Symptoms of adhesion formation after hysterectomy. Adhesions - causes, symptoms, treatment and prevention of adhesive disease

More than 50% of patients suffering from chronic pelvic pain and have been diagnosed with plastic pelvioperitonitis. In women, this pathology occurs approximately 2.5 times more often than in men, the development of acute intestinal obstruction caused by peritoneal adhesions is observed 1.6 times more often than in male patients.

Plastic pelvioperitonitis is diagnosed in patients whose anamnesis is aggravated by abdominal operations or inflammatory diseases of the pelvic organs. The likelihood of adhesion formation increases with the number of laparotomies undergone. Connective tissue bands are detected in 16% of patients after the first laparotomy and in 96% of cases after the third.

The reasons

Adhesion formation refers to the body's defense mechanisms and aims to delimit the damaged area (inflammation or injury) in the pelvic or abdominal cavity from healthy tissues. The tendency to adhesion formation, the intensity of their formation and the prevalence of the process is determined by a number of factors: increased reactivity of the connective tissue, weakened immunity and individual predisposition of the peritoneum to adhesion formation. Risk factors for the formation of connective tissue adhesions are divided into 3 groups:

1. endogenous, due to the genetic predisposition of the body to adhesion formation (reduced or increased production of the enzyme N-acetyltransferase);
2. exogenous - affect the body from the outside (trauma, surgery, infection);
3. combined, when external and internal factors participate in the formation of adhesions.

The immediate causes of adhesions in the pelvis are:

note

In 50 percent or more of cases, the formation of adhesions is due to the combined action of several factors. Predispose to their formation promiscuity, abortion, invasive gynecological procedures, non-compliance with intimate hygiene, late visits to the doctor.

Mechanism of Education

The abdominal cavity is lined from the inside by the peritoneum - a serous membrane that forms a closed space where the abdominal organs are located. The peritoneum is represented by 2 sheets: parietal, lining the abdominal cavity, and visceral, enveloping the internal organs. Both sheets of the peritoneum are interconnected and pass one into the other. The main functions of the peritoneum are to create the mobility of organs, prevent their friction against each other, protect against microbial agents and delimit the infectious process when microorganisms enter the abdominal or pelvic cavity.

A damaging factor (trauma or inflammation of the peritoneum) causes the release of mediators that stimulate regeneration. In the initial stage of the process, fibroblasts producing fibrin are activated. The resulting fibrin fibers cause adhesion of nearby organs and tissues. As a result, the inflammatory focus is delimited from healthy tissues. If there is extensive traumatic injury or chronic inflammation, the dissolution of the connective tissue is disturbed, blood vessels and nerve endings form in adhesions, and the density of collagen fibers increases. Loose adhesions and sheets of the peritoneum become denser, the mobility of the pelvic organs is limited. Any displacement of organs (turns, tilts, physical activity) leads to tension of adhesions, irritation of the nerve plexuses and the appearance of pain in the lower abdomen.

Classification

Depending on the characteristics of the course of the disease, the following clinical forms of plastic pelvioperitonitis are distinguished:

• Acute. The disease is characterized by a pronounced clinical picture. The patient is worried about intense pain, fever, lowering blood pressure, loss of appetite,. Increasing intoxication indicates development and requires immediate surgical intervention.
• Intermittent. It is characterized by phasic flow. Attacks of acute pain are replaced by periods of complete rest. Against the background of the occurrence of pain syndrome, intestinal disorders join. In the remission phase, there are no symptoms or they are mild.
• Chronic. This form of the disease occurs with mild symptoms or asymptomatically. The most frequent complaints of the patient: periodic constipation, dull or aching. The main reason for a woman to visit a gynecologist is a complaint about the lack of pregnancy.

Since adhesions of the small pelvis are often the cause of female infertility, gynecologists in the classification of pathology distinguish the stages of the disease, which are determined using laparoscopy:

• First. There are single thin strands located around the ovary, fallopian tube or uterus. The presence of adhesions does not interfere with the movement of the egg from the gonad into the tube, and then into the uterine cavity.
• Second. Between the ovary and the oviduct or other organs there are dense strands, but more than half of the area of ​​the gonad is free. Adhesions disrupt the process of capturing the egg by the fimbriae of the tube.
• Third. Most of the area of ​​the ovary is covered by dense adhesions, which disrupts the process of releasing the egg from the follicle and its release to the surface of the gland. There is also deformation and partial or complete occlusion of the fallopian tubes, which makes fertilization impossible.

