Connective tissue cords that cover the surface of the pelvic organs and connect them together. The adhesion process is manifested by constant or periodic pelvic pain, miscarriage or infertility, intestinal disorders in the form of constipation, frequent bowel movements and flatulence. When making a diagnosis, bimanual examination, ultrasound and tomography of the pelvic organs, hysterosalpingography, diagnostic laparoscopy are used. Conservative therapy includes the appointment of antibacterial, anti-inflammatory, hormonal and fibrinolytic agents. Surgical treatment is based on laparoscopic dissection of the adhesions.

General information

Treatment of adhesions in the small pelvis

Therapeutic tactics are determined by the stage, nature of the course, clinical severity and the presence of complications. At the initial stage of treatment of chronic adhesive disease, complex conservative therapy is recommended, which includes:

  • Antibacterial drugs... They are prescribed when confirming the leading role of infectious agents in the development of the adhesive process, taking into account the sensitivity of microorganisms.
  • Non-steroidal anti-inflammatory drugs... Effectively eliminate severe pain syndrome. They relieve swelling and accelerate the resorption of adhesions at the initial stages of the disease.
  • Hormonal drugs... Hormone therapy is indicated for adhesions that have arisen against the background of external genital or extragenital endometriosis.
  • Fibrinolytic enzymes... They break down glycopeptide bonds in the connective tissue cords, which contributes to the complete or partial resorption of adhesions.
  • Vitamins, immunocorrectors. They are used to improve overall health and correct possible immune disorders.
  • Physiotherapy, balneotherapy. Used as ancillary treatments.

With the ineffectiveness of drug treatment of the chronic form of the disease, acute and intercurrent variants of pathology, surgical intervention is indicated. Endoscopic surgery is usually used to cut adhesions. Often, laparoscopy is a diagnostic and treatment procedure, the connective tissue adhesions are dissected directly during the examination. Depending on the instruments used, such interventions can be laser surgery, electrosurgical and aquadissection. In the latter case, the adhesions are destroyed by increased water pressure. With a widespread adhesive process, alternative options for laparoscopy are performed: double laparoscopy with atypical points of trocar insertion, open (minilaparotomic) with direct trocar insertion, with the creation of high pressure pneumoperitoneum. Operations with dissection of adhesions with a scalpel are rarely performed these days.

Forecast and prevention

With adequate treatment in the early stages of the disease, the prognosis is favorable. Surgical dissection of adhesions can eliminate or significantly reduce pain and restore reproductive function in 50-60% of cases in women with stages 1-2 of adhesive disease. The use of an anti-adhesion gel barrier minimizes the risk of disease recurrence. Prevention of adhesions in the small pelvis includes routine examinations by a gynecologist to detect and treat inflammatory processes, refusal of unreasonable invasive interventions, planning pregnancy, and the use of contraceptives during sexual intercourse with casual partners. In order to reduce the likelihood of the occurrence of peritoneal pelvic adhesions, when performing operations in women, it is important to choose the most gentle type of intervention, to treat inflammatory complications in a timely manner, and to observe a motor regimen in the postoperative period.

The organs of the abdominal cavity are most often subject to the adhesive process. In most cases, the formation of adhesions is associated with the transferred operations. Let us consider in more detail what intestinal adhesions are, for what reasons they are formed and what methods are treated.

Intestinal adhesions are formations of connective tissue (cords) between the abdominal organs and intestinal loops, leading to fusion or adhesion of the serous membranes of the organs to each other. The adhesion process is facilitated by the natural feature of the peritoneum for adhesion (adhesion).

As you know, the peritoneum is a thin film that envelops the internal organs. If, for some reason, an inflammatory focus forms in the abdominal cavity, the film of the peritoneum sticks to the inflamed area and prevents the spread of the pathological process to other organs.

But there is another side to this useful protective function. Sometimes the adhesion process can go too intensively, which leads to dysfunction and deformation of the organs enclosed in such a peritoneal membrane. Blood vessels can be pinched, often narrowing of the intestine occurs due to compression of the adhesions of its walls.

Why are intestinal adhesions formed?

Doctors identify several main reasons leading to the formation of adhesions:

Doctors recognize that surgery is the most common cause of adhesions. According to statistics, they are formed in 15% of patients, and the heavier and more voluminous the surgical intervention, the greater the risk of formation of adhesions between the internal organs.

