Possible causes, dangers, types of diagnosis and treatment of postoperative adhesions. What are adhesions in gynecology and what is their treatment

Massage of postoperative adhesions.

What are postoperative adhesions and where do they come from? This is the tissue that grows between the organs and connects them. Spikes come in the form of films, scars, scars, threads of the most intricate shapes. They are formed during the period of inflammatory processes, both after surgery and as a result of infectious diseases. Thus, the body reacts to external stimuli. The growing tissue, probably, should additionally support the organ or serve as some kind of auxiliary fastening of the organ in the abdominal cavity. But as a result, adhesions limit the elasticity and mobility of internal organs, for example, make it difficult for food to move through the intestines and can even cause its acute obstruction. In milder cases, adhesions cause intermittent or persistent discomfort, bloating, and cramping or aching pain. Patients have intolerance to rough, poorly digested food, a tendency to constipation, decreased ability to work, and fatigue.

Many women, as a result of abortions or sexually transmitted diseases, suffer from adhesions of the reproductive organs, which, in turn, leads to difficulty in the movement of the egg and, as a result, to infertility.

Sometimes adhesions resolve on their own after the disappearance of the inflammatory focus, but more often they need to be removed, since over time the adhesions become rough, dense and look like scars that occur in places of mechanical damage to the skin.

Many doctors recommend surgical removal of adhesions.. But the paradox is that the more surgical interventions, the higher the likelihood of adhesion formation. So the effectiveness of this method is highly questionable.

To prevent adhesions, especially postoperative, doctors advise getting out of bed on the second day after surgery. Such a heartless recommendation is explained by the fact that when moving, even if slowly, the internal organs of the abdominal cavity are naturally massaged by the muscles of the abdominal cavity involved in the process of walking. And 5-8 days after the first short walks around the ward, it is advisable to start doing feasible exercises for the abdomen: tilts, turns, etc.

In addition to operations, official medicine also recognizes complex treatment using enzyme therapy. It includes injections of lidase, lyrase, streptase, urokinase, ribonuclease. Injections are combined with rubbing into the abdominal wall of ointments, including anti-inflammatory substances and plant enzymes.

But saliva remains the most effective remedy for adhesions.. which, after waking up, should be abundantly lubricated with adhesions and scars. In human saliva, especially in the morning, while you have not yet eaten or drunk anything, contains a large amount of enzymes that can dissolve adhesive tissue. In fact, you apply the same enzyme therapy, only in a natural and painless way, and absolutely free of charge!

Massage for postoperative adhesions and scars in the abdomen.

And of course, we should not forget about therapeutic massage. Its main task is to detect the adhesion (possibly with the help of an additional examination) and create such tension in this zone that the adhesion site is activated. By and large, you can massage any seal, especially the one left after surgery, especially if you feel a pulling pain in this place. Places like this are your battlefield. When doing a massage, you should try to sort of separate the organs, unstick them, without tearing them by force and without injuring them additionally. Your goal is to force the body to solve the problem on its own, however, not without help. And although with such a massage you may experience quite painful sensations, you will have to try and be patient. However, in no case should you massage recently injured places, fresh postoperative wounds.

So, let's begin. While massaging with the pads of your fingers, try to induce a sensation of pulsation in the area of ​​adhesions. The principle of action is simple, the main thing is to make movements in the course of the natural arrangement of organs.

Massage exercise for postoperative adhesions.

Lie on your back, bend your knees, put a roller under your head for convenience. Place your right hand to the right of the navel and place your thumb on the area three fingers above it. Place your left hand so that the thumb rests on the area below the navel by three fingers. As you exhale, press on the soft tissues, and then move your fingers towards each other (that is, towards the center of the abdomen) (Fig. 6.29). Hold your breath and perform slow massaging movements with your fingers. On an inhale, return your arms to the starting position. Repeat 5-6 times. Perform the exercise every 2 days for 1.5-2 months. Be sure to take weekly breaks after 10 exercises in a row.

Such a massage enhances blood circulation, promotes the resorption of adhesions, softens tissues and restores the mobility of organs.

Therapeutic massage has no contraindications. It can be used for pain in the joints, spine, muscles, to normalize blood circulation and the functioning of internal organs.

Causes of adhesions

What are spikes?

spikes- These are lumps of connective tissue that appear after inflammation or surgery and extend from one organ to another. Adhesions may occur after surgery.

If adhesions occur in the pelvic or abdominal cavity, then a woman may not conceive. Therefore, you should periodically contact a gynecologist to identify the cause of infertility. Adhesions are also formed due to periodic inflammation of the appendages or after infectious diseases, sexually transmitted diseases.

Reasons for the formation of adhesions

The cause of adhesions in the pelvis can be endometriosis, surgery, an inflammatory disease, blood in the abdominal cavity.

Another cause of adhesions can be inflammation - for example, inflammation of appendicitis, damage to the large and small intestines. Then adhesions will form in the fallopian tubes, ovary, uterus. In this case, the genitals will not be damaged.

But if the adhesive process has also affected the genitals, then their damage will also occur. The fallopian tube can be mainly affected, and then conception and pregnancy will be impossible. When an infection enters the fallopian tubes, an inflammatory process occurs, and then adhesions form. It is possible after an abortion.

If it is too late to see a doctor, then after the treatment of adhesions, the fallopian tube will no longer be able to advance the fertilized egg. Then fertilization will become almost impossible even artificially. Sometimes after a disease, in order to enable a woman to become pregnant, IVF is done and the fallopian tube has to be removed completely. After inflammation, the walls of the fallopian tube can stick together and grow together, which means that the egg will not be able to pass and the adhesions and the tube will need to be removed.

