Adnexitis diagnosis and treatment. Chronic adnexitis - what is it? Symptoms, treatment

Adnexitis is a unilateral or bilateral inflammation of the appendages, including the fallopian tubes and ovaries. Inflammation of this type is formed due to the influence of various microorganisms, which can be transmitted in acute or chronic form. It should be noted that adnexitis, the symptoms of which are quite common among women, defining the disease itself as one of the most common gynecological diseases, is also characterized by the occurrence of frequent relapses. Moreover, this inflammation, as a rule, affects both organs at once, and its danger lies in the formation of subsequent infertility for every fifth sick woman.

Etiology of adnexitis

Dwelling on this disease in more detail, we note that the severity of manifestations characteristic of adnexitis is based on the specific degree of prevalence of inflammation. Not the least role in this is played by the pathogen itself and the general condition of the body against the background of its immunity. The causative agents, in particular, are a variety of types of microbes and bacteria, which include chlamydia, gonococci, tuberculosis microbacteria and others.

When the disease occurs, the epithelium of the fallopian tubes is destroyed, as a result of which the walls are impregnated with waste products of infecting microorganisms, which, as a result, leads to inflammation.

Forms and symptoms of the disease

As already noted, adnexitis is characterized by symptoms based on the specific pathogen affecting the area. At the same time, the symptoms of acute adnexitis are characterized by a general malaise, which makes it similar to a cold. In particular, these include high fever and headaches, chills and body aches, nausea and even vomiting.

Along with this, there are also specific types of symptoms that act as aching and periodic (often constant) pain in the lower abdomen, and these pains can radiate to the thigh or lower back, as well as to the rectum. Additionally, we note such symptoms characteristic of adnexitis as irritability and nervousness, insomnia and depression. As for such a form as subacute adnexitis, its symptoms follow from the previous form, but in this case there is a decrease in pain and temperature, which are generally characteristic of it.

Another form of the disease is chronic adnexitis. It develops mainly from the acute form in its untreated stage. Periods of exacerbation that characterize chronic adnexitis have the following symptoms: deterioration in overall health, weakness, increased temperature (up to 38°C). It is noteworthy that about 40% of the total number of women diagnosed with chronic adnexitis are faced with a disorder in sexual function, and they also experience a lack of sexual desire. Often, disturbances occur in the functions of the digestive system (for example), the urinary system (, etc.).

In its chronic form, adnexitis causes anxiety in the form of a “dull pain” that is constant. Moreover, such pain can intensify during physical activity, during sexual intercourse or menstruation, under the influence of stress and during hypothermia. Again, if we are talking about a chronic form, adnexitis in this case provokes symptoms in the form of menstrual cycle disorders. Their severity lies in the scarcity of discharge or in its abundance, and in both cases, menstruation, as a rule, is extremely exhausting.

It should be noted that with prolonged adnexitis, there is a risk of infertility, which is formed due to the soldering of the tubes during their prolonged inflammation, which ultimately leads to their obstruction. By the way, it also happens that infertility is the only sign indicating the presence of adnexitis.

As we have already noted, bilateral adnexitis often occurs, but the course of the disease in a unilateral form is not uncommon. In the case of unilateral adnexitis, pain symptoms are localized in pain on a specific side, however, with nagging, strong pain, it is not always possible to determine this.

Diagnosis of adnexitis

Adnexitis, the symptoms of which the patient experiences, can be diagnosed not only based directly on them, but also on the results of special diagnostic studies. These include a two-manual gynecological examination, as well as a study based on smears taken from the urethra, cervix and vagina. Adnexitis can also be detected by prescribing a microbiological study aimed at studying the contents of the fallopian tubes, and, finally, by using ultrasound for this purpose.

To determine the presence of purulent formations, as well as to conduct a detailed examination of the fallopian tubes, along with intracavitary treatment in the case of inflammation of the appendages, laparoscopy is used, which acts as the most effective method for diagnosing acute adnexitis. But to determine the overall patency along with the degree of pathology of the fallopian tubes, a uterine X-ray examination allows for the introduction of a contrast agent; the research process itself is called hysterosalpingography.

If adnexitis is suspected, special functional tests are performed, in which the rectal temperature is measured, the pupil symptom is determined, as well as the tension of the cervical mucus. Adnexitis can also be determined by a blood test, which examines leukocytosis, indicators of an increase in the total amount of protein, bacteriuria and leukocyturia associated with damage to the bladder and urethra.

Treatment of adnexitis

The subacute stage of the disease requires a gradual transition to physiotherapeutic procedures, which are also prescribed in the case of chronic adnexitis. This particularly includes ultrasound and mud therapy, as well as a number of other methods. Note that the sooner adnexitis, the symptoms of which are taken into account by the doctor, is detected, and the sooner its treatment begins, accordingly, the less likely it is that the uterine appendages will suffer damage in the form of scar changes, which, in turn, , will define infertility as a more stable diagnosis.

Most often, treatment is based on antibacterial therapy, in which antibiotics corresponding to the cephalosporin or penicillin group are prescribed. The duration of the course is about 14 days, after which adnexitis and its symptoms disappear.

Also mandatory are drugs that help inhibit the growth of anaerobic bacteria. To eliminate symptoms characteristic of general intoxication, intravenous vitamins and solutions are used. With the development of peritonitis, as well as with the formation of purulent sacs, treatment is carried out surgically.