Symptoms of adhesions of the pelvic organs

Pain is the leading clinical sign of plastic pelvioperitonitis. Women with pelvic adhesions experience constant pain in the lower abdomen, which either increases or decreases. Pain can be dull or aching, localized in the suprapubic, lumbar, sacral regions, or radiate into the rectum. Pain increases during physical activity or exertion (lifting weights, exercise, sharp turns, bending or jumping), straining during bowel movements, during and after intercourse, full bladder or after urination. Increased pain can be provoked by nervous strain, hypothermia, menstruation or ovulation.

If the adhesions constrict the bladder, the patient complains of an inability to tolerate a full bladder, possible intermittent or painful urination. When the adhesions of the large intestine are compressed, disorders of its functions are observed. Periodically occurring constipation is replaced by frequent stools or diarrhea, flatulence and bloating are noted. Nausea and rarely vomiting may occur. Intestinal disorders increase after the consumption of foods that stimulate gas formation (peas, beans, garlic, grapes, muffins, beets). Constriction by adhesions of the ovaries and fallopian tubes is accompanied by a disorder of the reproductive function - infertility.

Complications

The disease is dangerous by the development of the following complications and consequences:

• Acute intestinal obstruction. Compression of the connective tissue strand of the intestinal tube leads to a complete or partial narrowing of its lumen and disruption of microcirculation in the intestinal wall, which requires an emergency operation.
• . It is diagnosed in 25% of patients with plastic pelvioperitonitis. It is caused by a violation of the patency of the fallopian tubes, a disorder in the processes of ovulation and fertilization.
• . Disturbed transportation of the egg through the oviduct due to its narrowing inhibits the penetration of the fetal egg into the uterine cavity and leads to its forced implantation in the fallopian tube.
• . Restriction of the mobility of the fetus by adhesions during its growth during the gestation period causes hypertonicity of the uterus, which can result in abortion (or).

Diagnostics

Diagnosis of pathology begins with the collection of anamnesis and complaints of the patient. A gynecological examination allows you to establish the limited mobility of the uterus, shortening of the vaginal arches, palpation in the area of ​​​​the appendages, pain is determined, heaviness is felt. Additional testing includes:

In order to establish the microbial agent that provoked chronic inflammation, swabs are taken for the vaginal flora, bacterial inoculation of the vaginal contents and determination of the sensitivity to antibiotics of the detected microorganisms, PCR for latent sexual infections.

Treatment of adhesive disease of the pelvic organs

Pathology is treated conservatively and surgically. . Conservative therapy is carried out at stage 1 of plastic pelvioperitonitis and includes:

• . Identification of an infectious agent requires antibiotic therapy, the selection of drugs is carried out according to the results of the tank. sowing and taking into account the resistance of bacteria to them.
• NSAIDs. Of the non-steroidal anti-inflammatory drugs, indomethacin, diclofenac are used, which stop the pain syndrome, eliminate the swelling of inflamed tissues and dissolve loose adhesions (the initial stage of the disease).
• Hormonal agents. Treatment with hormones is carried out with detected endometriosis.
• fibrinolytic enzymes. Longidase, lidase, terrilitin contribute to the dissolution of adhesions due to the splitting of glycopeptide bonds. Enzymes are prescribed in rectal suppositories, for intramuscular injection and during physiotherapy.
• Physiotherapy, gynecological massage, exercise therapy. Of the physiotherapeutic procedures, electrophoresis with enzymes, paraffin therapy, SMT are effective.
• vitamins, . They improve the general condition, normalize blood flow and metabolism in tissues, stimulate the immune system.

Surgical treatment is indicated for the ineffectiveness of conservative therapy, as well as in the case of acute and intercurrent forms of the disease.

With the development of formidable complications (ectopic pregnancy, intestinal obstruction), an emergency surgical intervention is performed.

Dissection of adhesions is performed endoscopically (laparoscopy):

• laser therapy (adhesions are cut with a laser beam);
• electrosurgery (unions are dissected with an electric knife);
• aquadissection (dissection of adhesions is performed with high-pressure water).

Sozinova Anna Vladimirovna, obstetrician-gynecologist

Collapse

Adhesions are connective tissue that grows in the abdominal and pelvic cavities. It connects organs and other structures to each other. Adhesions after surgery to remove the uterus appear quite often. Medical statistics show that they occur in 90% of cases. This condition is a complication that is dangerous for a woman's health.

