Adhesions of the intestines and pelvis after surgery: what causes them and how to treat them. Adhesions - causes, symptoms, treatment and prevention of adhesions

Pelvic adhesions are dense film formations that glue organs together. The occurrence of this process has been studied for more than 100 years, but as such, accurate results about the causes of their occurrence and methods of prevention still do not exist.

What are the adhesions for?

Many scientists and doctors tend to assume that pelvic adhesions They are not easily formed - they are designed to protect the entire body from the resulting inflammation. Therefore, the adhesive process is a threat only in cases where it has complications. If there isn't one

observed, which means they do not require treatment. But this fact still requires considerable proof.

The mechanism of formation of this pathology?

To put it simply, the main reason for the appearance of symptoms of pelvic adhesions is this: the entire space between the organs is filled with abdominal fluid, the production of which is carried out by the peritoneum (thin tissue covering the cavity from the inside). When inflammation of the organs (especially the genitals) occurs or surgery is performed on them, the secretion of this fluid increases sharply. In addition, it acquires a very viscous and sticky consistency. It is this thick liquid that is the adhesions that glue nearby organs and fabrics.

Factors that provoke the formation of pelvic adhesions

1. Inflammatory diseases of the pelvic organs. It can be various infections appendages, peritoneum or uterus: parametritis, endometritis, metroendometritis, salpingoophoritis, etc.
2. Any surgical effects on the uterine cavity: diagnostic curettage, installation of an intrauterine device, abortion, etc.
3. Sexual infections: mycoplasmosis, ureaplasmosis, gonorrhea, chlamydia, trichomoniasis.
4. Inflammation of organs abdominal cavity.
5. Injuries or others mechanical damage pelvic organs and peritoneum.
6. Bleeding due to ovarian apoplexy or ectopic pregnancy.
7. Overheating or cooling of the abdominal cavity.
8. Endometriosis disease.

Signs indicating adhesions

Symptoms of pelvic adhesions, or more precisely, their strength, largely depend on the spread and neglect of the disease. There are three forms adhesive process:

• Spicy. Signs of its manifestation are the following: increased pain, increased temperature, nausea (sometimes vomiting), rapid heartbeat. Intestinal obstruction may occur. When palpating the abdomen, the patient feels sharp pain. Over time, her condition may worsen sharply - appears severe drowsiness, weakness. The pressure begins to drop, the amount of urine decreases, and water-salt metabolism in the body is disrupted. Required urgent help in the form of surgery.
• Intermittent – ​​the appearance of periodic pain and intestinal upset.
• symptoms of pelvic adhesions chronic type – Clinical signs either absent altogether, or occasionally aching abdominal pain and constipation appear. In gynecology this form occurs most often. Basically, it manifests itself in the form of endometriosis and many infections that the patient does not even know about. Chronic manifestation this disease can cause the formation of adhesions fallopian tubes which lead to infertility in women.

Is it possible to confuse adhesions with another disease?

Yes, you can. The manifestation of the same symptoms as those of pelvic adhesions (abdominal pain, vomiting, nausea and fever) is characteristic of many diseases - ranging from inflammation of appendicitis, ectopic pregnancy, and ending with simple poisoning or viral infection.

What could be the consequences of the adhesive process?

Pelvic adhesions can spread in almost all directions, forming something like a chain of interconnected tissues and ligaments. Moreover, the most weakened and diseased organs are most often affected. As a result of the appearance of adhesions, the axis of their movement decreases. The area of ​​the adhesive process begins to increase, thereby reducing the mobility of organs more and more. Because of this, the blood circulation going to them may be disrupted. If we talk about the complications that pelvic adhesions give in the form of diseases, there are many of them:

• infertility;
• bend of the uterus;
• disturbance of the menstrual cycle;
• obstruction of the intestines and fallopian tubes;
• ectopic pregnancy.