Postoperative adhesions

Adhesions can form after surgery if tissue hypoxia or ischemia occurs, gross manipulations with the tissue, tissue drying during surgery, the presence of blood, separation of former adhesions, and the presence of foreign bodies have occurred.

Foreign bodies may remain after the operation - for example, in the case when particles of talc from the surgeon's gloves or fibers from tampons, gauze got into the body cavity. Adhesions can also occur with endometriosis. This is the entry of some menstrual blood into the abdominal cavity through the fallopian tubes. If a woman has a good immune system, then the cells of the uterine lining that are in the menstrual blood are removed by themselves. And if the immune system is impaired, then adhesions can form.

Treatment

With the help of special tools, dissection and removal of adhesions are performed. This can be done with laser therapy, electrosurgery and aquadissection.

spikes

Postoperative adhesions

The golden mustache is successfully used in the treatment in the postoperative period, due to which the patient feels better, the sutures heal faster, the recovery postoperative period is reduced and working capacity increases.

For treatment in the postoperative period, an alcohol tincture of callisia is used. To prepare the preparation, 25-30 joints of the plant are crushed, poured into 0.25 liters of vodka, insisted for 14 days, then filtered.

The tincture is used according to the following scheme:

On the first day, 10 drops of the tincture are mixed with 1.5 tablespoons of water and drunk in the morning 45 minutes before meals.

After the dose at the reception is 33 drops, they begin to decrease 1 drop per day.

When the amount of the drug taken is again 10 drops, take a break for 7 days, after which the course is repeated in the same sequence.

For the treatment of postoperative adhesions, it is necessary to undergo 4-5 courses, taking 7-day breaks after the first and second and 10-day breaks after all subsequent ones.

Adhesive disease (adhesions). Adhesion treatment

Adhesive disease (morbus adhaesivus) is a term used to refer to conditions associated with the formation of adhesions (connective tissue strands) in the abdominal cavity in a number of diseases (usually inflammatory), after traumatic injuries and surgical interventions.

Adhesive disease began to be frequently mentioned in the literature from the end of the 19th and beginning of the 20th century in connection with the development of abdominal surgery. The most common cause of adhesive disease is inflammation of the vermiform appendix (appendix) and appendectomy (about 43%), diseases and operations on the pelvic organs and operations for intestinal obstruction are in second place (about 30%).

General information about adhesive disease

The organs of the abdominal cavity and small pelvis (uterus, fallopian tubes, ovaries, bladder, rectum) are covered on the outside with a thin shiny membrane - the peritoneum. The smoothness of the peritoneum, combined with a small amount of fluid in the abdominal cavity, provides good displacement of the loops of the intestines, uterus, and fallopian tubes. Therefore, normally, the work of the intestine does not interfere with the capture of the egg by the fallopian tube, and the growth of the uterus during pregnancy does not interfere with the normal functioning of the intestines and bladder.

Inflammation of the peritoneum - peritonitis - a very dangerous disease. And it is the more dangerous, the more space in the abdominal cavity or in the small pelvis captures. But in the body there is a mechanism that limits the spread of peritonitis - the formation of adhesions.

With the development of an inflammatory process in the small pelvis, the tissues in the focus of inflammation become edematous, and the surface of the peritoneum is covered with a sticky coating containing fibrin (the protein that forms the basis of a blood clot). The fibrin film on the surface of the peritoneum in the focus of inflammation glues adjacent surfaces to each other, resulting in a mechanical obstacle to the spread of the inflammatory process. After the end of the acute inflammatory process, adhesions in the form of transparent whitish films can form in the places of gluing of the internal organs. These adhesions are called spikes. The function of adhesions is to protect the body from the spread of a purulent-inflammatory process in the abdominal cavity.

The inflammatory process in the abdominal cavity does not always lead to the formation of adhesions. If treatment is started on time and carried out correctly, the likelihood of adhesions is reduced. Adhesions are formed when the acute process becomes chronic and the healing process is stretched over time.

Adhesions can interfere with the normal functioning of internal organs. Violation of the mobility of the intestinal loops can lead to intestinal obstruction. Adhesions affecting the fallopian tubes, uterus, ovaries, disrupt the entry of the egg into the fallopian tube, the movement of spermatozoa through the fallopian tube, the meeting of spermatozoa and the egg, and the advancement of the embryo after conception to the place of attachment to the uterine cavity. In gynecology, adhesions can cause infertility and pelvic pain.

Symptoms of adhesive disease

The scale of the adhesive process in the abdominal cavity can be different: from total spread over the entire surface of the peritoneum to the formation of individual strands (strands) fixed at 2 points and causing compression of the intestinal loops.

The acute form is manifested by a sudden or gradual development of a pain syndrome, increased intestinal motility, vomiting, and a rise in temperature. Pain may be increasing.

A blood test reveals leukocytosis, accelerated ESR.

With an increase in intestinal obstruction, vomiting occurs with the contents of the small intestine, symptoms of peritoneal irritation, tachycardia appear. With a further increase in the phenomena of obstruction, bloating of the intestine and the absence of its peristalsis are observed. decreased daily diuresis. hypotension develops. cyanosis is observed. acrocyanosis. thirst, drowsiness, prostration, hypoproteinemia. violation of water metabolism - first extracellular, and then intracellular dehydration. Mineral metabolism is disturbed. the level of potassium and sodium in the blood decreases sharply, which is clinically manifested by general weakness, hypotension, weakening or disappearance of reflexes. Violations of protein and water-salt metabolism determine the severity of the patient's condition and the depth of intoxication.