The concept of adhesions

Adhesions are an additional tissue, a feature of which is the sticky fibrin secreted by it. Because of this, this tissue glues organs together. This is due to the protective reaction of the body, that is, the growth of adhesions is necessary to maintain a diseased organ or tissues affected by the inflammatory process.

Connective tissue can look different. Namely, in the form of a film, a scar, threads. These forms of tissue appear after strip surgery or after minimally invasive interventions.

Reasons for the formation of adhesions after removal of the uterus

The formation of adhesions after removal of the uterus is a frequent occurrence, since the wound healing process is accompanied by the formation of a connecting scar. The space that has been formed begins to overgrow. The main cause of the adhesive process is an individual feature of the body, in which it does not produce the enzyme responsible for the resorption of fibrin overlays.

The causative factors of this pathological condition are:

• Additional injury to neighboring anatomical structures.
• If during a surgical operation the doctor left instruments, napkins, tampons, etc. in the abdominal cavity.
• Infection during the operation, that is, the use of improperly processed instruments, or violations during dressings in the postoperative period.
• The occurrence of such a complication after surgery as internal bleeding.
• Activation of the inflammatory process.

Additionally, the formation of adhesions is influenced by the incision during the operation, namely, the correctness of its implementation. The duration of the operation itself is also important.

Note! Medical practice shows that strands after removal of the uterus occur in too thin women.

How long does it take for adhesions to form?

Adhesions begin to form from the accumulation of inflammatory fluid or blood that did not resolve after surgery. At the same time, their formation begins from 7-21 days. Exudate gradually thickens up to this time and begins to be replaced by connective tissue. After 30 days, blood capillaries and nerve fibers are formed in it.

Symptoms and signs

In most cases, the presence of adhesions is not manifested in any way. Symptoms appear even when the situation worsens.

The main symptoms include bowel dysfunction. Namely, intestinal obstruction, which is manifested by a pathologically rare defecation or a complete cessation of fecal discharge. Constipation and flatulence are also observed.

Additionally, there will be the following symptoms:

• general malaise and hypotension;
• pain in the lower abdomen;
• in the future, the patient's condition is complicated by frequent bouts of nausea and vomiting;
• soreness of the postoperative suture;
• the postoperative suture becomes inflamed - it becomes bright red, swollen;
• sometimes there is a fever;
• pain after intercourse.

Diagnostics

Diagnosis of the adhesive process is difficult, since the formulation of an accurate verdict is possible only after laparoscopy or a full-fledged abdominal operation. But the doctor can suspect the presence of adhesions after such diagnostic methods:

• Laboratory blood tests. With their help, the presence of an inflammatory process is determined and the activity of fibrinolysis can be assessed.
• Ultrasound of the abdominal cavity and small pelvis allows you to assess the location of organs. The doctor may assume that there is a connective tissue lesion, as the organs will not be located correctly.
• Diagnostic laparoscopy is a minimally invasive method that allows using a special manipulator to fully visualize organs and other structures.

With the formation of adhesions after surgery to remove the uterus, an X-ray examination of the intestine is sometimes prescribed, especially if there is a complex of symptoms of organ dysfunction. In this case, contrast agents are used. As a result, it is clear how narrow the intestinal lumen is and what degree of intestinal patency.

The danger of adhesions

Adhesions themselves are a postoperative complication. They can cause serious consequences, since the proliferation of connective tissue contributes to the disruption of the normal functioning of organs.

Dangerous complications are:

• acute intestinal obstruction;
• necrotic lesion of the intestine;
• peritonitis.

Treatment

When a woman's uterus is removed, she is prescribed prophylactic therapy. It includes a list of medications that also prevent the formation of adhesions. These include anti-inflammatory drugs, antibiotics and enzyme preparations,

Physiotherapy has also proven to be effective. They are used both to prevent the manifestation of adhesions, and already in their presence.

Physiotherapy

Electrophoresis is one of the physiotherapy procedures that can destroy postoperative adhesions. It also has a pronounced effect, that is, symptoms are removed. Usually 10-12 procedures are prescribed. Electrophoresis is used together with painkillers.

In addition, paraffin and ozocerite applications are used. To date, laser therapy and magnetotherapy are popular methods of treatment.