Diagnosis of adhesions

In order to diagnose this disease, a gynecologist will need a lot of time. The first thing he does is examine the patient in a chair, during which the patient may complain of pain. The final diagnosis will be made only after multiple studies. Namely:

• taking a vaginal smear;
• tests for urogenital infection;
• if necessary, an MRI of the pelvic organs is performed;
• laparoscopy (diagnostic).

Stages of the disease

Based on the results of the studies, we can say that pelvic symptoms belong to one of three stages:

• first - pelvic adhesions have formed only near the ovary or fallopian tube and do not yet interfere with the passage of the egg;
• second - adhesions are already located between the ovary and the fallopian tube, but are already beginning to interfere with the passage of the egg;
• third stage - torsion and blockage of the pipe with adhesions occurs. The passage of the egg is not possible at all.

Treatment of pathology

The tactics for treating pelvic adhesions largely depends on the severity (form) of the disease. Therefore, it can be divided into conservative and surgical.

Conservative treatment is used for the chronic form of adhesive disease. To do this, it is necessary to identify its cause, which should be eliminated. Recently, enzyme therapy has become very popular - taking drugs whose action is aimed at resolving adhesions. If no infectious disease is observed, then laser and magnetic resonance therapy are performed. But it is worth considering that such types of treatment will be effective only at the first stage of development of the pathology.

With the second or third degree of spread of this process, it is necessary to resort to diagnostic and treatment laparoscopy. This method is good because if the presence of adhesions is confirmed during the study, the doctor immediately performs an operation to remove (cut) them.

Prevention of disease relapse

To avoid recurrence of symptoms of pelvic adhesions, a woman must adhere to some rules:

• following a certain diet (avoiding foods, causing bloating abdomen);
• visit a gynecologist at least 2 times a year;
• maintaining physical rest for 4-6 months,
• performing physiotherapeutic procedures;
• light physical exercise;
• for painful attacks, taking antispasmodics (papaverine, no-spa);
• If you experience persistent pain, consult a doctor.

Pelvic adhesions are a disease that is very treatable. But preventing a disease is much easier than treating it! Therefore, pay attention to your health a little more often, and everything will be fine!

Adhesions in the pelvis are connective tissues formed between the walls and appendages of the uterus, bladder, ligaments and loops of the colon. They cause unpleasant painful sensations and other clinical signs, the severity of which depends on the stage of the disease. The adhesive process can cause infertility.

When the first signs of an anomaly appear, it is necessary to perform a diagnosis and take a course drug therapy. In some cases, surgical methods may be used. As a preventative measure, it is recommended to use folk remedies.

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What is the adhesive process?

Abdomen - closed space, lined with a serous membrane. It consists of 2 layers, passing into each other. Lines inner surface parietal leaf, covers internal organs- visceral. The peritoneum should ensure free mobility of organs, reduce their friction with each other, protect against the penetration of infectious microorganisms, preserve adipose tissue abdominal cavity. If, under the influence of provoking factors, the supply of oxygen to the peritoneum is disrupted, then the development of adhesions may begin. Different sections of the visceral layer or two sheets of the shell stick together. After this, adhesions are formed.

The process of development of pelvic disease can be divided into phases:

1. 1. Reactive. Occurs in the first 12 hours after damage to the peritoneum caused by mechanical stress or inflammation.
2. 2. Exudative. Observed in the first three days. Characterized by an increase in the level of vascular permeability. Because of this, undifferentiated and inflammatory cells, as well as a liquid fraction of blood containing fibrinogen, enter the pelvic cavity.
3. 3. Adhesive. From the fourth day, the released protein begins to degenerate into fibrin, which forms in the form of threads. Fibroblasts are formed from undifferentiated cells. They produce collagen, which is necessary for the formation of connective tissues.
4. 4. Phase of young adhesions. Lasts from 1 to 2 weeks. During this period, the formed connective tissues are characterized by looseness. This is due to insufficient collagen. New blood vessels and nerve endings are formed.
5. 5. Phase of mature adhesions. Lasts up to 1 month. During this period, dense fibrous connective tissues are formed. The process of converting capillaries into larger vessels occurs.