With an intermittent form of adhesive disease, pain attacks appear periodically, the intensity of pain is different, dyspeptic disorders, discomfort, and constipation occur. Patients with this form of adhesive disease are repeatedly hospitalized in surgical departments.

The chronic form of adhesive disease is manifested by aching pains in the abdomen, discomfort, constipation, weight loss and periodic attacks of acute intestinal obstruction.

Causes of adhesive disease

The most common cause of adhesion formation is pelvic inflammatory disease. Why? Let's figure it out together.

Inflammatory diseases of the genital organs occur in 60-65% of all gynecological patients. A significant proportion is inflammation of the fallopian tubes and ovaries.

When an infection enters the fallopian tubes, inflammatory exudate is not always formed. Abortion of acute inflammation of the mucous membrane of the tubes may occur before it passes into the stage of exudation. In many patients, the exudate formed in the acute stage of the disease resolves. Only in a small part of patients, an acute inflammatory process in the fallopian tubes leads to the spread of inflammatory serous or purulent exudate throughout the tube. The exudate poured out through the abdominal opening of the tube into the abdominal cavity can cause a response - loss of fibrin, sealing the abdominal opening, which is hermetically obliterated over time. The fallopian tube turns into a closed cavity. With the development of a purulent process, a pyosalpinx is formed in it. If the uterine opening of the tube remains open, exudate may flow into the uterine cavity and then out through the vagina. From the fallopian tubes with exudate and hematogenous way, bacteria can penetrate the ovary and cause its purulent fusion (pyovar).

As the inflammatory exudate accumulates, both the fallopian tube and the ovary increase in size, while the tube becomes retorted, and the ovary becomes spherical. In the mucous membrane of the tube, there are areas of desquamation of the epithelium and gluing of opposite surfaces with the formation of partitions. As a result, a multi-chamber saccular formation is formed, filled in some cases with serous exudate - hydrosalpinx, in others - with purulent exudate - pyosalpinx. When gluing and then fusion of the pyosalpinx and pyovar in the places of adhesions, the capsules may melt.

The protein membrane of the ovary and the walls of the fallopian tube, as hyaluronic acid is deposited in them and fibrous tissue grows, turn into dense, impenetrable capsules. These inflammatory formations (hydrosalpinx, pyosalpinx, pyovar, purulent tubo-ovarian tumors) are usually associated with the walls of the pelvis, with the uterus, fallopian tube, ovary of the opposite side, with the omentum, bladder and intestines. The formation of microbe-impermeable capsules and extensive adhesions in the acute stage plays a protective role, preventing the spread of infection. In the future, after the death of the causative agents of the inflammatory process, these impenetrable capsules delay the resorption of the accumulated serous or purulent exudate.

The location of the pelvic organs in inflammatory saccular formations changes significantly, and the function of neighboring organs (rectum, bladder) and, of course, reproductive function are often disturbed.

Mechanical (traumatic) damage to the peritoneum or serous membrane or exposure to certain chemicals (iodine, alcohol, antibiotics, sulfa drugs, talc, etc.) also contribute to the intense formation of adhesions.

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.

Occasionally, adhesive disease develops as a result of such congenital anomalies as planar adhesions between intestinal loops (Lane's bands) or adhesions between parts of the colon (Jackson's membrane).

In some cases, the formation of adhesions acquires a progressive course, the causes of which are not fully established, however, the significance of the vastness of the inflammatory process and the virulence of the microbial flora is beyond doubt. In these cases, intestinal deformities occur, normal motility and evacuation of intestinal contents are disturbed.

Diagnosis of adhesive disease in gynecology

Abdominal adhesions may be suspected in patients with a history of pelvic inflammatory disease, pelvic and abdominal surgery, and in women with endometriosis. However, only in half of the patients with more than two risk factors for the development of adhesions in a history of adhesions are detected during laparoscopy (an operation during which small holes are made in the anterior abdominal wall through which an optical device is inserted to examine the cavity, and special surgical instruments).

A gynecological examination suggests the presence of an adhesive process in the abdominal cavity with a probability of 75%.

Obstruction of the fallopian tubes according to hysterosalpingography (a contrast agent is injected into the uterus, x-rays are taken) and ultrasound with a high degree of certainty indicates 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.

The method of nuclear magnetic resonance seems to be very promising in the diagnosis of the adhesive process today. With this method, images are obtained that reflect the “state of affairs” at different levels.

The main method for diagnosing the adhesive process is the method of laparoscopy. It allows not only to detect the presence of adhesions and assess the severity of the adhesive process, but also to carry out treatment.

There are three stages of the adhesive process according to laparoscopy:

Stage I: adhesions are located around the fallopian tube, ovary, or in another area, but do not interfere with the capture of the egg;

Stage II: adhesions are located between the fallopian tube and the ovary, or between these organs and other structures, and may interfere with egg capture;

Stage III: there is either a torsion of the fallopian tube, or its blockage by adhesions, or a complete blockade of egg capture.

Treatment of adhesive disease

Treatment, depending on the indications, can be conservative or surgical.

Indications for surgery may occur with an acute attack of adhesive intestinal obstruction (emergency or urgent surgery) or with a recurrent course of adhesive disease (elective surgery). During an emergency operation, the adhesions are dissected, the necrotic section of the intestine is resected. In the chronic form of adhesive disease, the Noble operation or its modifications are performed.