Since the formation of adhesions is a rather long process, its symptoms do not appear immediately. Sometimes the pathological process does not manifest itself in any way and is discovered by chance during the examination. This becomes the reason that patients seek medical help with a complicated adhesive process. So, what are its main symptoms:

  • Recurrent pulling pains that are localized in the area of ​​the postoperative scar. Painful sensations can intensify after physical exertion, especially those associated with sharp turns of the body and lifting weights.
  • Dysfunction in the gastrointestinal tract, expressed in bloating, a tendency to constipation, a feeling of distention in the navel.
  • Violation of the act of defecation, which manifests itself in persistent constipation. This is due to a slowdown in the permeability of intestinal contents through the areas compressed by adhesions.
  • You may experience nausea and vomiting after eating.
  • In the chronic course of the process, the patient may experience weight loss.

In some cases, serious complications may arise that pose a threat to the patient's life and require immediate surgical intervention.

Diagnostics

The characteristic complaints of pain and intestinal disorders help to suspect the patient's adhesion process. The doctor must conduct a thorough examination and question the patient about the nature of pain, to clarify whether there have been surgical interventions or abdominal injuries in the past. After a digital examination of the rectum, the patient is assigned laboratory tests and instrumental examinations.

Treatment of intestinal adhesions

Treatment of the adhesive process is carried out by conservative methods, folk remedies and with the help of a surgical operation.

Treatment with conservative methods

In about half of the cases, when diagnosing an adhesive process, it is possible to do without surgical intervention, using conservative methods of treatment in conjunction with traditional medicine and a special diet. If adhesions do not manifest themselves in any way and there is no pain syndrome, special treatment is not required. Enough observation and preventive examinations of a doctor.

With minor pain and minor functional disorders, the patient is prescribed antispasmodics and analgesics. The doctor may prescribe injections of enzymes, vitreous, aloe preparations, splenin, which contribute to the partial resorption of adhesions. For chronic constipation, it is necessary to take laxatives prescribed by your doctor.

Diet and nutrition for intestinal adhesions

If you suspect an adhesive process, you must adhere to a special diet. In no case is it recommended to starve or overeat, this can lead to an aggravation of the problem and the development of complications. It is highly desirable to adhere to the regimen and eat at certain times.

Meals should be fractional, in small portions, you need to eat 4-5 times a day. Heavy and fatty foods, foods rich in fiber and provoking flatulence and bloating are excluded from the diet. These include:

  • legumes,
  • cabbage,
  • grape,
  • radish,
  • corn,
  • radish,
  • turnip.

It is not recommended to consume whole milk, any carbonated drinks, hot spices, sauces. The menu should include foods containing calcium, eat more cheese and cottage cheese. Fermented milk products, especially kefir, are very useful. They help move the contents through the intestines.

It is better to drink kefir at night, it must be fresh, since three-day kefir, on the contrary, has a fixing effect. Food should not be hot or cold; it should be taken warm. This will help relieve the intestinal spasm.

Patients with adhesive disease can eat:

  • low-fat broths,
  • steamed or boiled fish,
  • soft-boiled eggs or in the form of an omelet,
  • boiled chicken meat,
  • butter in a small amount.

The patient needs to give up marinades, smoked meats, hot spices, canned food. Compliance with such a diet allows you to prevent exacerbations of the disease and serves as a kind of prevention of the adhesive process.

Surgical treatment: removal of adhesions with surgery

If the doctor suspects that the patient has a violation of the blood supply to the intestines due to the adhesions, the operation should be performed immediately. Surgical intervention will be aimed at removing obstructions and restoring the normal passage of intestinal contents. The essence of the operations is reduced to the dissection of adhesions, for which two types of operations are used: through the incision of the peritoneum and minimally invasive laparoscopic surgery.

The main problem of the surgical treatment of adhesions is the fact that any abdominal operation can again cause the formation of adhesions. Therefore, they try to carry out operations with minimal trauma: adhesions are separated with an electric knife or a laser. Another method is hydraulic squeezing of the adhesions and the introduction of a special fluid under pressure into the connective tissue.

To date, two types of surgical intervention are used to remove adhesions:

  1. Laparoscopy. A low-traumatic, gentle operation, during which a fiber-optic tube with a miniature camera and lighting is inserted through a puncture in the abdominal cavity. Through two additional incisions, manipulators with a surgical instrument are carried out, allowing, under the supervision of a camera, to dissect adhesions and cauterize blood vessels. After such a procedure, the patient quickly recovers and after a week can return to normal life.
  2. Laparotomy... This method is used when there are a lot of adhesions. The operation is carried out through an incision of the anterior abdominal wall, about 15 cm long, which allows you to get extensive access to the internal organs.