Enzyme preparations

Fibrinolytic agents are very effective in the presence of adhesions, as they include enzymes that can dissolve fibrin. These include:

• Urokinase - breaks down blood clots by dissolving them.
• Fibrinolysis - this substance is able to dissolve fibrin.
• Chemotrypsin is a drug that helps thin viscous exudate and thickened blood. The active substance breaks down fibrous deposits and necrotic tissues.
• Hyaluronidase (Lidase) - this drug contains hyaluronic acid in its composition. The action is aimed at softening scars, as well as for the treatment of hematomas.
• Streptokinase - this tool is able to dissolve blood clots, or rather, dissolve fibrin in blood clots.
• Trypsin.

Laparoscopy

Laparoscopy is a surgical treatment related to minimally invasive interventions. This method consists in the doctor making several small incisions through which instruments and a manipulator are inserted. During the operation, the adhesions are dissected and the vessels are cauterized. Also, the doctor must remove the synechia. This is done with a laser, aquadissection, or electrosurgery.

A positive factor in such treatment is the minimum list of complications, which, moreover, are extremely rare. Also, rehabilitation after laparoscopy does not last long. The very next day after this operation, the woman can get up. The recovery period is not longer than a few days.

Strip surgery to remove adhesions is called a laparotomy.

Prevention

The main prevention of adhesions is the correct treatment of the surgical type, without any violations, since adhesions form after operations. Also, the manifestation of strands can be affected by incorrect rehabilitation methods. How to avoid adhesions? Doctors recommend after the intervention to remove the uterus:

• Follow a diet.
• Properly care for the postoperative suture so that there is no infection of the wound.
• Do not allow excessive physical exertion, but you need to move more.

If all these rules are followed, then the risk of adhesions is reduced.

Conclusion

The adhesive process after surgery is quite dangerous. Therefore, if you experience any symptoms, you should consult a doctor. After all, this pathological condition can lead to dangerous consequences.

Adhesive disease is a direct effect of surgical interventions in the human body, especially in the abdominal cavity. Any symptoms depend on the prevalence of the process and the severity of complications. Many scientists say that almost all abdominal surgery consists of adhesions, but over the course of life they resolve on their own.

How does adhesive disease develop?

With appendicitis, which was not treated at one time, a limited cavity is formed when the peritoneum is adjacent to the area of ​​\u200b\u200binflammation. This process is called appendicular infiltrate. Similar cases occur during surgical interventions.

The peritoneum may adhere to:

• area of ​​inflammation;
• operated body;
• Incision locations.

During the so-called "gluing", the normal functioning and arrangement of organs is disrupted.

In the future, such adhesions are shortened and compacted, which leads to even greater displacement. In this case, normal blood flow is disturbed and oxygen starvation begins to develop, which subsequently leads to abdominal pain in adhesive disease.

With such displacements, the movement of the exit of feces is disturbed, which leads to constant constipation. In the future, intestinal obstruction may develop.

ICD-10 (International Classification of Diseases) distinguishes between two types of diseases, such as:

• Adhesive disease of the small pelvis;

Visceral

In fact, these are two identical diseases, since the pelvis refers to the abdominal cavity. But this disease is usually attributed to a separate category, because the cause of adhesions, in this case, is an inflammatory disease of the female genital organs.

One of the main causes of constipation and diarrhea is use of various drugs. To improve bowel function after taking the drugs, you need every day drink a simple remedy ...

The reasons

There are a lot of reasons for the development of the adhesive process, but all of them lead to damage to the tissues and organs of the abdominal cavity, no matter what type they are.

Consider the most common causes of the adhesive process. These are:

1. Mechanical injuries of the abdominal cavity;
2. Chemical damage;
3. Inflammatory diseases.

The following indicators can rightly be attributed to mechanical injuries of the abdominal cavity:

• Surgical operations;
• Bullet wounds;
• stab wounds;
• Falls from a height;
• beats;
• Falls on a hard object.

Chemical damage includes:

• Rupture of the gallbladder with an outpouring of bile;
• Severe pancreatitis with multiple consequences;
• Perforation of the stomach with access to the abdominal cavity;
• Burns from alkalis or acids, intentionally or accidentally.

Inflammatory diseases include the following indicators:

• Pipes and appendages;
• disease of the large intestine;
• Disease of the small intestine;
• Diseases of the gallbladder;
• appendix (appendicitis).

Very often in women, the development of adhesive disease is formed during chronic inflammatory processes in the female genital organs. With minor symptoms and long-term treatment, adhesive disease can lead to an irreversible process and infertility.

Associated indicators of adhesive disease are diabetes, poor diet, foreign bodies in the wound.