Features of remission

As for the time of remission, resorption therapy is relevant here, for which magnetic therapy and mud tampons, suppositories and ultrasound, physiotherapy and electrophoresis are used. Spa treatment also has a beneficial effect. Considering the chronic form of adnexitis, its symptoms and treatment determine, accordingly, the need to increase the period for remission, for which hormonal contraceptives are used. The duration of their use can be about 6-8 months, and sometimes this period is longer.

If you suspect adnexitis, or the symptoms listed above in one way or another indicate the presence of problems, you should contact a gynecologist. Only he can make a final diagnosis of adnexitis, taking into account the symptoms, as well as the data obtained on the basis of a series of analyzes and studies aimed at identifying the problem.

Adnexitis is a disease of the genital organs of the female body, in which the uterine appendages, which are the ovaries and fallopian tubes, become inflamed. A woman is usually very bothered by discomfort in the lower abdomen. If treatment is untimely and of poor quality, a woman may face very unpleasant consequences for her, such as menstrual irregularities, adhesive diseases, ovarian cysts, and ectopic pregnancy. And one of the deplorable results of this disease can be infertility. However, all this can be avoided if you consult a doctor for help in time.

Adnexitis is not the only name for this female disease. Often, representatives of the fair sex can hear a diagnosis called salpingoophoritis. Salpingitis means inflammation of the fallopian tube, and oophoritis is an inflammatory process that occurs in the ovaries.

Etiology of adnexitis

The reasons that can lead to adnexitis are quite diverse. The disease can develop independently and the cause may be the following bacteria and microorganisms:

• Staphylococcus aureus;
• gonococcus;
• tuberculosis bacillus;
• chlamydia;
• coli;
• enterococcus

The intrauterine device can become the main route for bacteria to enter the ovaries. This is especially true for those women who have not yet given birth.

If the immune system of the female body is very weakened, this can also easily provoke the occurrence of the disease.

The above pathogens can easily enter the fallopian tubes during gynecological surgical interventions, abortions, curettage, and even during childbirth.

The following factors can also contribute to the development of adnexitis:

• sexual relations with multiple partners;
• unprotected sex;
• sexual relations without contraception during menstruation;
• hypothermia of the body during a period of weakened immunity;
• previous diseases of the female genital organs.

Abdominal diseases such as appendicitis and colitis can be the main cause of adnexitis.

Clinical picture

The main symptoms of this disease are as follows:

• severe nausea;
• vomit;
• increase in body temperature to 38-40°C;
• severe pain in the lower abdomen;
• chills;
• disturbances in the process of urination and menstrual cycle;
• general weakness and fatigue.

These are general signs of adnexitis, however, adnexitis is a disease that can manifest itself in the following two forms:

• acute adnexitis;

The acute form of adnexitis is characterized by slightly different symptoms than the chronic form. In acute adnexitis, a woman usually feels pronounced pain in the lower abdomen, which, in turn, is accompanied by high fever and intoxication of the whole body. Possible disruption of the urination process.

The chronic form of the disease is characterized by dull pain that appears constantly. At the same time, women's menstrual cycle and sexual function are disrupted.

Adnexitis is usually accompanied by mucous membranes or.

Types of adnexitis

There are several types of adnexitis:

1. Right-sided adnexitis, in which the ovaries and tubes become inflamed only on the right side. The pain felt is such that women often confuse them with symptoms of appendicitis. In this case, consultation with a surgeon is required.
2. Left-sided adnexitis - the left appendages become inflamed. The clinical picture is similar to colitis.
3. Bilateral adnexitis, in which both appendages are affected. The woman feels very strong pain in the lower abdomen, radiating to the anus and vagina. Bilateral adnexitis is very dangerous.

Possible consequences

If you do not start timely treatment of adnexitis, then its acute form will very soon develop into a chronic form, therefore, in order to prevent such a negative process, it is necessary to consult a doctor at the first symptoms.

And the consequences that neglected or untreated adnexitis can lead to are as follows:

• feeling of constant and ongoing pain in the lower abdomen;
• heavy or scanty discharge during menstruation;
• unpleasant or even painful sensations during sexual intercourse;
• ectopic pregnancy;
• peritonitis (pus entering the abdominal area);
• fusion of the fallopian tubes and, as a result, infertility;
• fatigue, constant irritability;
• very little chance of having a healthy baby.

Diagnosis of the disease

In order not to encounter such depressing and unpleasant consequences of the disease, you need to urgently consult a doctor. The doctor is obliged to ask the patient in more detail about the accompanying symptoms and conduct the necessary gynecological examination. To make a correct diagnosis, it is also necessary to take blood tests, which will show the general picture of the patient’s condition and make it possible to identify leukocytosis and C-reactive protein.

Diagnosis involves an ultrasound, in which the doctor determines how enlarged the ovaries are. It is also necessary to identify whether there are any tumor formations.

Treatment methods for adnexitis

The main question that worries all women diagnosed with adnexitis is how and how to treat such a serious disease. And is it possible to treat this disease at home?

Self-medication is strictly not recommended. If a person is a supporter of traditional medicine, it is strictly necessary to discuss it in detail with the attending physician. Only after coordinating the recipes of folk remedies with specialists can you begin to use them. In this case, the treatment will be successful and will delight you with positive results in the near future.