When choosing the tactics of surgical treatment, the doctor must take into account many factors. First of all, it is the age of the patient. Elderly people are trying to carry out a sparing laparoscopic operation. Concomitant pathologies play an important role. For example, if a patient has problems with the heart or blood vessels, this may be a contraindication for surgery.

The number of adhesions is decisive in the choice of tactics. If a patient has single adhesions, a laparoscopic operation is indicated; in the presence of a large number of adhesions, surgery with a midline peritoneal incision is required.

Postoperative period

In the postoperative period, an important point is to provide the intestine with functional rest until the wounds are completely healed. This is ensured by refusing food on the first day after the operation. The patient is allowed to take only liquid.

On the second or third day, you can gradually, in small portions, take liquid food: diet broths, liquid mashed cereals and liquid vegetable purees. In addition to water, you can drink herbal decoctions, diluted juices. As the patient's condition improves, you can gradually switch to the next diet.

A week after the operation to remove adhesions, foods of a denser consistency are added to the diet. The patient's nutrition should be complete and contain all the necessary nutrients, vitamins and minerals necessary for the speedy restoration of health. But the diet is still gentle, the food is pre-chopped, wiped, the food is steamed or boiled.

At this time, protein-rich foods are useful - eggs, boiled lean meat or fish, vegetable puree from carrots, beets, grated apples. It is recommended to use fermented milk products (kefir, yogurt). To avoid irritation of the intestinal mucosa, food must be thermally processed. You can drink plenty of fluids:

So that fresh juices do not irritate the intestines, they are diluted with water. Under no circumstances should unboiled chlorinated tap water be drunk.

After an operation of this kind, the intake of alcohol, strong coffee, chocolate is categorically excluded. The diet should not contain flour, confectionery, smoked meats, salty, spicy, spicy, fatty and fried foods. Compliance with such a diet will allow the patient to quickly recover and soon return to a full life.

Treatment of intestinal adhesions with folk remedies

Alternative methods for the treatment of adhesions can be used only after consultation with the attending physician and in cases where the disease is mild. Most often, traditional healers are advised to take herbal decoctions:

Folk recipes should be treated with caution. In case of deterioration of health or the appearance of adverse symptoms, you should seek medical help as soon as possible.

Prevention of intestinal adhesions

In order to prevent the development of the adhesive process in the intestine, it is necessary to avoid food poisoning and any inflammatory processes of the abdominal organs. After surgical operations, it is necessary to follow the doctor's recommendations, and on the second day try to turn from side to side.

This will help prevent adhesions. It is useful to perform deep exhalation and inhalation, bending and turning the trunk, if these exercises do not worsen the patient's condition and do not interfere with the healing of postoperative wounds.

It is equally important to choose the right diet and follow the diet, eating often and in small portions. It is necessary to monitor the correct functioning of the gastrointestinal tract,. An active lifestyle is helpful to prevent adhesions, but strenuous physical activity should be avoided. By adhering to these recommendations, you will save yourself from the occurrence of adhesions and will live a healthy and fulfilling life.

Laparoscopy is considered a low-traumatic surgical procedure, which is performed for various indications. Complications after it occur extremely rarely, and the recovery period does not last long. But can adhesions form after laparoscopy? This operation is the safest way to treat gynecological diseases. It is often used to eliminate adhesions, but it can itself be the cause of their formation.

- These are seals of connective tissue that connect the internal organs to each other. This is contrary to human anatomy. Adhesions after laparoscopic surgery appear as transparent or whitish stripes. They lead to deviations in the functioning of the body. That is why the adhesive process is a pathological phenomenon and needs treatment.

Adhesions after laparoscopy of the ovary are rare, but extremely darken the life of a woman. They do not always make themselves felt, but sometimes they lead to the development of complications. In addition, the cause of the pathology can be inflammatory processes in the pelvic area. It is noteworthy that adhesions are formed at almost any age.

Factors contributing to the development of adhesions after laparoscopy:

  • diabetes;
  • damage to the sheets of the peritoneum or their "overdrying" due to the filling of the abdominal cavity with carbon dioxide at an unsuitable temperature;
  • moving bacteria to the surgical site from other parts of the body (this interferes with normal tissue repair);
  • advanced age;
  • burn injury to tissues with a radio wave knife, plasma scalpel or other device in the process of coagulation;
  • use that takes too long to dissolve;
  • oxygen starvation of tissues and improper metabolism in them;
  • leaving cotton balls, suture material, etc., in the area of ​​manipulation;
  • development of the postoperative infectious process (rarely happens).