Causes and development factors

The adhesive process is an adaptation mechanism aimed at delimiting the area of ​​​​inflamed foci from healthy tissue. The body's defensive reaction occurs as a result of injuries, operations and other mechanical influences. In gynecology, predisposition to a pathological condition and the degree of its severity depends on the genotypic and phenotypic characteristics and characteristics of the woman’s body.

The main reason for the adhesive process is excessive reactivity connective tissue. This feature is explained by decreased immunity and predisposition of the body.

The following risk factors for the development of pathology are identified:

• Endogenous (internal). Genetic predisposition, leading to low adaptation of the body to hypoxia.
• Exogenous (external). Impacts on the body that exceed its adaptive capabilities.
• Combined (combines endo- and exogenous). A combination of factors increases the likelihood of adhesions forming.

The following are distinguished: clinical reasons development of pathology:






Clinical manifestations

Adhesions in the pelvis provoke the appearance severe symptoms which cause severe discomfort. The severity of their manifestation depends on the stage and form of the pathological process:

Disease stage	Symptoms
Acute	Clinical signs are clearly expressed. Intense pain occurs in the lower abdomen, which intensifies with pressure or changes in body position. There is an increase in body temperature to 38 degrees, nausea, and in some cases vomiting. If the large intestine is involved in the adhesive process, then its obstruction is observed. This causes severe deterioration of the condition. Against the background of obstruction, tachycardia develops, blood pressure decreases, and breathing quickens. In this case, emergency surgical care is required
Intermittent (intermittent)	This stage is characterized by periodic attacks of pain. No other discomfort is observed
Chronic	The most common form of adhesions. She poses the greatest threat. The pathology may not manifest itself for years. More often chronic stage occurs without symptoms, but with periodic pain in the lower back or pelvic area. With this form, a woman develops: endometriosis; ovarian pathology; obstruction of the fallopian tubes; infertility or inability to bear a child. Many women learn about the presence of chronic adhesions of the abdominal organs during a consultation with a gynecologist, when they cannot for a long time get pregnant

When adhesions in the pelvis of chronic form occur, tubal obstruction and Asherman's syndrome may develop. These conditions require urgent surgical intervention, since conceiving a child with them is almost impossible.





Diagnostics

Diagnosing an adhesive process is quite difficult, but the doctor can make an assumption about its presence after collecting an anamnesis. Suspicion of pathological condition occurs when transferred or existing venereal diseases, operations and abortions performed, the presence of inflammation.

To make an accurate diagnosis, a number of instrumental studies are performed:

• Ultrasound of the pelvic organs for the presence of endometriosis, inflammatory processes in the appendages and uterus;
• laparoscopy;
• magnetic resonance imaging;
• hysterosalpingography (contrast radiography performed to detect fallopian tube obstruction).

To diagnose pathology, laboratory tests are prescribed. These include:

• blood culture for sterility;
• bacterial culture of urine;
• clinical blood test;
• diagnosis using PCR for the presence of urogenital infections;
• clinical urine analysis.

Treatment

Adhesions in the pelvis are treated using two methods: conservative and surgical. If the adhesive process occurs in a chronic form, then conservative treatment is used. Define the real reason pathology. Based on the results obtained, effective drugs are selected:

1. 1. For urogenital infections, therapy is aimed at eliminating the pathogen and reducing the risk of developing adhesions in other parts of the abdominal cavity. For this purpose, antibacterial and anti-inflammatory drugs are prescribed.
2. 2. Hormonal disorders, for example, those that cause endometriosis, are treated with anti-inflammatory, symptomatic and desensitizing drugs.
3. 3. Enzyme therapy is widespread, which is based on the use of drugs that dissolve fibrins (Trypsin, Longidaza, Chymotrypsin). They are used in the presence of small adhesions.



