis of adnexitis during a manual gynecological examination consists of identifying 1- or 2-sided painful enlargement of the appendages. To determine the infectious pathogen, examination is carried out from the vagina, os of the uterus and urethra. Ultrasound reveals inflammatory formations in the ovarian tissues.

Treatment

Treatment of the acute form of left-sided or right-sided adnexitis should be carried out in a hospital setting, with the obligatory prescription of antibiotics and anti-inflammatory drugs, for example, Metronidazole, Oflaxacin, etc. After adnexitis, that is, after eliminating all inflammatory manifestations in the acute form, biostimulants can be prescribed, for example, Ovariamin , physiotherapeutic treatment (electrophoresis, vibration massage, etc.), stimulation of ovulatory function (drug Clofit).

Treatment of unilateral and bilateral chronic adnexitis depends on the cause that caused it. The therapeutic effect can be anti-inflammatory, absorbable, antimicrobial and immunostimulating. In most cases, these techniques are combined into a single complex. In addition to conservative therapy, physiotherapy (vibromassage, IFS, etc.), treatment with mud and mineral waters, ozokerite-based applications, and diet are often prescribed.

Prevention

Prevention of acute adnexitis and exacerbations of chronic adnexitis is as follows:

• general strengthening procedures - hardening, physical education, sanatorium-resort treatment, balanced nutrition;
• use (of condoms);
• administration of the gonococcus vaccine, regular examination by a gynecologist for sexually transmitted infections.

Answering the question of what adnexitis is and why it is dangerous, we can say that it is a gynecological disease, the causes of which can be different. It is difficult to identify the infectious pathogen with high accuracy, so the pathology is treated with broad-spectrum antibiotics. Every woman should take the treatment of ovarian inflammation seriously, as this disease is fraught with serious complications.

Even if the symptoms of adnexitis are behind you, it is important to cure the disease completely. Otherwise, the pathology will become chronic, the treatment of which will be longer and more complex. For a complete recovery, it is necessary to follow all the prescriptions of the gynecologist and completely complete the therapeutic course of the prescribed treatment.

Useful video about adnexitis

Adnexitis is an inflammation of the appendages (ovaries, fallopian tubes and surrounding structures). It can occur in acute, subacute and chronic forms. This largely determines the symptoms of the pathology, the timeliness and effectiveness of treatment, as well as the likelihood of complications. How to choose the appropriate treatment regimen? Which treatment method is preferable for different forms of adnexitis?

Read in this article

Why is adnexitis dangerous?

Inflammation almost never goes away without a trace in the body, especially when it affects such delicate, delicate and small-sized structures as the ovaries, fallopian tubes and everything that connects them. Therefore, any adnexitis should be taken very seriously, following all recommendations and treatment regimens. Otherwise, you may encounter a number of complications.

Formation of adhesions in the pelvis

This has to be faced in all cases of chronic adnexitis, as well as in untimely treatment of other forms. cause pain, the intensity of which depends on the severity of the process and concomitant diseases.

Pain may occur constantly throughout the entire cycle or appear only during menstruation. They can be mild and sometimes unbearable.

Adhesions can involve the fallopian tubes and ovaries, increasing the risk of ectopic pregnancy. They also present great difficulties during IVF. Sometimes the process of retrieving eggs is technically impossible due to severe adhesions.

Tubal obstruction

It is formed both due to adhesions and due to inflammation of the internal lining of the fallopian tubes. And their normal clearance is only a few millimeters, so even minor inflammation can lead to obstruction and infertility.

Autoimmune disorders

Chronic salpingo-oophoritis can lead to the destruction of some ovarian cells. After which the body begins to “attack” them as foreign objects. As a result, the woman experiences the following:

• problems with ovulation;
• due to ovarian depletion.

Cyst formation

Inflammation of the ovaries is one of the reasons for the formation of functional cysts. And they affect the general hormonal status of a woman, the quality of intimate relationships and many other processes.

Formation of abscesses, pyosalpinxes

The most dangerous complication of inflammation of the appendages is the formation of ovarian abscesses, as well as the accumulation of pus in the fallopian tubes. Without treatment, pelvioperitonitis develops. All of these are acute surgical conditions that require urgent surgical treatment, often with removal of the uterus and appendages.