It is almost impossible to predict the course of adhesive disease. With frequent recurrences of adhesive disease, patients lose their ability to work. The prognosis is more favorable with single spikes.

In gynecology, the main method of treatment of the adhesive process is laparoscopy. With the help of special micromanipulators, adhesiolysis is performed - dissection and removal of adhesions. Adgeolysis is performed by the following methods:

- laser therapy - dissection of adhesions with a laser);

- aquadissection - dissection of adhesions with the help of water supplied under pressure;

- electrosurgery - dissection of adhesions with an electric knife.

During laparoscopy, the following methods are used to prevent the formation of new postoperative adhesions:

introduction into the spaces between the anatomical structures of various barrier fluids (dextran, povidine, mineral oils, etc.);

wrapping the fallopian tubes and ovaries with special absorbable polymeric films.

Spikes. Treatment with folk remedies. Symptoms of various types of adhesions

Many people have heard about such a disease as adhesions. but not everyone has an idea what it is and because of what it is formed. Depending on localization adhesions can be manifested by various clinics: palpitations, pain, shortness of breath, food obstruction, etc. In this article we will tell you what spikes are, types of spikes, how treat adhesions with folk remedies .

What are adhesions and how to treat them?

Adhesive disease. Or, as the people say, adhesions- this is a condition that is characterized by the appearance of adhesions in the organs of the small pelvis and abdominal cavity.

Causes of adhesions in the pelvis

- inflammatory diseases. This includes various infectious diseases of the uterus, uterine appendages and pelvic peritoneum (endometritis, parometritis, salpingoophoritis, pelvic peritonitis);

- long-term wearing of an intrauterine device;

- curettage of the uterine cavity (abortion);

- STIs (sexually transmitted infections);

- inflammatory diseases of the peritoneal organs (appendicitis);

- any mechanical damage to one or more elements of the small pelvis and peritoneum;

- any hemorrhage in the abdominal cavity. This may be due to rupture of the fallopian tube due to ectopic pregnancy, ovarian apoplexy, etc.;

- endometriosis is a disease that is characterized by the growth of endometrial tissue outside the endometrium (inner layer of the uterus);

- surgical intervention;

Symptoms of pelvic adhesions

Spikes can manifest themselves in different ways, depending on the forms of the disease:

acute form

Patients with this form of the disease report severe pain. They are concerned about nausea, vomiting, sometimes the body temperature rises, and the heart rate also increases. When pressing on the abdomen, there is a sharp pain, due to the adhesions formed, intestinal obstruction occurs, which is characterized by a sharp drop in pressure, a decrease in the amount of urine excreted, patients note weakness, drowsiness. The condition of such patients (with an acute form of adhesions) is usually assessed as severe.

Intermittent form

This form of the disease is characterized by recurrent pain, and patients may also complain of constipation or diarrhea.

Chronic form of adhesions

The chronic form is characterized by a latent course. As such, there is no clinic, but rare aching pains in the lower abdomen may occur.

The chronic form of adhesions is most common in gynecology. The course of the latent adhesive process causes obstruction of the fallopian tubes ( fallopian tube adhesions), leading to infertility.

Intestinal adhesions

Intestinal adhesions or adhesive disease of the abdomen characterized by "fusion" of organs among themselves (gut-gut, omentum-gut). Such an adhesive disease manifests itself depending on the dysfunction of the organs that have “grown together”:

1) asymptomatic manifestation of intestinal adhesions;

2) pain form intestinal adhesions. Abdominal pain is noted, most often in the area of ​​postoperative scars (postoperative adhesions);

3) pain form intestinal adhesions with dysfunction of internal organs. This form can be manifested by diarrhea, constipation, a feeling of fullness after eating, bloating, etc.;

4) sharp adhesive intestinal i obstruction.

Adhesion treatment

There are several ways adhesions treatment. These are conservative surgical methods. But it should be remembered that in the early stages treat adhesions can folk remedies .

Take two tablespoons Flaxseed and wrap them in gauze. Immerse this bag in boiling water for three minutes, then cool it, squeeze out the water, and distribute the gauze bag with the seed on the sore spot. So hold on throughout the night.

Badan for the treatment of adhesions

For adhesions treatment this folk remedy it is necessary to prepare the infusion. It is done like this - take 60 grams bergenia root(shredded) and pour hot water (60 degrees) in the amount of 350 grams. Then the broth must be insisted for 8 hours. After the infusion has been infused, it should be put in the refrigerator. The infusion is used for douching, which is carried out in the morning and evening (for douching, dilute two tablespoons of bergenia infusion per liter of boiled water).

St. John's wort for the prevention and treatment of adhesions

It is very useful during the rehabilitation period to use herbal remedies as an addition to the main treatment. For such purposes, it is better to use St. John's wort. dried and crushed. To prepare a decoction, take a tablespoon of St. John's wort and pour one glass of boiling water. The broth should be boiled for 15 minutes, then cool and strain. Take this remedy ¼ cup three times a day.

For the prevention of adhesions it is necessary to regularly observe a gynecologist, conduct gynecological massage, treat urogenital infections in time, refuse abortions, give birth only through the natural birth canal, and have a regular sex life.

One of the unpleasant complications of gynecological diseases are adhesions. They lead to menstrual irregularities and infertility. In the article, we will consider the causes of adhesions, as well as the existing methods for their treatment - drugs (in the form of suppositories, for i / m administration) and folk remedies.

What are spikes and why do they occur?

Adhesions in gynecology, or the adhesive process, is the process of fusion of the pelvic organs with each other with the help of connective tissue. Normally, this should not be observed.