If there is no acute infectious process, then physiotherapy is prescribed. Magnetic laser equipment is used for treatment.

The surgical method is used when the pathological process occurs in acute and intermittent forms. To remove adhesions, laparoscopy is used, which is characterized by high efficiency and speed. Sometimes surgery is used in combination with conservative therapy (or if it is ineffective).

Typically, the problem is diagnosed and treated at the same time. The surgeon cuts and removes adhesions. There are 3 methods of laparoscopy:

• laser therapy;
• aquadissection;
• electrosurgery.

The method is determined during the operation at the discretion of the doctor. The choice is influenced by the location of the adhesions and their prevalence.

Therapy with folk remedies

To prevent the spread of adhesions and stop the process of their development, methods are used traditional medicine. They are advised not to be used as the main treatment, but only as additional preventive measures. Therapy folk remedies can be performed after surgery, but only with the permission of the attending physician.

1. 1. Irrigate the vagina with an infusion of medicinal herbs. To prepare, take 1 tablespoon of elderberry flowers, pharmaceutical chamomile, crushed flax seeds. Fill them with 4 cups of boiling water. Wrap the mixture in a blanket and leave to infuse for 1 hour. The resulting product is used for douching 2 times a day: morning and evening. The course of therapy is 1 month.
2. 2. Douche with iris infusion. Take one tablespoon of crushed iris rhizomes and pour boiling water over it. Infuse the solution until it cools completely. Used for washing for a month and a half.
3. 3. Drink plantain decoction. Take a teaspoon of plant seeds. Pour into a glass cold water. The solution is put on fire. After boiling, cook for 10 minutes. Leave to stand until completely cooled. The finished product is filtered and drunk 3 times a day. The course of treatment is 30 days.
4. 4. Take milk thistle remedy. A tablespoon of crushed seeds is poured into 250 ml of boiling water. The solution is placed on low heat and kept for 15 minutes. After cooling, filter the broth. Drink a third of a glass 3 times a day. After taking the decoction, the connecting threads begin to dissolve.



Folk remedies have a general strengthening effect, therefore they should not be perceived as a panacea. If we abandon the conservative drug treatment in favor of decoctions and infusions, the condition can be seriously aggravated.

Adhesions can be successfully treated, but it is better to prevent their formation. To do this, it is recommended to follow preventive measures. Women are advised to engage in light exercise, periodically visit a gynecologist, and take antispasmodics during painful attacks.

Plastic pelvioperitonitis (adhesive process of the pelvic organs) is pathological process, characterized by the formation of connective tissue adhesions (cords) between the walls of the uterus, uterine appendages, ligaments, bladder, and also loops of the large intestine. The organs located in the pelvic area are externally covered with a visceral serous membrane, and the abdominal cavity is covered with a parietal membrane (peritoneum). The visceral type of peritoneum, due to the presence of peritoneal fluid, promotes the normal movement of internal organs relative to each other. The presence of adhesive neoplasms limits the free movement of organs.

Adhesive process in the small pelvis has a wide range etiological factors and various pathomorphological development options. The main reasons leading to the appearance of this pathology are:

1. Infectious and inflammatory pathologies of the pelvic organs: endometritis ( inflammatory lesion uterine cavity), metroendometritis (inflammatory and infectious process that affects the mucous and muscular inner layers of the uterus), parametritis (an inflammatory process of an infectious nature that affects the parametrium - periuterine tissue), salpingo-oophoritis (inflammatory phenomena in the uterine appendages), pelvioperitonitis (infectious and inflammatory process, affecting the entire pelvic peritoneum). The occurrence of the above diseases is facilitated by such factors as prolonged use of the intrauterine device, abortive operations (curettage), venereological infections (ureaplasmosis infection, trichomoniasis, gonococcal lesions, chlamydia). The pathogenesis of the development of adhesions in the pelvis with this etiology is as follows: during inflammatory phenomena, the affected tissues swell, and the visceral and parietal membranes become covered with a fibrin film. Fibrin plaque has a gluing effect on nearby tissues, after which a mechanical barrier appears for the subsequent spread of pathological phenomena. After relief of inflammatory manifestations, the bonded tissue surfaces form adhesions;
2. Inflammatory pathologies of organs located in the abdominal region (colitis, peritonitis, appendicitis);
3. Mechanical impact on organs localized in the pelvic and abdominal areas due to traumatic injuries and surgical interventions. In this case, the adhesive process occurs when infected blood flows into the abdominal area, prolonged ischemic state of organs, dryness of the outer membranes of organs (due to their long stay open air operating room);
4. Often the development of adhesions is facilitated by bleeding due to ectopic pregnancy, ovarian apoplexy;
5. Presence foreign objects in the abdominal cavity (during surgical procedures);
6. – a pathological process characterized by abnormal growth of the endometrium (inner uterine lining).

Symptoms of the disease

The adhesive process in the pelvis may have various symptoms. Manifestations of such pathology have a certain dependence on the degree of development of the process, its localization and clinical form:

• The acute form has the most pronounced signs of manifestation of the adhesive process in the pelvis, which tend to progress. The main complaints are gradually increasing pain of a pulling (and then cutting) nature, typical manifestations of intoxication syndrome are observed - sharp increase body temperature indicators up to febrile levels (from 38 0 C to 40 0 ​​C), significant increase in heart rate, tachycardia, constant nausea, possible vomiting, which does not bring relief. Intestinal obstruction occurs, as evidenced by the detection of sharp pain in the peritoneum during abdominal palpation and characteristic peritoneal symptoms. If therapy is not started in a timely manner, the patient’s condition deteriorates very quickly: it progresses renal failure(acute form) and occurs hypovolemic shock with corresponding manifestations (sharp drop blood pressure, significant oliguria, disruption of all types of metabolism in the body);
• The intermittent form is characterized by such signs of adhesions in the pelvis as paroxysmal sharp pain in the lower abdomen, dyspeptic disorders in the intestines (diarrhea);
• The chronic form of adhesions in the pelvis is characterized by the following symptoms: irregular pulling pain sensations, aching character in the lower abdominal zone, which can intensify during intense physical activity, during sexual intercourse, and during gynecological examinations. Dyspeptic symptoms and disturbances in the processes of urination and urination are also common manifestations. However, there is also an asymptomatic type of chronic form of the disease, when the presence of adhesive disease is diagnosed only when undergoing examinations by gynecologists regarding the problem of infertility.

Diagnostics

It is quite difficult to diagnose the presence of plastic pelvioperitonitis, but a gynecologist can assume its presence after collecting anamnestic data (previous or existing venereal pathologies, surgical operations in the abdominal or pelvic area, previous abortions, inflammatory diseases of the pelvis or peritoneum) and corresponding complaints, which are quite often confused with ordinary poisoning.

Therefore, to make an accurate diagnosis, it is necessary to carry out a number of instrumental and laboratory research. Laboratory methods include:

1. Clinical blood test;
2. Blood culture for sterility;
3. Clinical urine analysis;
4. Bacterial culture of urine;
5. Vaginal smear for microflora;
6. Diagnosis of the presence of urogenital infections using polymerase chain reaction.

Instrumental methods include:

• Ultrasound examination of the pelvis can detect the presence of endometriosis, inflammatory diseases uterus and its appendages;
• Magnetic resonance imaging;
• Hysterosalpingography is a contrast radiography of the uterus to detect fallopian tube obstruction.
• - the most informative method and is surgery With diagnostic purpose. Two incisions are made on the wall of the peritoneum, then an air mass is pumped into the cavity. A laparoscope is placed in one hole, and a manipulator is placed in the second, with the help of which a doctor examines the organs.