Symptoms of adhesions in the small pelvis

Signs of an adhesive process may be absent. As the postoperative scar thickens, it is possible that pulling pains appear in the operated area, intensifying with active movements, as well as soreness during intimacy.

The following manifestations of pathology are possible:

  • development of intestinal obstruction;
  • improper functioning of internal organs;
  • pelvic pain (abdominal or chronic);
  • menstrual irregularities;
  • infertility;
  • the presence of uterine bleeding with an unpleasant odor, not caused by menstruation.

What to do if adhesions develop after laparoscopy

Change in nutrition

In the presence of an adhesive process after the operation, the laparoscopic method shows a change in the diet, contributing to the early elimination of pathology. Spicy, fried and fatty foods are excluded from the diet, as well as:

  • foods that increase gas production in the intestines;
  • alcohol;
  • spicy and fatty sauces;
  • pickled and smoked dishes;
  • canned food.

The menu for soldering should consist of fermented milk products, lean soups, low-fat meat and fish dishes, chicken eggs, fruits and vegetables, and various cereals. It is optimal to eat food in small portions from five to six times a day.

To avoid the development of the adhesive process, it is recommended to use an anti-adhesive gel, for example, Mesogel. It is rubbed into the skin with a thin layer. You can perform special exercises aimed at eliminating pathology. Learn more about anti-adhesion exercises HERE.

Adhesive process therapy

With an asymptomatic course of pathology, conservative therapy is indicated, involving the use of drugs and the passage of physiotherapeutic procedures. If these methods are ineffective, then at the request of the patient, relaparoscopy is performed.

Chronic pain is usually treated conservatively, including by localizing the affected tissue. Physiotherapy and electrophoresis procedures with the use of absorbable agents (iodides and lidase) are practiced. Drugs are prescribed to relieve pain and other symptoms of pathology.

The patient, who developed intestinal obstruction as a result of the adhesive process, is hospitalized in a hospital. Next, an analysis of the viability of the intestine is carried out and the question of the need for the capture of healthy tissue is resolved.

Laparoscopic adhesion removal

Dissection of adhesions is performed by laparoscopic access. In this case, three incisions are made on the woman's abdomen (no more than a few millimeters in size). In the process of manipulation, the normal ratio of the organs of the reproductive system is restored, adhesions are removed, and a new hole is formed in the fallopian tube instead of the sealed one.

Methods for removing adhesions:

  • laser therapy, in which adhesions are dissected with a laser after removal of the uterus and ovaries or other surgery;
  • aquadissection - problem tissues are eliminated using water supplied under pressure;
  • electrosurgery, in which an electric knife is used to eliminate adhesions in the small pelvis.

Laparoscopy of the formed adhesions rarely leads to complications. After it, the patient is in the hospital for no more than two days. They let her go home on the third day and from that moment she is under the supervision of a gynecologist at the place of residence.

Prevention of adhesion formation after laparoscopy

To prevent adhesions after laparoscopic surgery, it is necessary to focus not only on drug treatment. The patient needs to move carefully after the operation, temporarily giving up active sports. Other measures to prevent the development of pathology are presented below.

  1. Drug therapy, consisting of antibacterial and anti-inflammatory drugs, as well as anticoagulants and fibrinolytic agents, will help to avoid the formation of adhesions. The action of the latter is aimed at preventing the growth of fibrin - the main component of adhesions. Longidaza, Wobenzim, Ascorutin are often appointed. Collection No. 59 normalizes female reproductive function, eliminates the inflammatory process in the ovaries, and reduces the likelihood of adhesions formation.

Drug therapy lasts 2-4 weeks. As practice shows, in women who undergo it, the adhesion process develops less often than in those who neglect the doctor's prescriptions.

Another way to prevent pathology is the introduction of a barrier fluid into the abdominal cavity, which prevents the connection of tissues with fibrin threads. Due to the special solution, the organs stop touching and "sticking" to each other.