The entire treatment process should be carried out under the control and supervision of experienced doctors, because with this disease it is necessary to monitor how the intestines function and how all urinary organs behave. Therefore, if adnexitis is detected in a woman, she must be hospitalized immediately.

A woman diagnosed with adnexitis must be on constant bed rest. The doctor prescribes painkillers to the patient, but pain relief can be carried out not only with medications, but also with physical methods. Physical methods include applying cold to the area of ​​the affected appendages.

Drug treatment involves taking broad-spectrum antibiotics. If the patient has adnexitis of a purulent nature, then surgical intervention is indispensable. In this case, laparoscopy is performed, with the help of which all existing purulent accumulations are removed. Then antibacterial agents are injected into the area affected by the disease.

A disease that has become chronic is treated in a slightly different way. Here it would be correct to adhere to an integrated approach, involving the use of antibiotics and antifungal agents. It is also necessary to restore the intestinal microflora and strengthen the immune system. It is recommended to carry out gynecological massage, mud treatment and physiotherapy.

If we talk about folk remedies, then it must first be discussed with your doctor. Traditional medicine involves the use of various decoctions and steam baths of medicinal herbs. You can use douching based on the same herbs. Effective results can also be expected from propolis with honey, which is suitable for both external and internal use.

Every self-respecting and self-loving woman should take care of her health, therefore, to avoid the occurrence of adnexitis, prevention is necessary. And the prevention of adnexitis involves the following rules:

• strengthening immunity;
• avoidance of abortion;
• compliance with all rules of personal hygiene;
• use condoms during sexual intercourse;
• avoid hypothermia.

Compliance with all preventive measures will provide an opportunity not only not to get adnexitis, but also a chance not to catch any other gynecological disease.

If a disease is detected, you must adhere to all recommendations and prescriptions of your doctor.

Adnexit- inflammation of the female internal genital organs (“appendages”). The inflammatory process is associated with the presence of an infection that enters the appendages (ovaries, fallopian tubes), usually from the underlying parts of the genital tract, primarily from the vagina, which normally contains a lot of bacteria, but they do not penetrate further than the vagina.

Inflammatory diseases of the vagina and external genitalia can lead to the penetration of pathogenic microbes inside. Therefore, treatment of even mild vaginitis and vulvitis (infection of the vagina and labia) should not be delayed.

Signs of adnexitis can be diagnosed in girls 10-12 years old and in women over 60. Adnexitis and salpingitis occupy leading positions among other pathologies of the female genital area. The nosoological classification according to the International Classification of Diseases (ICD-10) adnexitis has a code of 70 and implies not only inflammation of the ovaries, but also the fallopian tubes.

Causes of adnexitis

The cause of adnexitis is often sexually transmitted infections, for example, chlamydia, gonococcus, trichomonas, sometimes Staphylococcus aureus, etc. The cause of adnexitis can also be a frequent change of sexual partner, unprotected sex, as well as too rapid resumption of sexual life after childbirth, abortion or gynecological operations.

The state of immunity plays an important role, since if a woman is constantly under stress, she is more susceptible to adnexitis. Adnexitis can also be caused by hypothermia due to the fact that a woman does not dress appropriately for the weather. The presence of an intrauterine device can also provoke inflammation of the appendages.

Symptoms of adnexitis

Symptoms of acute adnexitis

The main symptom of acute adnexitis is severe pain in the lower abdomen on the right or left. The pain has a pulling or aching character and can radiate to other areas: the lower back, sacrum and rectum. In addition, purulent or serous discharge from the vagina begins. Additional symptoms of acute adnexitis are high body temperature, headache, loss of strength, pain in joints and muscles.

Symptoms of chronic adnexitis

Sometimes chronic adnexitis occurs immediately, without an acute form, but, as a rule, it develops from acute adnexitis in the absence of the necessary treatment. The main symptom of chronic adnexitis is also aching and nagging pain in the lower abdomen, but less intense than in the acute form of adnexitis. Pain occurs periodically, usually before or after menstruation. Another symptom of chronic adnexitis is dyspareunia - painful sensations during sexual intercourse.

In addition, with chronic adnexitis, menstrual irregularities occur: oligomenorrhea, amenorrhea, dysmenorrhea, etc. Exacerbation of chronic adnexitis can occur due to stress, hypothermia, various diseases, and the symptoms are similar to the acute form of adnexitis. A common symptom of adnexitis in advanced chronic form is infertility due to obstruction of the fallopian tubes or ovarian dysfunction.

Diagnosis of adnexitis

Diagnosis of adnexitis is difficult, since the symptoms of acute adnexitis are characteristic of various diseases of the pelvic organs, and the symptoms of chronic adnexitis are often not expressed.

To diagnose adnexitis, a gynecological examination is used, which consists of laboratory analysis of vaginal discharge, as well as urine and blood tests. However, the detection of microorganisms characteristic of adnexitis cannot indicate adnexitis with a sufficient degree of probability, since these signs are not specific.

A more reliable method for diagnosing adnexitis is laparoscopy - an endoscopic examination that makes it possible to examine the ovaries and fallopian tubes and detect such signs of an inflammatory process as accumulations of pus and serous effusion, inflamed mucous membrane, adhesions with changes in tissue structure.