There are three stages of development of adhesive disease (depending on the results of laparoscopy):

1. at the first stage, the adhesions are located near the fallopian tubes, ovaries or another area, and do not interfere with the normal movement and capture of the egg;
2. in the second stage of the disease, adhesions are located between the fallopian tubes and the ovaries, which creates an obstacle to the movement and capture of the egg;
3. in the third stage of adhesive disease, the fallopian tubes are twisted, the tubes are blocked by adhesive formations, which is main reason infertility in this case;

Treatment

Treatment of adhesions in the pelvis depends on the symptoms identified during the diagnosis process. The treatment regimen will depend on the stage of the disease identified during laparoscopic examination.

There are surgical methods of treatment and therapy with medicines(conservative therapy). Treatment of chronic pelvic adhesions with a conservative method includes the following areas of therapy:

• In the presence of venereological pathology, antibiotics are prescribed (Metronidazole, Doxycycline, Ciprofloxacim, Clindamycin), as well as non-steroidal anti-inflammatory drugs (Ketonal, Nurofen, Pirocam - in the form of injection solutions, Voltaren ", "Piroxicam", "Oruvel" - suppositories for adhesions in the pelvis) or corticosteroids;
• If the etiological cause of the disease is endometriosis, then hormone therapy, also combined with anti-inflammatory, desensitizing agents;
• Symptomatic therapy is carried out to relieve acute symptoms;
• Enzyme therapy is highly effective, the action of which is aimed at dissolving fibrin plaque and resolving small adhesions. Such fibrinolytic drugs include the following: Longidase, Trypsin, Chymotrypsin.

Treatment of adhesions in the pelvis using conservative methods possible only in the first stage of the disease. In all other cases it applies surgery, where laparoscopy is the main method.

There are several types of laparoscopic dissection of adhesions - adhesiolysis:

1. Laser therapy (use of laser technologies during surgery);
2. Electrosurgery (adhesiolysis is carried out using a special electric knife);
3. Aquadissection (adhesiolysis is carried out using a stream of water supplied under high pressure).

Adhesions in the pelvis are formed from connective tissue and can be localized between the walls of the uterus and its appendages, the bladder, as well as the loops and ligaments of the rectum.

They lead to development pain syndrome, and also cause others unpleasant symptoms. The intensity and characteristics of their manifestation depend on the stage of the pathological process. If left untreated, it can lead to secondary infertility.

If a woman has the first signs of this pathology, she should not hesitate to visit a doctor and undergo diagnostics. In some cases, treatment can be carried out exclusively surgically. But to prevent adhesions in the pelvis, you can use alternative medicine recipes.

What it is?

The abdominal cavity is lined with a closed serous membrane. It is formed by 2 sheets that smoothly transition into one another. The parietal layer lines the entire surface of the abdominal cavity and small pelvis, and the visceral layer covers the internal organs.

The main tasks of the peritoneum are to ensure free mobility of organs and reduce their friction with each other. It protects internal organs from infection and preserves the fatty tissue of the abdominal cavity. Under the influence of unfavorable factors, hypoxia develops in the area affected by the pathological process. Further, the situation can develop in 2 directions:

• independent (physiological) restoration of damaged peritoneal tissue;
• development of the adhesive process.

When adhesions form, the process of adhesion (fusion) of different areas occurs visceral peritoneum, or tissues of the latter with a parietal leaf.