  • softening of connective tissue. As a result, it becomes more elastic, which reduces the severity of pain syndrome, contributes to the prevention and treatment of adhesions.
  • improving tissue metabolism. Adhesions often lead to compression of organs, which is the cause of chronic constipation and menstrual irregularities. Physiotherapy normalizes metabolism and blood supply in tissues, stimulating the regeneration of the latter.
  1. Massage therapy is usually used in conjunction with physiotherapy. It is contraindicated in some patients. The obstacles to its implementation are:
  • any oncological;
  • the presence of an infectious disease due to the performed laparoscopy;
  • violations of the integrity of the skin in the pelvic area or abdominal cavity.

Moderate physical activity and special exercises will help prevent the appearance of adhesions. Before proceeding with them, you need to consult your doctor.

To avoid adhesions, you need to adhere to a certain diet. In addition, the penetration of infection into the seam must not be allowed, and it is also forbidden to play sports for some time. A correct lifestyle significantly reduces the likelihood of developing pathology.

It is advisable that the specialist explain to the patient all the measures for the prevention of the adhesion process. It is important to do this before hysterectomy or any other surgery. A woman is unlikely to have to undergo repeated laparoscopy of the appendages if she is attentive to her health, avoiding strenuous physical exertion and following all the doctor's prescriptions in the postoperative period.

Despite the long period of study of adhesions in the abdominal cavity, in particular, in the small pelvis, unified views on the mechanism of their occurrence and prevention have not yet been developed. Mortality from intestinal obstruction caused by adhesions, according to US researchers, is about 2000 people in 1 year. In women, the adhesive process in the small pelvis occurs 2.6 times more often than in men, and adhesive intestinal obstruction - 1.6 times. At the same time, mortality as a result of this pathology among women is 10-15% lower.

What is the adhesion process in the small pelvis

The abdominal cavity is lined with a peritoneum, which is a closed serous membrane. It consists of 2 sheets, passing one into the other. One of them, parietal, lines the inner surface of the entire abdominal cavity and the cavity of the small pelvis, the second, visceral, covers the internal organs.

The main functions of the peritoneum are to ensure free mobility of organs, reduce their friction with each other, protect against infection and localize the latter when it penetrates into the abdominal cavity, preserving the adipose tissue of the abdominal cavity. As a result of exposure to damaging factors, there is a disruption in the supply of oxygen to the damaged area (hypoxia). In the future, 2 options for development are possible:

  • physiological restoration of the peritoneum;
  • development of adhesions.

In the second case, adhesion ("sticking") occurs between different parts of the visceral peritoneum or the latter with the parietal leaf, the formation of strands (adhesions, adhesions). This process occurs in phases:

  1. Reactive, flowing within the first 12 hours after inflammatory or mechanical damage to the peritoneum.
  2. Exudative - vascular permeability increases on days 1-3, which leads to the release of undifferentiated cells, inflammatory cells and a liquid fraction of blood, which contains fibrinogen protein, into the pelvic cavity.
  3. Adhesive - on the third day, fibrinogen is transformed into fibrin, which falls on the surface of the peritoneum in the form of threads. Undifferentiated cells develop into fibroblasts. The latter synthesize collagen, which is the main substance of connective tissue.
  4. The phase of young adhesions, lasting 1 to 2 weeks. They are loose due to insufficient collagen. In adhesions, new vessels and nerve endings grow, smooth muscle cells migrate in them.
  5. Formation of dense fibrous connective tissue mature adhesions - lasts from two weeks to 1 month. They become denser by increasing collagen density and converting capillaries into larger vessels.

Causes and risk factors

The entire multiphase adhesion process of the pelvic organs is universal for any damage - inflammatory or mechanical (with trauma, inflammation, operations). It is an adaptive mechanism that is aimed at delimiting the site of inflammation from healthy parts. By itself, the formation of adhesions is a protective reaction of the body in response to tissue damage and a decrease in their supply of oxygen. However, the tendency to adhesions, the degree of its severity and prevalence in all people are different, which depends on the genotypic and phenotypic (genotype-related) traits and characteristics.

Thus, the main cause of the adhesion process is currently considered to be a genetically determined excessive reactivity of connective tissue, reduced immunological protection and a predisposition of the peritoneum to the corresponding type of reaction. In this regard, the risk factors for the occurrence of adhesive disease are divided into:

  • endogenous, or internal, which are genetically determined characteristics of the organism that reduce its adaptive ability to cause hypoxia;
  • exogenous, or external - these are those that are outside the body and, in terms of their area and impact force, exceed the degree of its adaptive capabilities;
  • a combination of endogenous and exogenous factors, which greatly increases the likelihood of formation and the degree of prevalence of adhesions.