Treatment of adnexitis

When treating acute adnexitis, hospitalization is necessary, since the acute form of adnexitis can have serious consequences and complications: the formation of purulent cavities in the tubes, purulent melting of the ovaries, peritonitis, etc.

The patient is prescribed bed rest, medications are used for pain relief, and broad-spectrum antibiotics and anti-inflammatory drugs are used to eliminate the inflammatory process. In the presence of a purulent process, surgical treatment is used.

When treating chronic adnexitis, the same scheme is used, except that antibacterial drugs are selected taking into account the pathogen, and corticosteroids are used as anti-inflammatory drugs. In addition, immunostimulating and restorative therapy is carried out.

Physiotherapeutic methods are also used in the treatment of adnexitis:

• magnetotherapy,
• Microwave and UHF therapy,
• paraffin therapy,
• mud therapy, etc.

Treatment of adnexitis with folk remedies at home

Treatment of adnexitis with folk remedies at home is used for chronic adnexitis. You should not use folk remedies to treat acute adnexitis, since in the acute form of adnexitis there is a significant risk of developing severe complications, including life-threatening ones.

As a folk remedy for treating adnexitis at home, douching, enemas or baths of infusions and decoctions of medicinal herbs with anti-inflammatory action are used:

• yarrow,
• pharmaceutical chamomile,
• caragana officinalis,
• St. John's wort,
• calendula,
• series,
• sage,
• Kalanchoe juice,
• Golden mustache,
• eucalyptus.

In addition, to stimulate the immune system, aloe juice, ginseng infusion, echinacea purpurea infusion, mumiyo, honey and other bee products are taken orally. It must be remembered that folk remedies for treating adnexitis at home should be used only after consultation with your doctor.

Prevention of adnexitis

You should adhere to certain rules for the prevention of adnexitis.

Classification of adnexitis

Adnexitis is classified according to several criteria:

Method of occurrence

• endosalpingoophoritis: the pathogen penetrates the mucous membrane;
• peresalpingo-oophoritis: infection begins in the abdominal cavity;
• myosalpingoophoritis: a rare type of disease - the pathogen penetrates from muscle tissue.

Flow type

• chronic: occurs against the background of insufficient treatment effectiveness;
• acute: characterized by severe conditions with fever;
• subacute: is a transitional stage on the path to recovery or chronic adnexitis;
• purulent inflammation: an extreme form of acute salpingoophoritis - cavities filled with pus form in the appendages.

Nature of distribution

• unilateral: only the right or left ovary is affected;
• bilateral: both sides are affected.

Questions and answers on the topic "Adnexit"

Question:Hello! Is it possible to have sex during treatment for adnexitis?

Answer: Hello. Sexual contact is permitted subject to the following conditions: sex during inflammation should be carried out only with one sexual partner; It is imperative to use a condom. It is not recommended to have sex with this pathology in women if painful sensations and pathogenic discharge are observed during sexual contact. It is important to follow the recommendations of your doctor regarding sexual activity during inflammation of the uterine appendages.

Question:Hello. Can there be wandering pains with adnexitis and thrush, sometimes on the left, sometimes on the right, sometimes in the middle, sometimes subsiding, sometimes intensifying?

Answer: Hello. Yes, this happens with adnexitis, you need it.

Question:Good evening, I was diagnosed with adnexitis, prescribed treatment, today I have been taking antibiotics for the 5th day, the pain this evening for some reason increased, it radiates to my leg and makes me feel nauseous, what should I do? Go to the doctor again or it could be from antibiotics.

Answer: Hello. Treatment of adnexitis should be comprehensive. To reduce pain, suppositories and physiotherapy are used. Tell your doctor about your condition.

Question:Hello. I am 27 years old and planning a pregnancy. Is it possible to conceive with chronic right-sided adnexitis?

Answer: Hello. Perhaps against the background of persistent remission.

Question:Hello! This is the question that worries me. I am 22 years old, two years ago I gave birth to a daughter. After birth, the placental polyp was curetted. Six months later, pain began in the lower abdomen, first they diagnosed endometritis, then they began to diagnose adnexitis, after treatment the pain did not go away. The doctor prescribed me to take hormonal drugs, but I’m afraid to take them. Is it possible to do without hormones? Is it possible to get pregnant with chronic inflammation?

Answer: Good afternoon, I can’t answer whether I can do without hormones or not, there is not enough information, pregnancy can occur against the background of inflammation, but most likely with problems.

Question:Good afternoon My sister recently suffered from adnexitis. The disease is not the most pleasant, and I would really like to avoid it. Tell us how to protect yourself from it, what prevention of adnexitis is necessary?

Answer: Good afternoon It is very good that you want to avoid this disease, because preventing it is much easier than treating it, and the consequences can be very serious, including infertility, peritonitis, and in rare, most severe cases, death. Read about the prevention of adnexitis.

Question:Hello, I am 19 years old, exacerbation of chronic adnexitis. Please tell me if the herbs red brush and boron uterus will help me relieve inflammation and get rid of adhesions. These herbs are highly praised. I just can’t inject antibiotics in the near future, because... I’m not sure that I’m not pregnant, I didn’t use contraception with my husband. I’m waiting for my period, when it comes, I’ll take the antibiotics prescribed by the doctor. So I wanted to heal a little with herbs.

Answer: In our opinion, the medicinal herbs you mentioned will not be able to provide a fundamental anti-inflammatory effect, much less eliminate the adhesive process.