Classification

According to the international classification of diseases (ICD-10), abdominal adhesions are divided into the following types:

1. Abdominal adhesions (K66.0);
2. Postoperative adhesions in the pelvis (N4);
3. Peritoneal inflammatory adhesions in women in the pelvis (N6).

Abdominal adhesions include the following types of adhesions:

• Adhesions of the stomach;
• Omental adhesions;
• Adhesions of the mesentery of the large or small intestine;
• Pelvic adhesions in men;
• Adhesions of the intestine;
• Diaphragm adhesions;
• Abdominal adhesions.

Types of pathologies

The outer surface of the organs in the abdominal cavity and the abdominal cavity itself consists of a translucent cellular tissue, which was formed using two plates:

These two plates gradually pass into one another and form a closed space, which is called the abdominal cavity. All the spaces that have formed between the organs and their walls do not have a void. All of them are filled with serous substance.

Spike adhesions are divided into 2 types:

1. Viscero-parietal. Organs or intestines adhere to the wall of the abdominal cavity.
2. Viscero-visceral. Intestinal loops or organs grow together.

What type of adhesions and what places of their localization make clear the obvious symptoms of the disease, and also provide an opportunity to recognize the impact on the functioning of other organs.

Symptoms

There are a number of symptoms by which to determine the disease of adhesions. These indicators are:

• Prolonged constipation. With a normal and proper diet, the absence of feces is noticed. This has been going on for over two days. This symptom is the most dangerous, because it indicates the most dangerous complication of the adhesive process, such as intestinal obstruction.
• Dyspeptic syndrome. This symptom means a violation of the normal functioning of the stomach. In the area of ​​the digestive system, there are inconveniences, discomfort, pain, and there is difficulty in digestion. With these symptoms, a tendency to constipation is often noticed. The patient may feel fullness in the abdomen, fullness, bloating, heaviness.
• Pain. Either pulling or short-term seizures may appear, which can be aggravated by physical exertion or sharp turns and changes in body position.
• Violation of intestinal motility. In case of failures, short-term constipation is observed. In the normal state, the walls contract and move the feces to the exit.

Diagnostics

Treatment

Adhesions of the intestine are removed only surgically. There are no other methods to free intestinal loops from connective tissue. During the operating period, a course of conservative therapy is also prescribed.

Surgical method

Adhesion removal surgery has two kinds.

The first is laparoscopy (this is a micro-operation). 3 small incisions are made on the anterior abdominal wall. A thin fiber-optic tube with a video camera and a diode lamp is inserted through them, as well as a manipulator for fixing the internal organs.

The operation does not carry severe injuries, so the patient can be discharged already on the 3rd day.

The second is laparotomy. An incision is made in the abdominal wall at 15 centimeters. This method is used with a large number of intestinal adhesions.

Conservative treatment

1. special diet.
2. Installation of a nasogastric tube.
3. Spasmolytics;
4. hypertonic enemas;
5. Intravenous injection solutions.

Folk remedies

Pain during adhesions. Apply 3 tablespoons of flax seeds, put in a bag and dip in boiling water for three minutes. After they are taken out, squeezed out, and the finished compress is applied to the diseased area.

General discomfort. Use 1 tablespoon of dry St. John's wort and pour a glass of boiling water. Leave to infuse for about 15 minutes and strain. The finished broth is divided into three parts and drunk during the day.

Prevention

In order to avoid recurrence, you must perform the following steps:

• Follow proper nutrition;
• Do not lift weights;
• Do health exercises.

Adhesions in the pelvis - this is a condition that is characterized by the formation of adhesions in the abdominal cavity and pelvic organs - connective tissue cords.

Recently, the prevalence of adhesive disease in gynecology has greatly increased.
This is due to many provoking factors in the modern world. Girls do not take care of their health, leave inflammation of the appendages without treatment, maybe it will go away on its own, with chronic inflammation, adhesions form.

Causes and mechanism of adhesions in the pelvis

The most common causes contributing to the occurrence of adhesions in the pelvis are as follows:

3) mechanical damage to the organs of the small pelvis and abdominal cavity (injuries, surgical interventions). Adhesions develop with hemorrhage in the abdominal cavity, especially with infection of the outflowing blood. In gynecology, often the cause of the formation of adhesions is bleeding during ectopic pregnancy and ovarian apoplexy. The importance of peritoneal injury, cooling or overheating of it in the development of adhesive disease has been experimentally proven.