Adhesions disrupt the mobility of internal organs, and if they occur between hollow organs or in their lumen, they impede their patency.

There are many reasons for the occurrence of adhesions in gynecology. Spikes occur:

The pathological process in the reproductive organs causes a response of the body - it tries to limit this process so that it does not spread further. And this is done with the help of the formation of connective tissue in places of pathology - adhesions.

What happens to the body?

How is the formation of adhesions in gynecology? The adhesive process disrupts the normal functioning of organs. Clinically adhesive process proceeds in three variants.

Usually women do not pay attention to the above listed signs. The reason for consulting a gynecologist is only the impossibility of getting pregnant if a woman is planning motherhood.

The longer the adhesive process proceeds without treatment, the more difficult it becomes to cure it in the future.

Asherman syndrome

One of the severe options for the adhesive process is Asherman's syndrome, or the growth of adhesions inside the uterus. Here they are called synechia. The reasons for their occurrence are basically the same as for adhesions of other localization - inflammatory processes, frequent injury due to abortions or diagnostic operations, endometriosis.

According to the number and nature of synechia, three types of the syndrome are distinguished:

There are also three variants of the pathology, depending on the prevalence of the adhesive process:

• first degree - no more than a quarter of the uterine cavity is occupied by light synechiae, the bottom of the uterus and the openings of the fallopian tubes are free;
• the second degree - light or medium synechia, cover up to three quarters of the uterine cavity, do not lead to adhesion of the walls, the mouths of the fallopian tubes are not completely closed;
• third degree - the entire uterine cavity is covered with dense synechia, the openings of the pipes are closed, fusion of the walls of the uterus with each other is possible.

In recent years, a new classification has been developed that takes into account almost all pathological manifestations of Asherman's syndrome. Here are five degrees of the disease:

As a result, menstrual function is disturbed by the type of hypomenorrhea or amenorrhea, secondary infertility develops. If the exit from the uterine cavity is closed with spikes, a hematometer develops - an accumulation of menstrual blood in the area of ​​​​the fundus of the uterus, which is manifested by pain in combination with the absence of menstruation. If a woman is able to become pregnant, then she can no longer bear a child - miscarriages or premature births occur.

Tubal obstruction

The cavity is present not only in the uterus, but also in the fallopian tubes. An egg passes through them to get to the uterus, connect with the sperm and attach to the uterus. Adhesions can also form in the cavity of the fallopian tubes. They arise as a result of acute and chronic inflammatory diseases of the tubes - salpingitis, as well as after tubal pregnancy.

The adhesive process in the pipes can close part of their lumen or the entire lumen. However, even if only a part is closed, pregnancy still does not occur.

Methods for diagnosing adhesions

The diagnosis of adhesive process in gynecology is made on the basis of survey data, examination and instrumental research methods, the latter being of the greatest importance in diagnosis.

From the anamnesis, signs of menstrual dysfunction are found out, the duration of the period in which the woman could not become pregnant. You can also collect data that indicates a possible cause of the development of the adhesive process.

On examination, little is found, since the adhesive process is localized deep enough in the pelvic cavity. On palpation, one can note soreness, a denser structure of the uterus. When viewed on the mirrors, you can see a closed internal pharynx.

The basis of diagnosis is the use of instrumental research methods:

How is the therapy carried out?

Treatment of adhesive disease is a laborious process, especially if the pathology is in advanced form. Various methods are used for this:

In the treatment of adhesions by medication, drugs are initially used to eliminate the cause of adhesions.

If it is an inflammatory process, anti-inflammatory drugs, hormone therapy are used. If the cause is an infectious disease, appropriate antibiotics are prescribed. The following medications are used to directly eliminate adhesions:

• means that dissolve fibrin - the main component of adhesions. These include Lidaza for intramuscular injection, Longidaza in suppositories, Trypsin for intramuscular and intracavitary administration;
• hormone therapy is simultaneously used to restore damaged endometrium and menstrual function.

Of the physiotherapeutic methods of treatment, laser therapy, electrophoresis on the area of ​​localization of the adhesive process with Lidaza are used.

The most effective method of removing adhesions is surgical treatment.

There are also folk methods for the treatment of adhesive disease. However, they can only be used as an additional therapy and only after consultation with a specialist. Here are some traditional medicine recipes:

Folk remedies have a more restorative effect, but are not able to treat adhesions. Many women who use only folk remedies in such cases further aggravate their condition. After such a “folk treatment”, an operation is required, and sometimes even several, in order to eliminate the adhesive process and infertility.

"My lower abdomen often pulls, and the doctor believes that adhesions are to blame, although ultrasound does not show anything like that. How can I be treated?"

Irina, Tula

Adhesive disease, or, more simply, adhesions in the pelvis, occurs after frequent inflammation of the appendages, as well as due to untreated infections. Usually women go to the doctor with complaints of constant aching or pulling pains in the lower abdomen and lower back. Since these sensations are caused by anatomical disorders, the use of painkillers does not bring relief.

Unfortunately, it is impossible to see adhesions on ultrasound. They can be suspected during a routine manual gynecological examination. When all possible causes of pain are rejected, the diagnosis of adhesive disease is made. There are several methods for treating adhesions.

Conservative treatment for the prevention of adhesions should be started in combination with anti-inflammatory. It can also be effective at the initial stage of adhesive disease, when the pain is intermittent and not too intense. Aloe has a good healing effect. It is used in the form of injections of 2 milliliters every day. The course of treatment should consist of at least 10 injections. Together with aloe, you need to take folic acid 1 capsule 3 times a day and vitamin E 2 capsules a day.