Question:I was diagnosed with adnexitis. The ovary and left tube were removed. I passed all the tests and took a course of injections. Now they prescribed Regulon, after reading the instructions, I became scared to drink it and, in my opinion, does not relate to my illness at all. Tell me, is the use of this drug necessary or can we get by with other, more gentle and safe means?

Answer: Regulon is not a treatment for adnexitis, but can only be prescribed if you need reliable contraception.

Question:Good afternoon At the last ultrasound of the pelvic organs, my doctor concluded: “Ultrasound signs of chronic adnexitis, adhesions in the pelvis (left ovary).” I'm pregnant now, about 5-6 weeks pregnant. I feel good, there are no signs of an ectopic, but I can’t stop thinking about it. I do not know what to do.

Hello! You need to register for pregnancy and warn the doctor who will manage the pregnancy about the diagnosis, discuss possible risks and in the future follow his recommendations. At the moment, there is no reason to worry - one of the most dangerous complications of adnexitis - infertility - has not affected you, the adhesive process is dangerous, in particular, ectopic pregnancy - this can be excluded using an ultrasound (an ultrasound will show that the fertilized egg has attached to the uterus). As for the chronic inflammatory process, in this case you need to trust the doctor who will observe you, do not miss scheduled visits, and in case of alarming symptoms (unusual discharge, pain, bleeding) - come for an urgent consultation.

Question:Hello, 7 months ago an ultrasound revealed adnexitis, because when I applied pressure with a vaginal sensor, I experienced terrible pain in my left ovary. But before the ultrasound, nothing bothered me, and I didn’t even know. Truth felt discomfort when having sex with her husband. But no treatment was prescribed. No pregnancy for 9 years. In general, how do I know at what stage I have adnexitis? During my last menstruation I experienced terrible pain (and on the first day of my menstruation I had an ultrasound again). Are there any chances for treatment and what form of adnexitis do I have now?

Answer: Hello! You have already answered your first question and answered it yourself. Ultrasound showed the presence of chronic inflammation of the appendages. Diagnosis: chronic adnexitis. If adnexitis does not bother you, this does not mean that there is no problem. Infertility (temporary with adnexitis) is one of the possible complications of adnexitis. In the worst case, adhesions and obstruction of the fallopian tubes form. Treatment of adnexitis is, of course, carried out by a doctor. It would be good to know what infections there are. But the usual regimen for taking natural remedies for adnexitis is also suitable for you. If there are infections, then maintaining immunity will last longer.

Question:Hello! Please tell me, I had adnexitis, the doctor prescribed Wobenzym and Celebrex after a course of pills, at the end of this course I started having some kind of brown discharge, and my period was a couple of days later. Please tell me what could be causing this? Thank you.

Answer: Hello. This happens when taking antibiotics. But in order to more accurately answer this question, it is better for you to do an ultrasound of the pelvic organs, since such discharge can also occur with other diseases.

Question:Good afternoon I would like to know what could be causing my condition; my period ended on the 23rd. Now my lower back is constantly aching and my back hurts, I have bloating and pain in my right side. And it’s as if my period is coming again. Could it be something to do with the stomach?

Answer: The symptoms you describe can be observed in a number of diseases (adnexitis, ovarian cyst) and to determine their cause, you need to see a doctor and undergo an examination. First, you should see a doctor, take a blood test and do an ultrasound of the internal organs of the pelvis.

Adnexitis (salpingoophoritis) is an inflammatory process affecting the uterine appendages (tubes, ligaments, ovaries). Many infections, once they enter the body, do not cause unpleasant symptoms, so they are not treated in a timely manner. When immunity decreases, pathogenic microorganisms begin to actively multiply.

Chronic adnexitis is a consequence of acute or subacute inflammation of the uterine appendages. It occurs with periodic exacerbations.

Types of chronic adnexitis

The following types of chronic adnexitis are distinguished:

1. Left-handed. The inflammatory process affects the left fallopian tube and ovary.
2. Right-handed. The right tube and ovary are affected.
3. Double-sided. The inflammatory process is detected both in the left tube and ovary, and in the right.

Most often, bilateral adnexitis is observed.

Causes of chronic adnexitis

The fallopian tubes originate in the upper corners of the uterus and go towards the lateral areas of the pelvis. Their length can reach 12 cm, and their thickness is 0.5 cm. Anatomically, they are divided into the funnel, ampullary part, isthmus and uterine part. They differ in width. The other side of the fallopian tubes reaches the ovaries. The mature follicle moves along them into the uterine cavity.

The ovaries are paired sex glands that are located on the sides of the uterus and perform very important functions in a woman’s body. The size of these organs can reach up to 5 cm in length and up to 3 cm in width.

In the chronic form of the disease, women often experience disorders of the digestive system. The kidneys and bladder may also be involved.

Inflammation begins from the mucous membrane of the fallopian tube, gradually spreading to the muscular and serous membrane, and subsequently to the epithelium of the ovary. Organs become swollen, and blood circulation in them worsens.

As a rule, the clinical picture of this disease is erased. Exacerbation of chronic adnexitis most often occurs in spring or autumn.

Bacterial infections can cause accumulations of pus in the tubes, which leads to their thickening and the development of adhesions, as a result of which patency worsens and infertility develops.