Diagnosis of adnexitis in women

The assumption of the disease is established based on the woman’s complaints. In the chronic form, symptoms will be minimal.

In order to confirm adnexitis, a routine gynecological examination is sufficient. In this case, painful areas of the appendages are determined, the ovaries are enlarged and may contain a cyst. A number of other symptoms are also detected, for example, pain when moving the cervix and many others.

For the subsequent choice of treatment, an examination is not enough; a complex of diagnostic measures is required. Namely:

• (free fluid, enlarged ovaries, etc. are determined);
• from the vagina and cervical canal (after all, the infection is often ascending);
• PCR of vaginal and cervical secretions for the main pathogens (chlamydia, mycoplasma, ureplasma, Trichomonas, gonococci and others);
• bacteriological culture of the vaginal flora, including taking into account sensitivity to antibiotics.

Watch the video about adnexitis:

Primary treatment of bilateral adnexitis

In most cases, the first episode of adnexitis occurs in an acute form. Therefore, the chances of curing the disease with a minimum number of consequences are higher. The main directions are as follows:

Treatment regimen for chronic adnexitis: drugs, suppositories

Chronic adnexitis is often associated with formation against a background of constant inflammation, which must be taken into account when examining and prescribing treatment. The following is also characteristic of chronic adnexitis:

• moderate pain syndrome;
• adhesive process;
• dysfunction;
• hidden course, pathogens cannot always be detected immediately.

The severity of certain symptoms should be taken into account when prescribing treatment regimens. The tactics are as follows:

• It is useful to prescribe first of all physiotherapy methods that will cause an exacerbation of the pathology. And after that, use all other drugs. This way you can achieve the most effective treatment.
• Antibacterial drugs taking into account cultures and sensitivity.
• It is recommended to use absorbable drugs, for example, Wobenzym, Longidaza in the form of suppositories, Lidaza (including physiotherapy with it), Trypsin, Streptokinase and others. They can somewhat reduce the severity of the adhesive process and thereby reduce pain.
• Antispasmodic, anti-inflammatory drugs (No-shpa, Ketanov and others).
• Against the background of chronic adnexitis, inflammation in the vagina often develops, so suppositories are used locally. They can be either monocomponent or contain several active substances. These are Hexicon, Clotrimazole, Ginocaps, Terzhinan, Polygynax and others at the discretion of the doctor.
• To restore menstrual function, as well as to normalize the functioning of the ovaries, vitamin complexes, dietary supplements, homeopathic remedies or oral contraceptives are prescribed. Cyclodinone, Time Factor, Cyclovita and others are effective.

Treatment method for exacerbation of adnexitis: antibiotics as an emergency measure

The reappearance of symptoms of the disease against the background of chronic adnexitis is fundamentally no different from the acute form of the disease. Therefore, the principles of therapy are the same.

But chronic forms of adnexitis often occur against the background of resistant flora. This means that previously used treatment regimens, in particular antibacterial drugs, may be little or completely ineffective. Therefore, prescribing antimicrobial agents should be approached with extreme vigilance, following culture and sensitivity results.

Exacerbation of adnexitis is often accompanied by the formation of ovarian abscesses, accumulation of pus or other fluid in the fallopian tubes. Treatment in these situations is only surgical, often with removal of the uterus and appendages.

Treatment of adnexitis during pregnancy

Often women believe that pain in the lower abdomen during pregnancy is associated with adnexitis. In reality, everything is completely different. The pain is very similar, in the same places, and may even be the same in intensity. But this is not adnexitis, but a threat of interruption, possibly due to infection.

The hormonal background of a woman during pregnancy, as well as all the structural changes that occur at this moment, exclude the occurrence of adnexitis.

If there is inflammation of the appendages, either fertilization will not occur, or the fertilized egg will not be fixed in the uterine cavity. When pregnancy occurs, inflammation is in remission or absent.

During pregnancy, any infection is concentrated in the vagina, cervix, and in extreme cases, in the endometrium, which has adverse consequences.

Features of treatment with traditional methods

Adnexitis should not be treated only with traditional methods. Alone they are ineffective. But if you combine it with drug treatment, you can get a more significant result.