Now there are new effective drugs for the treatment of adhesive disease. Due to the content of special enzymes, they make adhesions more elastic and extensible. This helps to reduce pain. The course of treatment consists of 5-7 intravenous injections. But do not try to do it yourself - only a doctor can prescribe treatment.

A very effective method of treating chronic inflammation and the associated adhesive process is physiotherapy. It allows you to soften adhesive structures, make them thinner and more extensible. This reduces, and in some cases completely stops pain, improves bowel function, which is often tightened with adhesions. The most effective physiotherapeutic methods include paraffin and ozocerite applications on the abdomen. During the procedure, a paraffin or wax compress is applied to the lower abdomen, which, as it were, warms up the adhesions, contributing to their resorption. The duration of the procedure is 10-15 minutes. The course of treatment - 10 procedures. Courses can be repeated in 2-3 months.

Electrophoresis with zinc, magnesium and calcium has a good effect. With severe pain syndrome, novocaine is added to them. Procedures alternate every day. If necessary, the course can reach up to 20 sessions. A contraindication to any of the physiotherapeutic methods is active inflammation. It is not necessary to conduct a course during menstruation.

It must be remembered that physiotherapy is not surgery, it cannot completely "resolve" adhesions. Therefore, if symptoms persist after a full course, an operation to dissect the adhesions may be necessary.

The most unpleasant consequences of the adhesive process are obstruction of the pipes. You can find out if your fallopian tubes are passable using hysterosalpingography. This is an X-ray examination of the uterus and tubes. At the same time, a special substance is injected into the uterine cavity and they watch how it is distributed in the tubes. If they are obstructed, the adhesions are separated using laparoscopy. If the pipes are in order, then physiotherapy is prescribed to reduce soreness and soften adhesions.

Laparoscopy- this is a surgical intervention in which 3 small punctures are made in the abdominal wall, through which microinstruments and an optical device are inserted into the abdominal cavity, to which a video camera is attached. The image is displayed on the screen, and with the help of manipulators, an operation is performed to separate the adhesions and restore the patency of the fallopian tubes.

- connective tissue adhesions, usually occurring against the background of inflammatory processes and leading to partial or complete obstruction of the pipes. Outside the period of inflammation, the adhesive process is manifested only by tubal infertility and the occurrence of an ectopic pregnancy. For the diagnosis of adhesions, hysterosalpingography, hydrosonoscopy, salpingoscopy are used. Patients are shown physiotherapy, resolving and immunocorrective therapy, sometimes in combination with antibacterial and anti-inflammatory drugs. To restore reproductive function, reconstructive plastic surgery or IVF is recommended.

Complications

The main complication of adhesions in the fallopian tubes is a partial or complete violation of their patency with the impossibility of natural fertilization of the egg. With partial obstruction, the probability of conception and normal implantation of the fetal egg, according to various authors, decreases by 45-85%, while the risk of an ectopic pregnancy increases significantly. With complete obstruction, a normal pregnancy is impossible. In addition, a violation of the outflow of inflammatory exudate from the fallopian tube can lead to the formation of hydro- or pyosalpinx.

Diagnostics

Of key importance in the diagnosis of the adhesive process are instrumental methods that make it possible to identify connective tissue adhesions. The survey plan includes:

• Look at the chair. On bimanual palpation, the appendages may be heavy and slightly enlarged. In the presence of inflammation, pain is determined.
• Ultrasonic hysterosalpingoscopy. Ultrasound with the introduction of sterile saline allows you to identify and assess the degree of deformation of the tube due to adhesions.
• Hysterosalpingography. Despite its invasiveness, radiography with the use of a contrast agent remains the main method for detecting adhesions. The accuracy of the method reaches 80%.
• Salpingoscopy and Falloscopy. Endoscopic techniques make it possible to visually detect adhesions inside the fallopian tube, but their use is limited by the technical complexity of their implementation.
• Laparoscopic chromosalpingoscopy. During the study, a dye is introduced into the tubes, which normally enters the abdominal cavity, taking into account the result, the patency of the tubes is assessed.

In addition to these studies, according to indications, the patient is prescribed diagnostic laparoscopy to exclude adhesions in the small pelvis. With a combination of adhesions and inflammation, laboratory tests aimed at detecting the causative agent of infection and determining its sensitivity to antibacterial drugs are informative. To do this, perform smear microscopy, bacterial culture of vaginal discharge, PCR, RIF, ELISA. The condition is differentiated from adhesive disease, inflammatory and volumetric processes in the pelvic cavity. If necessary, consultations of a reproductologist, surgeon, dermatovenereologist are prescribed.

Treatment of adhesions of the fallopian tubes

The key factors determining the choice of therapeutic or surgical tactics are the presence of inflammation and the woman's reproductive plans. If adhesions are diagnosed in a patient who does not complain and is not going to become pregnant, dynamic observation by a gynecologist with an examination twice a year is recommended. When detecting inflammation and determining the provoking infectious agent, the following are recommended:

• Antibacterial agents. The choice of a specific antibiotic and treatment regimen depends on the pathogen and its sensitivity.
• Anti-inflammatory drugs. Non-steroidal drugs reduce the degree of inflammation and the severity of pain.
• Immunocorrectors. To increase reactivity, immunogenesis stimulants and vitamin-mineral complexes are prescribed.