In most cases, the cause of the inflammatory process is pathogenic microorganisms. Infection can enter the affected area in the following ways:

• hematogenous - through blood vessels from other organs;
• lymphogenous – through lymphatic vessels;
• ascending - from the vagina and uterus;
• descending - from the abdominal cavity.

The most common pathogens of the disease include sexually transmitted infections:

• trichomoniasis;
• chlamydia;
• gonorrhea;
• genital herpes;
• cytomegalovirus;
• papillomavirus.

Each sexually transmitted infection that causes the development of chronic adnexitis has its own characteristics:

• pathogenic viruses or bacteria that are sexually transmitted - most often bilateral chronic adnexitis develops;
• gonococcal infection - can provoke the occurrence of purulent adnexitis;
• chlamydia - most often causes adhesions.

Factors that influence the development of the disease:

1. Immune system dysfunction. The cause of this may be autoimmune diseases, chronic inflammatory processes, endocrine diseases, and malignant neoplasms.
2. Other chronic diseases of the genitourinary system.
3. Violations of personal hygiene rules.
4. Abortion. The greatest damage to the mucous membrane occurs during curettage. In this case, even the muscle layer can be damaged. Subsequently, the affected areas become overgrown with connective tissue, and blood circulation in this area is disrupted, which reduces resistance to infections.
5. Birth injuries of mucous membranes. The ruptures that appear as the child passes through the birth canal also contribute to impaired blood circulation in the pelvic organs, which causes a decrease in local immunity.
6. Presence of intrauterine devices. They are often perceived by the body as foreign bodies, so reactions are triggered that contribute to a decrease in local immunity. When inserting or removing the coil, the mucous membrane may be damaged, which allows infection to quickly penetrate inside.
7. Diagnostic manipulations.
8. Promiscuous sex life.

Symptoms of chronic adnexitis

Symptoms of chronic adnexitis:

1. Pain in the lower abdomen. In the chronic form of the disease, it can be irregular, aching, dull, worsening after physical activity, sexual intercourse or during urination. Pain may radiate to the rectum or lower back. In some cases, the pain intensifies in the middle of the cycle or before the start of menstruation.
2. Increased body temperature. In most cases it does not exceed 37.5 °C. This disorder can occur at certain hours and then go away on its own. With chronic adnexitis caused by chlamydia, the temperature does not rise.
3. Discharge. This symptom depends on the causative agent of the disease and the stage of the inflammatory process. Leucorrhoea can be mucous, purulent, yellowish or greenish. In some cases they have an unpleasant odor. Discharge may be absent or appear periodically during exacerbation of the disease.
4. Menstrual irregularities. This is an integral symptom of chronic adnexitis. Menstruation becomes heavy, painful and prolonged, and a large number of clots are released. But in some cases, the amount of menstrual flow is reduced to a minimum, and the disorder is accompanied by severe pain. Also, with chronic adnexitis, cycle disturbances are often observed.
5. Pain during sexual intercourse. They may be caused by inflammation of the mucous membrane of the genital organs.
6. Decreased sexual desire. With chronic adnexitis, the functions of the ovaries are disrupted, resulting in the production of an insufficient amount of hormones responsible for sexual desire.
7. Reproductive dysfunction. Adhesions formed as a result of inflammation close the lumen of the tube. This causes the egg to not reach the fundus of the uterus. As a result, a woman who does not use protection during sexual intercourse cannot become pregnant.

In the chronic form of the disease, women often experience disorders of the digestive system. The kidneys and bladder may also be involved. Patients with chronic adnexitis feel worse, they experience weakness, become lethargic and irritable.

With exacerbation of chronic adnexitis, the following symptoms may occur:

1. Deterioration in health.
2. Increase in body temperature to 38 °C.
3. Pain in the lower abdomen, radiating to the back or anus. The pain can be constant and quite intense.
4. Purulent vaginal discharge.

During surgery, the affected tube can be removed or adhesions that cause its obstruction can be eliminated.

Diagnostics

In order to diagnose the disease, the gynecologist conducts an examination using mirrors and a digital examination. To confirm the diagnosis, the following instrumental studies may be prescribed:

1. Ultrasound examination of the pelvic organs. It can be transabdominal (the sensor is applied to the lower abdomen) or transvaginal (the sensor is inserted into the vagina). Thickening of the walls of the fallopian tubes, anechoic contents, accumulation of fluid in the space behind the uterus and adhesions, heterogeneous structure of the ovaries and blurred contours are determined.
2. Laparoscopy. A tube with a lens system (laparoscope) is inserted into the abdominal cavity through small holes under local anesthesia. Using this device, the ovaries and fallopian tubes are examined, determining the presence of inflammation, pus and adhesions.
3. Metrosalpingography. A contrast agent is injected into the uterine cavity and fallopian tubes, which is monitored on x-rays. The study is necessary to check the patency of the fallopian tubes.

Laboratory research methods include:

1. Bacteriological examination of a smear.
2. General and biochemical blood test.
3. General urine analysis.
4. Smear for oncocytology.
5. An examination to detect sexually transmitted infections.