For adnexitis, it is effective to use tampons with healing solutions, baths, and it is also recommended to take the compositions internally.

Recipe 1. You should take aloe juice or mix fresh leaves with liquid honey and let it brew for 10 - 14 days. Apply to gauze swabs and leave overnight for 7 - 10 days.

Recipe 2. In equal quantities, you need to take nettle and dandelion roots, calendula and cinquefoil flowers, mistletoe and horsetail leaves. Pour hot water over it all, let it sit for several hours, and then use it to warm it up in a hot bath.

Recipe 3. It is useful to take an infusion of boron uterus and red brush. To do this, the plant should be filled with alcohol or vodka in equal parts and allowed to brew in a dark place for two weeks. Take 5 - 10 drops 3 - 4 times a day for 10 - 14 days.

Adnexitis after treatment

Adnesitis is not always easily and smoothly treated; complications, consequences of non-compliance with the course of medication, and much more are possible.

Possible complications

Adnexitis often requires the prescription of serious medications. Therefore, in some cases, thrush may develop if prophylaxis with antifungal agents is not carried out in time.

Various types of allergic reactions are also possible. The doctor should be warned in advance about the presence of hypersensitivity to drugs.

If there are any problems with the liver or kidneys, it is better to carefully monitor the function of these organs. Antibiotics and other drugs put a significant burden on them.

When can you get pregnant?

After suffering acute adnexitis (or activation of a chronic infection), it is recommended to abstain from pregnancy for 2 - 3 months. Do not forget to treat your sexual partner. It is useful to take contraceptives during this period.

This tactic is due to the following:

• the ovaries and the reproductive system as a whole need time to recover for a successful pregnancy;
• During this period of time, it will become clear whether the infection has been completely cured, and it will be possible to undergo control tests, including PCR.

Is relapse possible?

Adnexitis often occurs repeatedly in one girl and can subsequently become chronic with periodic exacerbations. This may be caused by the following:

• all doctor’s treatment recommendations have not been followed;
• pathogens have already developed resistance to the antibiotics used;
• the sexual partner did not undergo treatment and did not monitor the recovery.

Prevention of adnexitis

Prevention of adnexitis primarily includes sexual education. This means that all questionable intimate relationships must be protected.

You should also be regularly examined by a doctor, undergo all treatment prescribed if necessary, and follow the recommendations.

Adnexitis is an inflammation of the appendages, which often occurs in a chronic form. Consequently, it entails infertility, menstrual irregularities and many other gynecological diseases. Only timely detection and competent full treatment will allow you to avoid all troubles if the disease cannot be avoided.

Related articles

Adnexitis or salpingoophoritis is caused by the activity of bacteria entering through the genital tract or bloodstream.

Inflammation of the appendages in women is an infectious pathology, and the process affects the ovaries or fallopian tubes, but not the uterus itself. Penetration of the infectious agent into the body occurs in various ways.

The disease can last for a long time without symptoms, sometimes characterized by the appearance of pain in the lower abdomen and menstrual irregularities. Treatment is aimed at destroying the pathogen and restoring the function of the uterine appendages.

Causes

Why do women experience inflammation of the appendages, and what is it? In medicine, this disease is called salpingoophoritis. If the inflammation affects only the fallopian tubes, then salpingitis is diagnosed. An inflammatory process that affects only the ovaries is called oophoritis.

The development of the inflammatory process in the uterine appendages occurs under the influence of pathogenic and conditionally pathogenic microorganisms. There are two types of disease:

• specific adnexitis caused by diphtheria bacteria, tuberculosis bacillus, gonococci;
• nonspecific salpingoophoritis, caused by viruses, fungi, E. coli, streptococci, staphylococci, mycoplasmas, chlamydia and other microorganisms.

Penetration of infection into the uterine appendages can occur in the following ways:

• ascending (pathogenic microbes from the vagina penetrate the uterus, bypassing the cervical canal, into the tubes, and then can enter the ovaries);
• descending (there is already inflammation in the abdominal cavity, which gradually spreads to healthy tissue);
• hematogenous (microbes enter the fallopian tubes and ovaries with blood from other internal organs).