The presence of foreign bodies (napkins, drains) in the abdominal cavity during surgery is also accompanied by the formation of adhesions. ;

4) hemorrhages in the abdominal cavity (ectopic pregnancy, ovarian apoplexy, etc.);

MRI - magnetic resonance imaging of the pelvic organs - is performed after a preliminary ultrasound of the pelvic organs. Non-invasive instrumental research method with high information content;

- Diagnostic laparoscopy is an operative, but the most reliable diagnostic method. Two small incisions are made in the abdominal wall. Air is forced into the abdominal cavity. A laparoscope (a thin tube with a video camera unit at the end through which the image is transmitted to the monitor screen) is inserted into one incision. A manipulator is inserted into another incision; with its help, the doctor examines the organs, displaces them, examining them in detail. This allows you to make an accurate diagnosis with complete confidence.

Depending on the laparoscopic picture, 3 stages of the spread of adhesive disease are distinguished:
Stage 1 - adhesions are located only near the fallopian tube, ovary or other area, but do not prevent the capture of the egg;
2nd stage - adhesions are located between the fallopian tube and the ovary or between these organs and prevent the capture of the egg;
Stage 3 - torsion of the fallopian tube, blockage of the fallopian tube by adhesions, which makes it absolutely impossible to capture the egg.

Obstruction of the fallopian tubes according to hysterosalpingography (a contrast agent is injected into the uterus, x-rays are taken), gynecological examination and ultrasound with a high degree of certainty indicate the presence of an adhesive process, however, the patency of the fallopian tubes does not exclude the presence of adhesions that seriously prevent pregnancy. Conventional ultrasound does not reliably detect the presence of pelvic adhesions.

Thus, it is the determination of the stage of the spread of the adhesive process that is fundamental for determining the tactics of treatment. In many cases, patients can be observed and examined by a gynecologist for years with an unexplained diagnosis, but it is laparoscopy that allows not only to make an accurate diagnosis, but also to conduct an effective treatment of adhesive disease at the same time.

Treatment of adhesive disease

Treatment of adhesive disease entirely depends on the severity of the disease, it can be both conservative and surgical. I will immediately make a reservation that in the acute and intermittent form of the disease, surgical treatment - laparoscopy, is the only method of treatment due to its high efficiency and rapid effect. Very often, surgical treatment is combined with conservative for greater effect.

In the chronic form of adhesive disease, it is possible to use exclusively conservative treatment. It is necessary to identify the cause of the development of adhesive disease. If any urogenital infection (say, chlamydia) is detected, then, first of all, treatment should be aimed at eliminating the underlying disease in order to prevent further spread of the adhesive process. For this purpose, antibiotics and anti-inflammatory drugs (NSAIDs, corticosteroids) are the drugs of choice. If the cause of adhesive disease is endometriosis, then hormonal treatment, anti-inflammatory drugs, desensitizing and symptomatic therapy are prescribed.

Nonspecific therapy - enzyme therapy - fibrinolytic drugs that dissolve fibrin (longidase, trypsin, chymotrypsin) is widely popular, these are quite effective drugs that resolve small adhesions. In the absence of an acute infectious process, physiotherapy is used - internal laser therapy and external magnetic laser therapy.

This treatment is not a panacea for the chronic form of adhesive disease. Conservative treatment is most effective in the 1st stage of the disease.

With the ineffectiveness of all these methods and with the further spread of adhesions, therapeutic and diagnostic laparoscopy is indicated. As a rule, a gynecologist surgeon diagnoses adhesive disease already on the operating table and simultaneously performs an operation - dissects and removes adhesions. There are 3 options for laparoscopy:
- spikes are dissected by means of a laser - laser therapy;
- adhesions are dissected with water under pressure - aquadissection;
- adhesions are dissected using an electric knife - electrosurgery.

The choice in favor of one or another method of treatment is determined by the doctor during laparoscopy, depending on the location of the adhesions and the prevalence of the process. During the operation, the surgeon also conducts conservative treatment in order to prevent adhesions: barrier fluids are introduced - dextran, povilin, etc.), absorbable polymer films are applied to the fallopian tubes and ovaries.

Factors affecting the treatment of adhesive disease

With the established diagnosis of “Adhesive disease”, it is necessary to adhere to certain canons and rules in order to avoid repeated relapses of the disease:

Visiting a gynecologist once every six months;
- a rational diet - eat in small portions with small breaks between meals - about 5 times a day; avoid foods that cause increased gas formation;
- physiotherapy procedures are very useful for a speedy recovery, therefore it is recommended to visit a physiotherapist regularly - electrophoresis with drugs, therapeutic massage and physical education can be performed);
- in the event of a pain attack, you can use antispasmodics (no-shpa, papaverine). If the attacks do not go away, you need to contact a gynecologist and do not self-medicate yourself.