Treatment of chronic adnexitis

The main goal of treating chronic adnexitis is to eliminate the infection and strengthen the immune system. The following groups of drugs are prescribed:

1. Antibiotics from the group of penicillins, cephalosporins, tetracyclines.
2. Sulfonamides.
3. Antiprotozoal agents.
4. Non-steroidal anti-inflammatory drugs.
5. Vitamin complexes.
6. Antifungal agents.
7. Immunostimulants.
8. Biogenic stimulants.

Depending on the course of the disease, drugs can be prescribed in the form of tablets, intramuscular or intravenous injections or suppositories. The treatment regimen is determined by the doctor individually.

Physiotherapeutic treatment methods include:

1. UHF to the area of ​​the appendages and uterus.
2. Electrophoresis with drugs.
3. Ultraphonophoresis.
4. Magnetotherapy.
5. Radon or hydrogen sulfide gynecological irrigation.
6. Plasmapheresis.

Surgical intervention for chronic adnexitis is performed in the following cases:

• tumors in the ovarian area;
• purulent formations in the appendage area;
• lack of effect of conservative treatment;
• obstruction of pipes as a result of adhesions.

Contraindications to surgery are bleeding disorders, obesity, or infectious diseases in the acute stage. The most effective and safe method is laparoscopy.

Chronic adnexitis is not life-threatening, but if left untreated, the infection can spread. In this case, the prognosis worsens - the woman develops infertility and other diseases.

In some cases, a full-fledged surgical intervention is indicated, in which the abdominal wall is dissected, which makes it possible to gain access to the pelvic organs. This method is more traumatic and often leads to the formation of new adhesions.

During surgery, the affected tube can be removed or adhesions that cause its obstruction can be eliminated.

You should immediately consult a doctor in the following cases:

• severe pain in the lower abdomen;
• purulent discharge;
• increase in body temperature to 38 °C and above;
• urinary disturbance;
• general weakness;
• bleeding;
• increased heart rate.

Complications

Complications of chronic adnexitis include:

• infertility;
• lack of ovulation;
• the appearance of both benign and malignant neoplasms in the ovarian area;
• purulent melting of the pipe;
• ectopic pregnancy.

Chronic adnexitis can cause ovarian dysfunction. In this case, the ability to mature the egg is lost. Hormonal levels may also change, which negatively affects your well-being.

Forecast

The prognosis can be favorable with timely and correct treatment of chronic adnexitis. In the future, if you follow all the doctor’s recommendations, it is possible to avoid exacerbation of the disease.

Chronic adnexitis is not life-threatening, but if left untreated, the infection can spread. In this case, the prognosis worsens - the woman develops infertility and other diseases.

Preventive measures

In order to prevent the development of the disease, it is necessary:

1. Use condoms during sexual intercourse with unreliable or new partners.
2. Avoid sexual intercourse during menstruation.
3. Follow the rules of personal hygiene, change tampons and pads on time.
4. Avoid hypothermia. In cold weather, wear warm clothes and shoes. Do not swim in ponds or pools with cold water.
5. Strengthen the immune system (eat right, exercise).
6. To refuse from bad habits.
7. Treat diseases of the genitourinary system in a timely manner.

At the first signs of adnexitis, you should consult a gynecologist.

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Adnexitis or “salpingoophoritis” is an inflammatory process that occurs in the female reproductive organs (appendages). Inflammation occurs when infection enters the fallopian tubes and ovaries from the vagina or other underlying parts. It is one of the most common gynecological inflammatory diseases in women aged 20-30 years.

The disease is accompanied by aching pain in the lower abdomen and fever, with signs of intoxication; in addition, there are obvious irregularities in the menstrual cycle. Adnexitis is prone to periodic relapses, with the formation of adhesions and tissue adhesions.

Adnexitis and its causes

At its core, adnexitis is a combination of simultaneous inflammation of the ovaries and fallopian tubes. The development of inflammation occurs due to the entry of fungi, viruses, chlamydia, staphylococci, E. coli and other microorganisms into the body. It is noted that such pathogens of adnexitis can be resistant to most antibiotics, which can complicate treatment. The development of adnexitis and its relapse are facilitated by non-compliance with hygiene standards, promiscuity, hypothermia and simply a careless attitude towards one’s health. Pathogenic microbes in inflammatory diseases occurring in the vagina or external genitalia can penetrate inside, thereby causing adnexitis. Therefore, even mild diseases such as vaginitis or vulvitis must be treated efficiently and quickly.

The state of a woman’s immunity is also important; hypothermia and being in a stressful state makes her more susceptible to adnexitis. The use of an intrauterine device can lead to inflammation of the appendages.

The causative agents of adnexitis can penetrate the fallopian tubes and ovaries in the following ways:

1. Lymphogenic - Through the lymph, in cases of damage to the rectum and sigmoid colon.

1. Hematogenous - Through the blood, when the genitals are affected by tuberculosis.

1. Ascending - Through the ascending anatomical canals of the genital tract: from the vagina through the cervical canal to the fallopian tubes and ovaries. The most common causes of adnexitis are Escherichia coli, staphylococcus and streptococcus.