This is not a lightning-fast process: the formation of adhesions occurs in several stages:

1. Reactive phase. This stage lasts for 12 hours after the integrity of the peritoneal tissues is damaged.
2. Exudative stage (1-3 days). Characterized by increased permeability of blood vessels. Under the influence of this process, unchanged and inflammatory cells, as well as the liquid fraction of blood containing fibrinogen, penetrate into the pelvic cavity.
3. Adhesion stage. On day 3, fibrinogen is transformed into fibrin, located on the surface of the peritoneum in the form of threads. Unchanged cells form fibroblasts, which synthesize collagen, which is the main component of connective tissue.
4. The phase of young adhesions, which lasts 1-2 weeks. Such formations have a loose structure, since the amount of collagen in them is still quite small. In the thickness of the adhesions it begins active education and growth of blood vessels and nerve fibers. Soon smooth muscle cells migrate into them.
5. The last phase is accompanied by the formation of fibrous mature adhesions consisting of connective tissue. This phase can last from 14 to 30 days. An increase in collagen density leads to their thickening, and the capillaries grow into larger vessels.

Causes of adhesions in the pelvis

The following can lead to increased formation of connective tissue:

1. Inflammatory processes in the pelvic organs: colpitis, endometritis, adnexitis, parametritis, etc. In this case, we can talk about both the acute and chronic phases of the pathological process.
2. Postponed surgeries. The risk of developing adhesions in the pelvis increases if the patient has previously undergone surgical laparotomy operations: appendectomy, C-section, removal of the uterine appendages, hysterectomy, etc.
3. Hemorrhage into the pelvic cavity during ovarian apoplexy, rupture of the fallopian tube during ectopic pregnancy, etc.
4. Endometriosis. Stages 3 and 4 of this dangerous gynecological disease are characterized by the formation and spread of adhesions to the abdominal organs.
5. Injuries of the pelvic organs - open and closed.

According to research, in most cases, adhesions in the pelvis are formed by a combination of 2 or more reasons. The development of a pathological process can occur after surgical interventions, when a woman has a promiscuous sex life, as well as when she fails to seek medical help in a timely manner.

Symptoms

The more adhesions are in the abdominal cavity, the more vivid and intense the symptoms of the pathological process will appear. It is usually divided into 3 forms: acute, intermittent and chronic.

Acute form

This form of adhesive process is characterized by the occurrence of acute and pronounced pain. Women suffer from a constant increase in their intensity, the presence of attacks of nausea and vomiting. Body temperature and heart rate increase.

One of accompanying symptoms adhesions in the pelvis are intestinal obstruction, accompanied by decreased blood pressure, drowsiness, weakness, decreased daily diuresis, and constipation. This condition requires urgent medical intervention. Often in similar situations resort to emergency surgery.

Intermittent form

In this case, the pathology may not manifest itself in any way. The pain syndrome is weak and not very pronounced, and most patients complain mainly of digestive disorders.

Chronic form

In this case, the symptoms will either be too mild or not manifest at all. From time to time, a woman will experience pain in the lower abdomen and constipation. Exactly chronic form pathology is considered the most common.

A similar deviation is observed in endometriosis, as well as in latent sexually transmitted infections. In this case, women cannot become pregnant and, having addressed this complaint to their gynecologist, they learn their diagnosis for the first time.

Complications

Failure to treat adhesions in the pelvis can cause serious and serious complications. So, the disease can lead to:

• bending of the uterus;
• rupture of the ovary or fallopian tube;
• internal bleeding;
• sepsis.

Adhesions in the pelvis lead to the fact that a woman, instead of a normal conception, experiences an ectopic pregnancy with all the ensuing consequences.

Complications of the pathology are difficult to treat, so if suspicious symptoms occur, you should seek help from a doctor as soon as possible.

Diagnostics

Adhesions in the pelvis are difficult to diagnose. As a rule, they cannot be identified at the first examination, but, nevertheless, the doctor may suspect their presence.

In order not to make a mistake with the diagnosis, it is important to carry out a number of diagnostic procedures. So, the diagnostic scheme necessarily includes:

• taking a smear from the cervix for microflora and cytology;
• conducting a PCR test;
• MRI of the pelvic organs.

Ultrasound diagnostics and MRI are performed in all cases, since these procedures provide the maximum amount of information necessary for making a diagnosis. Sometimes an x-ray of the uterus is taken to assess the patency of the fallopian tubes. If their obstruction is detected, then the presence of adhesions in the pelvis will be almost 100% confirmed.