After the treatment - after surgery or conservative treatment - patients are shown physical rest for 3-6 months, dynamic observation by a gynecologist. In the first 2-3 months, it is necessary to adhere to the rational diet described above. Physical therapy and physiotherapy also contribute to a quick recovery. With the implementation of all rehabilitation measures, the prognosis is favorable.

Folk remedies for adhesions in the pelvis

Traditional medicine is also used for adhesive disease as a symptomatic treatment. However, it should be borne in mind that all folk remedies are effective only if we are talking about single adhesions, otherwise herbal tinctures are not helpers and the condition can only worsen from prolonged “leaning” on herbs. It is very useful to use herbal tinctures in the rehabilitation period and as an additional remedy to the main treatment. For this purpose, St. John's wort is used in dried and crushed form. A tablespoon of St. John's wort is poured with a glass of boiling water, boiled for 15 minutes, filtered and taken a decoction of 1/4 cup 3 times a day.

Complications of adhesive disease

Adhesive disease is a very formidable disease to look at him through your fingers. There are cases when the disease proceeds quite favorably, without making itself felt, however, under adverse circumstances, the adhesive process is rapidly spreading and, in the absence of a competent approach and treatment, very serious complications are possible, such as: infertility, menstrual irregularities, bending (displacement) of the uterus, intestinal obstruction, obstruction of the fallopian tubes, ectopic pregnancy, not to mention the acute form of the development of the disease, which can lead to very unfavorable consequences for life.

Prevention of adhesive disease

Prevention of adhesive disease includes: regular monitoring by a gynecologist, gynecological massage, timely treatment of urogenital infections, natural family planning: prevention of unwanted pregnancy, refusal of abortions, vaginal delivery, regular sex life.

Questions and answers on the topic of adhesions in the pelvis

1. Ultrasound showed adhesions in the pelvis. Will I be able to get pregnant?
Yes, pregnancy is possible as long as adhesions do not interfere with egg capture.

2. How likely is pregnancy after laparoscopy?
Approximately one in five women can become pregnant naturally after surgery. Otherwise, IVF (in vitro fertilization) is indicated.

3. Can there be adhesions after a caesarean section?
Yes, it is possible that any surgical intervention contributes to the formation of adhesions.

4. Can adhesions resolve after physical therapy?
Physiotherapy is an effective method, during the procedure, the adhesions soften and decrease, this relieves pain, but it is unlikely that the adhesions will disappear completely.

5. Is it possible to put a spiral with spikes?
It is possible, but undesirable, since the spiral can provoke an inflammatory process.

6. Can there be pain during sex if there are adhesions?
Yes, they can, especially when the adhesive process is combined with endometriosis.

7. I have a tilted uterus. Does this mean I have adhesions?
Not necessary. This may be the norm.

8. What sexual infections most often lead to the formation of adhesions and infertility?
Chlamydia and gonorrhea.

9. My lower abdomen is constantly pulling. The doctor says I have adhesions. But the ultrasound showed nothing. What to do?
Unfortunately, it is not always possible to detect the presence or absence of adhesions by ultrasound. To clarify the diagnosis, additional research methods are required - MRI, laparoscopy.

Photo Adhesive process in the pelvic cavity.

Obstetrician-gynecologist, Ph.D. Christina Frambos.

Adhesions are cords of connective tissue formed as a result of surgical interventions or any kind of inflammation, stretching from organ to organ. Sometimes there are cases that adhesions are formed in the abdominal cavity and in the small pelvis, such adhesions can block the path to conception, therefore it is necessary to be constantly examined, and if they are found, it is necessary to eliminate them.

Adhesions after surgery - what is it?

The organs of the small pelvis and abdominal cavity (fallopian tubes, uterus itself, bladder, ovaries, rectum) are usually covered on the outside with a thin bright membrane - the peritoneum. A small amount of fluid and the smoothness of the peritoneum provides a fairly good displacement of the uterine loops, fallopian tubes. In the normal functioning of the intestines, there are no problems with the capture of the fallopian tube by the egg, the growth of the uterus does not interfere with the good functioning of the bladder and intestines.