The likelihood of inflammation of the appendages increases with the action of provoking factors on the body:

• hypothermia;
• weakened immunity;
• using a contraceptive method such as an intrauterine device;
• unprotected sex;
• childbirth or abortion.

• acute;
• chronic;
• latent (asymptomatic, or sluggish).

The disease can be diagnosed at any age. Both young girls who are not sexually active and older women who have reached menopause turn to doctors for help.

Symptoms of inflammation of the appendages

In the case of inflammation of the appendages in women, the presence of certain symptoms depends on certain factors:

• pathogenicity of the ingested microorganism, its type;
• on the course of the disease, whether it is an acute process, with pronounced symptoms, or chronic, with erased, barely noticeable symptoms;
• the girl’s body’s ability to resist microorganisms and fight the inflammatory process, from the state of the immune system.

In acute form women complain of the following symptoms:

• tense abdomen in the lower regions;
• , sometimes radiating to the legs or lower back;
• increased body temperature (it can reach 39 degrees);
• changes in the menstrual cycle (sudden bleeding or delayed menstruation);
• vaginal discharge that is different from normal (it may be greenish-purulent or yellowish, thick or foamy).

An incompletely cured disease in the acute period can develop into chronic inflammation of the appendages, the symptoms of which depend on the period of remission or exacerbation. Every second woman with chronic adnexitis experiences the following pathological changes:

• menstrual irregularities;
• sexual function disorder;
• concomitant diseases of the urinary organs (,), etc.

During the period of exacerbation, all symptoms characteristic of acute adnexitis resume.

Chronic adnexitis

Chronic adnexitis develops as a result of untimely or poor-quality treatment of the acute form of the disease; it occurs with periodic seasonal exacerbations. This form of inflammation of the appendages is characterized by the presence of dull, aching pain in the lower abdomen, radiating to the vagina and lumbar region. Palpation of the abdomen determines moderate pain.

Due to structural and functional transformations in the ovaries (lack of ovulation, hypoestrogenism), chronic inflammation of the appendages in women is accompanied by menstrual irregularities, which are manifested by oligomenorrhea (scanty periods), polymenorrhea (heavy periods), algomenorrhea (painful periods). Patients may also complain of a lack or decrease in sexual desire, pain during intercourse.

Diagnostics

The above symptoms may also be present in other diseases of the genital organs, so only a gynecologist can make an accurate diagnosis after examining the patient, collecting anamnesis, and the results of laboratory and instrumental studies:

• Ultrasound of the uterus and appendages;
• PCR diagnostics (vaginal smear), which allows you to identify sexually transmitted infections;
• colposcopy (examination of the vagina and its walls);
• bacterial sowing;
• tomography;
• laparoscopy.

Signs of inflammation of the appendages can be determined by the results of a blood test. During inflammatory processes, the blood formula changes significantly. In addition, during a gynecological examination at an appointment with a gynecologist, a woman feels severe pain in the ovaries and uterus.

Consequences

Any inflammation of the appendages is dangerous because the following complications are possible:

• development into a chronic form;
• infertility as a result of the adhesive process, which causes obstruction of the fallopian tubes and anovulation;
• quite high risk of ectopic conception;
• purulent complication (tubo-ovarian formation) - purulent melting of the ovaries and tubes, followed by an abscess.

Prevention

1. Visit a gynecologist regularly, do not resist an examination in the chair, and take smears.
2. Avoid hypothermia by dressing appropriately for the weather, changing clothes after swimming, and avoiding sitting on cold objects.
3. If termination of pregnancy is necessary, do it early or with the help of medications, or a mini-abortion (avoid curettage).
4. Cure teeth, intestines and other foci of chronic infection.
5. Use barrier methods of contraception.
6. Treat gynecological diseases in a timely manner.
7. Follow the rules of healthy eating.
8. Follow the rules of intimate hygiene.
9. Avoid douching.
10. Avoid stress.

Thus, inflammation of the appendages is a serious disease that requires timely treatment, which involves strict compliance with medical instructions.

Treatment of inflammation of the appendages

When diagnosing inflammation of the appendages, treatment in women should be comprehensive: a combination of medications with physiotherapy, gynecological massage, osteopathy, and physiotherapy.