No less common is diagnostic laparoscopy, during which the stage of the pathological process can also be determined. At the first stage of the pathology, egg capture is still possible, at the second it becomes difficult, and at the third it becomes completely impossible.

How to treat adhesions in the pelvis?

Treatment of the pathology depends on the stage of its development, severity of manifestation and associated complications. At the first stage, complex conservative therapy can be carried out, including:

1. Use of antibiotics. They are necessary if the adhesive process is the result of exposure pathogenic microflora. The drugs are selected according to the sensitivity of the identified bacteria to certain types of antimicrobial substances.
2. Use of NSAIDs. Non-steroidal anti-inflammatory drugs are used for severe pain and swelling. At the same time, they promote the resorption of adhesions on initial stages their formation.
3. Hormone therapy. Hormones are used if the adhesive process in the pelvis is the result of adenomyosis or extragenital endometriosis.
4. Use of fibrinolytics. This group medications contains enzymes whose main action is the breakdown of connective tissue cords. As a result, the adhesions gradually dissolve - completely or partially.
5. Carrying out vitamin and immunotherapy. These drugs are prescribed as an addition to the main treatment regimen. They are aimed at improving the patient’s overall well-being and correcting the functioning of the immune system.

To complement the treatment regimen, patients are prescribed physiotherapy and balneotherapy sessions.

Surgical intervention

If ineffective or inappropriate conservative treatment doctors may resort to surgery. It is often combined with diagnostic laparoscopy. Surgical intervention is necessary for acute, intermittent and chronic pathological processes (only in the acute phase).

During the operation, adhesions are dissected and removed. This manipulation is performed laparoscopically.

There is another surgical method for treating adhesions in the pelvis - the use of a laser. It is advisable to use it if:

• adhesions do not cover a very large area of ​​the abdominal cavity;
• it is possible to clearly see the places of tissue fusion.

If the pathological process has affected too large an area, open surgical method excision of pathological growths. In this case, they resort to the use of a trocar - a special instrument that provides access to the pelvic cavity.

For excision of adhesions the following can be used:

1. An electrosurgical method that involves the use of a special electric knife to cut and remove adhesions.
2. Aquadissection method. During this procedure, a special liquid is used, under the influence of which the tissue of adhesions is destroyed.

Folk remedies

Treatment of adhesions in the pelvis is possible, and it can be very high efficiency, but it is better to carry it out along with medications and procedures prescribed by a doctor. In this case, infusions prepared from the flowers and seeds of plantain, dill, and fresh parsley help well. But you need to talk to your doctor about the possibility of such therapy, since best case scenario these remedies simply will not help, and at worst, will lead to a deterioration in the patient’s health.

Prevention

The development of adhesive processes can only be prevented if timely treatment inflammatory and infectious diseases pelvic organs. Also follows:

• avoid physical inactivity;
• take place regularly gynecological examinations at the gynecologist;
• exercise;
• avoid hypothermia;
• monitor body weight;
• practice safe sex, especially if you are promiscuous;
• refuse operations unless they are carried out according to strict indications;
• promptly and completely cure infectious pathologies of the genital tract and STDs.

To avoid the development of adhesions after operations or inflammatory diseases of the pelvic organs, it is necessary:

• follow a diet to avoid constipation and bloating;
• undergo a course of physiotherapy;
• strictly follow the physical activity regimen prescribed by your doctor;
• plan pregnancy;
• avoid excessive physical activity within six months after surgery;
• consult a doctor if suspicious symptoms occur.

Forecast

Timely and correctly prescribed treatment gives a favorable prognosis for recovery. Surgical intervention can reduce the intensity of pain and restore function reproductive system women are almost 60% in patients who were diagnosed with adhesive disease at stages 1-2 of development.

The use of a special gel barrier against adhesions will help avoid relapse of the disease in the future.