Already at the stage of relief of inflammation, a patient with partial obstruction begins to undergo resolving therapy with agents that can prevent the formation of synechia or soften existing adhesions. For this purpose, enzymes, placenta-based preparations, and biogenic stimulants are used. A number of authors note the effectiveness of combining drug treatment with physiotherapy procedures: mud therapy, drug electrophoresis, electrical stimulation of the uterus and appendages, gynecological massage. Previously, for diagnostic and therapeutic purposes, with partially impaired tubal patency, hydro- or perturbation was actively used with the introduction of a liquid or gas into the lumen. Currently, due to the high invasiveness and the risk of complications, the use of these techniques is limited.

When restoring reproductive function, the most effective are reconstructive plastic surgery and in vitro fertilization. With bilateral obstruction, patients planning a pregnancy undergo a laparoscopic salpingostomy or salpingoneostomy. The combination of adhesions in the fallopian tubes with adhesions in the pelvis is an indication for laparoscopic salpingo-ovariolysis. If it is impossible or ineffective to perform operations for tubal infertility, IVF becomes the only way for the patient to have a child.

Forecast and prevention

The prognosis is favorable. The correct selection of the treatment regimen allows not only to improve the quality of life of the patient, but also to realize her plans for motherhood. After microsurgical interventions, pregnancy occurs in 40-85% of patients. The effectiveness of in vitro fertilization during adhesions in the tubes reaches 25-30%. Prevention of the formation of adhesive adhesions includes early diagnosis and treatment of salpingitis, adnexitis, other inflammatory gynecological diseases, pregnancy planning with the refusal of abortions, reasonable appointment of invasive interventions. An ordered sexual life with barrier contraception, protection against hypothermia of the legs and lower abdomen, and sufficient physical activity are recommended.

What are adhesions in gynecology? Adhesions are fragments of scar tissue that connect 2 organs, which normally should not be connected. For example, intestinal loops and uterus, ovary, fallopian tubes.

Adhesions may appear as thin bands, barely visible during laparoscopy, but often appear as dense, well-perfused adhesions. Adhesions develop in response to any impact in the body that requires repair processes. Such effects include surgery, inflammation, endometriosis, trauma, or exposure to ionizing radiation.

Although adhesions can occur anywhere, one of the most common locations where they form is in the pelvic organs.

The adhesive process and the fight against its consequences have long occupied one of the leading places in abdominal surgery. Adhesions in the abdominal cavity are a frequent complication of operations and occur in 55-93% of cases after gynecological operations. Abdominal adhesions are also seen in about 10% of people who have never had surgery.
Fortunately, most patients with intra-abdominal adhesions are asymptomatic.

However, pelvic and abdominal adhesions are associated with significant gynecological morbidity, including infertility, chronic pelvic pain, small bowel obstruction, and potential future surgical complications.
The urgency of the problem today is higher than ever, since convincing evidence has been obtained that the frequency of clinically significant adhesions after gynecological operations does not decrease as we would like, but invariably increases, which is manifested in an increased frequency of hospitalizations and repeated surgical interventions associated with adhesive process.

This is apparently due to the widespread use of laparoscopy in gynecology, primarily surgery for infertility, ovarian cysts, endometriosis. In addition, the frequency of myomectomy is increasing every year among those women who would have previously been offered a hysterectomy. Previously, only highly qualified surgeons operated in specialized centers, having microsurgical equipment and carefully following the principles of adhesion prevention outlined below.

Nowadays, almost any operating gynecologist performs these operations, often neglecting proper preventive measures.
The adhesive process is considered as a natural consequence of surgical trauma and repair processes. Classical ideas about the causes of the adhesive process identify several main sources of adhesion formation, such as trauma to tissues of any origin (mechanical, thermal, infectious process, ionizing radiation, reaction to a foreign body, etc.).

Such an injury triggers a cascade of reactions that begins with the destruction of mast cells, the release of histamine, and an increase in the permeability of the vascular wall. Then fibrin is deposited. Peritoneal healing is a combination of fibrosis and mesothelial regeneration. Fibrin deposits form within 3 hours after surgery. If fibrin lysis does not occur, blood vessels grow into these accumulations and fibroblasts migrate.

Most fibrin deposits are temporary and resolve within 72 hours, but trauma-induced suppression of fibrin destruction by the peritoneum leads to adhesion formation.
This point of view, which has become a classic, was confirmed in a series of experiments on animals, where the use of silicone membranes, which separate the injured peritoneal surfaces for 30 hours, led to the absence of adhesions.
There are data that complement the concept of the local origin of adhesions.

It is believed that the entire peritoneum can be an essential cofactor in the formation of the adhesive process. The following factors have been identified that promote adhesion: dessication, hypoxia, acidosis, reactive oxygen radicals, and tissue manipulation, which leads to increased local adhesion formation.

Intercoat Gel (Oxiplex/AP)

Infiltrative endometriosis is a clonal disease. The disease begins with the appearance of a single accumulation of endometrial cells, no larger than 1 cm in size.




Doctors associate the signs and symptoms of adhesive disease not with problems that appear due to the presence of adhesions in the pelvic cavities, but from compression of organs and tissues by them, which leads to functional disorders




Intercoat Anti-Adhesion Gel is a clear, viscous, single-use gel. Composed of a compound of polyethylene oxide (PEO) and sodium carboxymethyl cellulose (CMC).

Questions from patients and answers from doctors

Can adhesions dissolve on their own? 2017-09-22T17:28:44+00:00

It develops in most women after undergoing diagnostic or therapeutic surgical procedures and is divided into acute and chronic according to the duration of the disease.