1. Descending - Through the cecum into the peritoneum, for diseases of the rectum and appendix.

Consequences of adnexitis

The process of inflammation of the appendages begins with the infection penetrating the lining of the fallopian tube and gradually involving other layers: serous and muscular. Spread also occurs to surrounding tissues, which include the ovarian epithelium and pelvic peritoneum. During ovulation, the infection penetrates the ruptured follicle or corpus luteum, affecting the ovaries themselves. With adnexitis, the ovary fuses with the fallopian tube, thereby forming a single inflammatory center. As a result, the consequence of adnexitis can be the development of multiple adhesions, depriving the fallopian tubes of patency, which threatens infertility. In the absence of adequate treatment, adnexitis leads to many other diseases: colitis, cystitis, pyelonephritis, metrorrhagia and much more. Inflammation of the appendages often leads to spontaneous miscarriage and ectopic pregnancy.

Symptoms of adnexitis

The course of adnexitis happens:

1. Sharp;
2. Chronic (recurrent and non-recurrent).

Acute adnexitis

Symptoms of acute adnexitis resemble acute appendicitis, which is why it may be misdiagnosed. An increase in inflammation leads to an abscess, which threatens to rupture the fallopian tubes and allow purulent contents to enter the peritoneal area. To the symptoms acute form of adnexitis The following characteristic ailments can be attributed:

• Increased body temperature to 39 degrees and chills;
• Sharp pain in the lower back and lower abdomen;
• The appearance of purulent and mucous discharge;
• Feeling weak and overwhelmed;
• Bloating;
• Urinary incontinence;
• Peritoneal irritation;
• Intoxication;
• Leukocytosis (blood test indicator).

Acute adnexitis goes through two phases:

• Toxic, with a predominance of symptoms of intoxication;
• Septic, with worsening symptoms and development of complications. A purulent formation forms.

Such severe symptoms persist for a week, and then gradually weaken, including normalization of temperature and blood tests. Without treatment, adnexitis develops into a chronic form.

Chronic adnexitis

This form develops as a result of the lack of necessary treatment for acute adnexitis. The disease occurs with relapses that occur under the influence of hypothermia, stressful situations or overwork. Chronic adnexitis is determined by the following symptoms:

• Deterioration in general health;
• Increased body temperature;
• Purulent vaginal discharge;
• Nagging pain in the lower abdomen;
• Digestive and urinary dysfunction;
• Pain during sexual intercourse;
• Lack of sexual desire;
• Menstrual irregularities.

As with acute adnexitis, the symptoms of chronic adnexitis subside after 7 days, only abdominal pain persists. Relapses occur quite often, thereby leading to decreased ability to work, irritability and the development of neurosis.

Diagnosis of adnexitis

In order to make a diagnosis of “adnexitis,” the doctor uses data from the medical history, the patient’s complaints and examination results. For diagnosis, it is extremely important to take into account the presence of factors from the past, such as a previous abortion, complicated childbirth, or the use of an intrauterine device.

• On gynecological examination consultation with a gynecologist; palpation reveals a painful enlargement of the uterine appendages (ovaries, fallopian tubes).
• To identify the causative agent of adnexitis, it is necessary to carry out laboratory diagnostics: bacterial culture, smear examination of the vagina, cervix and urethra, urine and blood tests.
• Allows to identify inflammatory formations Ultrasound of the pelvis.
• It is possible to identify and simultaneously cure purulent formations using diagnostic laparoscopy.
• To determine the patency of the fallopian tubes and identify pathological changes, X-ray examination with the introduction of a contrast agent.

In general, diagnosing acute adnexitis is difficult, since the symptoms are characteristic of many other diseases of the pelvic organs. Diagnosis of chronic adnexitis is complicated due to the lack of severity of symptoms.

Treatment of adnexitis

After examination on a gynecological chair, a study of the vaginal flora is carried out. Diagnostic laparoscopy is sometimes required. The main treatment for adenomyosis is antibacterial therapy. Medicines are selected from the group of penicillins, treatment of which continues even after the disappearance of symptoms for another 2 weeks. Based on the severity of the disease, the doctor may prescribe painkillers and anti-inflammatory drugs. After the symptoms disappear, the patient may be prescribed physical therapy (electrophoresis, ultrasound, vibration massage).

When acute adnexitis is diagnosed, a diet with a certain amount of fluid intake is prescribed to control excretory function. Following a diet allows the body to become more resistant to infections and improves metabolic processes. Outside of illness, nutrition should be rational and balanced. For antibacterial therapy, antibiotics in various combinations are first prescribed.

Symptoms of intoxication are relieved with infusion therapy.

Purulent forms of inflammation are subject to surgical treatment: using laparoscopy, purulent foci are removed and irrigation is carried out with disinfectants.
To treat chronic adnexitis, the same treatment measures are carried out as for acute adnexitis. When eliminating the symptoms of chronic adnexitis, all efforts are directed toward maintaining and strengthening the body as a whole. Physiotherapy with ultraviolet irradiation, electrophoresis with the use of drugs, ultrasound and vibration massage are prescribed. The results of physiotherapy are necessarily monitored. In case of stable remission, women are prescribed spa treatment.

Prevention of adnexitis consists in observing the rules of personal hygiene and timely treatment of sexually transmitted infections. To avoid risk, you first need to lead a healthy lifestyle and strengthen your immune system. Regular visits to the gynecologist will help identify the disease in the early stages and prevent negative consequences.

The following preventive measures should be observed:

• Protect yourself from hypothermia and stress,
• Beware of sexually transmitted infections;
• Do not eat spicy, sweet and canned foods;
• Use rational contraception;
• Timely undergo complex therapy for inflammatory diseases;
• Consult a gynecologist 2 times a year.