The main point in the treatment of inflammation is antibiotics. They are selected with a wide spectrum of action and maximum half-life. In addition, the woman herself needs to monitor her lifestyle (proper nutrition, abstinence from sexual activity, physical exercise, smoking and alcohol should be stopped).

The disease cannot be neglected, since the inflammatory process soon becomes chronic, which leads to infertility.

Antibiotics for inflammation of the appendages

Antibiotics for inflammation of the appendages are the first and main condition that must be met for a favorable outcome of the disease. How to treat inflammation of the appendages, the dosage and number of doses for each individual woman is determined by a specialist, but we will give you the most commonly prescribed pairs of medications:

1. Nitroimidazole derivatives (for example, Metronidazole) to eliminate anaerobic flora that can live in an oxygen-free environment, such as gonococci (the causative agents of gonorrhea);
2. Inhibitor-protected penicillins (Amoxiclav), 3rd generation cephalosporins (Ceftriaxone), macrolides (Erythromycin), etc., which affect aerobic (living in an oxygen environment) flora;
3. Antifungal drugs (eg, Diflucan, Nystatin).

For the first three to four days until the condition normalizes, all these drugs are administered by injection. Then you can switch to tablet forms and reduce the dose.

Concomitant treatment

In addition to the prescription of antibacterial drugs, detoxification therapy is carried out (intravenous infusions of saline solutions, glucose, hemodez, rheopolyglucin and others in a volume of 2 - 3 liters).

Relief of pain and reduction of the inflammatory process is carried out using tablets. These are Diclofenac, Ibuprofen, Ketarol and other drugs. Be sure to prescribe vitamins C and B, as well as allergy pills.

When relieving an acute process and in the treatment of chronic inflammation of the appendages outside of exacerbation, physiotherapy is widely used: copper and zinc electrophoresis according to the phases of the menstrual cycle, electrophoresis with lidase or iodine, ultrasound, high-frequency pulsed currents (CMT, DDT). Also used in rehabilitation treatment are immunomodulators, autohemotherapy, injections of aloe, FIBS, Longidase, etc. For chronic adnexitis, sanatorium-resort treatment is indicated - mud, paraffin, medicinal baths and douching.

Suppositories for inflammation of the appendages

To reduce signs such as inflammation, pain, swelling, and temperature, special suppositories are used that can relieve inflammation. They can also prescribe suppositories that can strengthen the immune system, and this is very important for any illness. Also, such drugs cleanse the body of harmful substances.

All suppositories are prescribed by a doctor, but in any case such treatment will be additional.

Folk remedies

At home you can use some folk recipes:

1. Take 4 teaspoons finely chopped buckthorn, Chernobyl and peony roots, add 3 teaspoons of burnet and elecampane roots. After this, pour 2 tablespoons of the resulting mixture with half a liter of boiling water. Boil for half an hour over low heat, and then let cool for half an hour. Afterwards, strain and you can add a little honey for taste. Take half a glass 3-4 times a day.
2. One tablespoon chopped dry boron uterus grass pour a glass of boiling water. Leave for 2 hours. Strain. Take 1/3 cup 3 times a day half an hour before meals. The course of treatment is 1 month. After a month's course of treating adnexitis with boron uterus, it is advisable to drink another infusion for 2 months - from the grass of the field grass. 1 tbsp. l. pour a glass of boiling water over the herbs, leave for 4 hours, strain. Drink 1 tsp. 30 minutes before meals 4 times a day.
3. Buldenezh should be collected at the very beginning of flowering (until insects infest them). A tincture of them has excellent antiseptic, anti-inflammatory and analgesic properties. A liter jar is filled with inflorescence balls, filled with vodka and sent to a dark, cool place for 15 days. This tincture is rubbed on the lower abdomen, and the inflorescences are applied in the form of compresses.
4. Take flowers of coltsfoot, sweet clover, centaury in equal proportions. Mix, pre-grind, pour boiling water, let it brew for an hour, then strain the broth through cheesecloth and drink half a glass twice a day. During treatment, abstinence from sexual intercourse is recommended.

Remember that folk remedies are only a supplement and cannot in any way replace drug therapy prescribed by a specialist.