"Young" adhesive tissue, formed during the first three months after the onset of the disease, sometimes undergoes reverse development as a result of an intensive course of properly selected therapy.

The most effective types of therapy for adhesive disease include physiotherapy and resorption therapy, carried out in combination with anti-inflammatory drugs. Good effect on "young" adhesions and hirudotherapy - treatment with leeches, as well as gynecological massage.

However, in the presence of a chronic adhesive process, only surgical treatment can destroy adhesions, since the adhesive tissue in this case is characterized by increased density, the absence of any elasticity, and usually does not respond to conservative therapeutic methods.

Can pelvic adhesions be seen on ultrasound? 2017-09-22T16:33:10+00:00

Like many other studies, ultrasound has its advantages and disadvantages.

The advantages of the study include its non-invasiveness, painlessness and information content.

The disadvantages are the inability to determine the newly formed inflammatory tissue - for example, adhesions in the acute stage of adhesive disease. "Young" adhesive tissue has a low density and high plasticity, unlike mature adhesions in the chronic stage of the disease. Therefore, newly formed adhesions are practically invisible to ultrasound, especially if they are single.

Mature adhesive tissue is rigid and dense, so it is clearly visible on ultrasound.

To clarify the diagnosis of pelvic adhesive disease, additional examination methods are needed, such as MRI and laparoscopy.

Spikes - what is it? How are they formed? 2017-09-12T22:14:44+00:00

Sometimes you have to deal with illnesses that bring poor health with them, but to understand that this is completely impossible without the help of a doctor. There is an erroneous opinion that it is better not to have an idea about some ailments for your own peace of mind. But if you learn in time about the changes that occur with the body, you can prevent the aggravation of the disease. Treatment provided at the right time will have a beneficial effect. In this article, we will talk about the causes of adhesions.

Very thin fibers are formed in the body, and then films that can stick together nearby organs. Thus, the operation of a certain system is disrupted. Most often, this disease affects the fair sex. Spikes appear mainly in the small pelvis. But sometimes they also occur in other systems.

One of the most common causes of this disease is inflammation. At this time, any organs increase slightly in size. In the process, liquid begins to stand out. It is this mucus that turns into thin threads. Subsequently, films are formed - adhesions that connect the organs to each other or the organ to the peritoneum.

What are the differences between Intercoat Gel and Anti-Adhesin Gel? 2017-09-12T20:34:26+00:00

According to the anti-adhesion action, the drugs are similar. Interkot and Antiadhesin showed positive qualities. Both drugs have positive reviews. Both effectively prevent the development of adhesions.

Preparations differ in chemical and pharmaceutical composition:

• Antiadhesin : Hyaluronic acid + carboxymethyl cellulose Sometimes it can provoke a tissue reaction to a foreign body, which ends with fibrosis of the surfaces of organs in contact with the barrier agent.
• : Barrier antiadhesion agent based on copolymer of carboxymethyl cellulose with polyethylene oxide showed in the study the absence of inflammatory reactions and the least likelihood of fibrosis.

And how to use the gel? Please send instructions for use to your doctor 2017-09-06T14:39:35+00:00

Instructions for use of Intercoat anti-adhesion gel can be found on our website.
Also, a complete instruction in Russian is in each package with a gel.

Is it possible to have sex with pelvic adhesions? 2017-09-22T17:50:20+00:00

Sexual life with a permanent partner is not contraindicated for women suffering. Full sex has a special therapeutic effect, positively affecting the endocrine and psychological status of both partners.

However, it should be remembered that during the chronic stage of the adhesive process, dyspareunia may appear - painful sexual intercourse, when a woman experiences recurring pain in the lower abdomen and rectum.

Dyspareunia is a "calling card" of adhesive disease and can completely disappear after surgical treatment.

Is it possible to get pregnant with adhesions of the fallopian tubes? 2017-09-22T16:23:03+00:00

The onset of pregnancy with adhesions in the fallopian tubes largely depends on a timely diagnosis, individually selected treatment, a full course of examination and the severity of the disease.

Sluggish, chronic infections, as well as endometriosis, can cause serious inflammation of the mucous membrane in the fallopian tubes, which can result in the formation of adhesions. Adhesions located in the cavity of the fallopian tubes sometimes completely block their lumen. In this case, the passage of the egg through the tubes becomes impossible and the woman becomes infertile. However, adhesive disease in the fallopian tubes can be expressed to a lesser extent, and then the likelihood of pregnancy remains.

How to prevent the occurrence of adhesions? 2017-09-06T14:17:23+00:00

Many scientists and surgeons have spent their whole lives on solving this issue.

Today in the world, despite the achievements of modern science and medicine, there are no reliable and highly effective means of preventing the development of adhesions after surgery.

Patients complain of abdominal pain, more often in the area of ​​postoperative scars. Pain can be aching or pulling, aggravated by physical exertion, changes in body position, disappear on its own or after taking painkillers.

Painful form of adhesive disease may be with dysfunction of internal organs. As a result of the adhesive process, the work of the organs of the gastrointestinal tract is disrupted. Manifestations can be varied:

• diarrhea,
• constipation,
• feeling of bloating after eating
• intolerance to certain types of food.

How do adhesions appear? 2017-09-06T14:18:10+00:00

The manifestations of adhesions depend on where the adhesions were formed and how many of them were formed. It depends on the extent to which the functions of the organs that are soldered together will be impaired.

The most significant consequences of adhesion formation occur in the abdominal cavity, therefore these manifestations are called adhesive disease of the abdominal cavity.