Peritonitis - inflammation of the peritoneum is a very dangerous disease. The more inflammation, the more dangerous the disease. The body has a mechanism that limits the spread of this disease, this is the formation of adhesions.

The tissues during the inflammatory process become edematous, the peritoneum is covered with a sticky coating that contains fibrin - this is a protein, the basis of a blood clot. Touching this thin film of fibrin in the focus of inflammation, it can be said that it glues the surfaces together, the result of this action is a mechanical obstacle to the inflammatory process. After the inflammatory process has ended, adhesions (transparent - whitish) films may form in the places of gluing. They are called spikes. The main function of adhesions is to protect the body from pus and inflammation in the peritoneum.

But we want to note that adhesions are not always formed during the inflammatory process. In the event that the treatment began on time, and all procedures were carried out correctly, the likelihood that adhesions form in the body decreases. But nevertheless, adhesions are formed when the disease becomes chronic and drags on over time.

These adhesions after the completion of the gynecological operation interfere with the normal functioning of the internal organs. If the mobility of the intestinal loops is disturbed, this can lead to intestinal obstruction. Adhesions that affect the fallopian tubes, ovaries, uterus, disrupt the body (the egg enters the fallopian tube, movement, advancement of the embryo into the uterine cavity). Adhesions can be a major cause of infertility.

• All kinds of inflammatory diseases;
• Operations;
• endometriosis;
• Thickened blood in the abdomen.

Adhesions due to inflammation

The ovaries, uterus and fallopian tubes may be involved in adhesions, which may result from inflammation of the organs (eg appendicitis), in some cases with damage to the large and small intestines. In such cases, the genitals are not severely damaged - the process of adhesion formation does not violate the internal structure. In the case when inflammation occurs in the genital organs, there is a process of formation of adhesions that disrupt the functioning of the genital organs.

The most unprotected is the fallopian tube - this is the most delicate organ. Plays a major role in conception and in maintaining pregnancy.

Spermatozoa that enter the vagina are in turn filtered in the mucus of the cervix, pass first into the uterine cavity, and then penetrate into the fallopian tube. Speaking about the fallopian tube, we can say that it provides transportation of the embryo and germ cells, creates an environment for the development of the embryo. A change in the composition of the mucus that appears in the fallopian tube can kill the embryo. Immunity in the fallopian tube is minimal, there are practically no mechanisms that would reject foreign substances, excessive immunity activity is unfavorable for pregnancy. The fallopian tubes are very delicate and easily fall prey to infections (diagnostic curettage, abortion, hysteroscopy).

From the very beginning, the infection affects the mucous membrane, then the muscle layer, at the last stage, the outer layer of the fallopian tube is involved and conditions arise for the occurrence of so-called intestinal adhesions. If the treatment of these adhesions is not carried out on time, scar tissue forms. The fallopian tube turns into a connecting sac, loses its ability to promote the egg. With such severe violations, the elimination of adhesions does not restore the function of the fallopian tube, the presence of this focus of inflammation leads to infertility. In these cases, for pregnancy, the entire tube is removed entirely.

Postoperative intestinal adhesions

After the operation has been performed, adhesions are formed in such cases:

• Tissue ischemia or hypoxia;
• Drying of tissues;
• Rough actions with the fabric;
• Foreign bodies;
• Blood;
• Separation of early adhesions.

Those foreign bodies that cause the formation of adhesions include particles from the doctor's gloves, cotton fibers from tampons and gauze, and suture material. Intestinal adhesions after gynecological surgery are a dangerous problem, and such adhesions can also appear with endometritis. During the menstrual cycle, blood containing living cells of the membrane - the mucous membrane (endometrium) can enter the abdominal cavity. The immune system itself must remove these cells, but if there are malfunctions in the immune system, the cells take root and form islands of the endometrium, adhesions usually form around these foci.

Adhesion treatment

Only under the control of the vision of an experienced surgeon is it worthwhile to isolate the tumor and separate the adhesions. The intestine is retracted by the finger of the surgeon's assistant or by the anatomical patient from behind and to the top. If the tumor is located behind the belly, then in this case the peritoneum is dissected where the intestine is not observed above the upper pole of the tumor, and then the tumor is carefully and slowly isolated. In order not to damage the intestine in any way, professional surgeons leave capsules or part of a benign tumor on the intestinal wall with tight adhesions. In some cases, it will even be better if you first cut the fibromyoma capsule in an accessible place, then enucleate it, and then carefully separate the intestine from the capsule or excise the capsule as carefully as possible without damaging the rectum.