The adhesion process of the small pelvis in its severity is interconnected with the severity of the adhesion process of the entire abdominal cavity. The most common clinical causes are:

  1. Surgical interventions. The severity and frequency of adhesions are influenced by the urgency of surgical treatment (in 73%), the type of access, the volume of the operation, the introduction of drains into the small pelvis for the outflow of blood and inflammatory fluid (in 82%). So, for example, a laparoscopic approach is less traumatic than a laparotomy one (with an incision of the anterior abdominal wall); removal of the fallopian tube, ovary, fibroids, supravaginal amputation of the uterus without appendages or its extirpation, etc. also differ in the degree of damage to the peritoneum. The frequency of adhesive disease significantly increases after repeated operations in various parts of the abdominal cavity: after the first operation, it averages 16%, and after the third - 96%.
  2. Processes of an inflammatory nature of the uterus and appendages, bacterial vaginosis (colpitis). Most often, the adhesion process is provoked by inflammation caused by chlamydia, gonococci, as well as a combination of sexually transmitted infections.
  3. Complications of the course of pregnancy and childbirth, diagnostic curettage of the uterine cavity, artificial termination of pregnancy, especially repeated instrumental abortions, contraception using an intrauterine device. All this contributes to the development of an ascending infection.
  4. External endometriosis of the pelvic organs (proliferation of cells of the inner lining of the uterus beyond its limits). Endometriosis damage in many cases stimulates immune mechanisms leading to the formation of fibrinous connective cords between adjacent structures.
  5. Systemic immune diseases of the connective tissue (scleroderma, dermatomyositis, rheumatism, systemic lupus erythematosus, etc.).

In the studies conducted, one reason for the formation of adhesions was established only in 48%, in other cases it was a combination of two or more factors.

Clinical course of adhesive disease and its diagnosis

Adhesions become a clinical problem only if they lead to specific complications, on which the symptoms of adhesions of the pelvic organs depend. The main complications include:

  1. Intestinal obstruction
  2. Violation of the bearing of the fetus, infertility

Signs of intestinal obstruction

Intestinal obstruction can occur in acute and chronic forms. Acute intestinal obstruction occurs as a result of a decrease in the intestinal lumen due to compression of it by adhesion, infringement of the wall of the intestinal section or the entry of the intestinal loop in the form of a double-barreled into the "window" formed by adhesions, etc. As a result of the infringement of the intestinal section, the passage of feces and discharge gas through the intestines, which leads to overstretching of its more upper sections. In addition, irritation of the nerve receptors of the intestinal wall causes spasm of the terminal branches of the mesenteric arteries, impaired microcirculation in them, deterioration of the outflow of venous blood and lymph, effusion of the liquid part of the blood into the intestinal lumen.

This simplified mechanism of acute intestinal obstruction explains:

  • the appearance in the abdomen of cramping pains, and then of a permanent nature;
  • dry mouth;
  • bloating;
  • nausea and vomiting;
  • the absence of an act of defecation and gas discharge.

With the provision of timely surgical care, the prognosis is favorable. Otherwise, necrosis (necrosis) of the wall or a certain part of the intestine occurs, which no longer requires just dissection of adhesions and the release of a section of the intestine, but its resection (partial removal). With a longer course of the disease, dehydration of the body, electrolyte disturbances, hypovolemic shock, vascular, cardiac and respiratory failure, etc., occur, followed by a likely unfavorable outcome.

Chronic intestinal obstruction can sometimes last for years and not lead to more serious consequences. It is manifested by intermittent cramping pains of varying intensity, constipation, sometimes diarrhea, moderate transient abdominal distention, nausea, and rarely vomiting. Such symptoms can sometimes be triggered by physical activity, the use of foods that contribute to gas formation (garlic, legumes, fiber-rich foods).

Chronic Pelvic Pain Syndrome

The pain is associated with the tension of the adhesions when the pelvic organs are displaced. In this case, irritation of pain receptors and short-term ischemia (violation of blood supply) occurs as a result of both the mechanical effect of the strands themselves and reflex vasospasm.

Chronic pelvic pain is characterized by:

  1. Long-term, almost constant, with a periodic increase in the intensity of pain in the lower abdomen, groin and lumbar regions. These pains can be sharp, aching or dull. Often their tendency to increase is associated with psychoemotional and physical stress, hypothermia, a certain position of the body for a long time.
  2. Painful periods and periods of ovulation.
  3. Pain during overly active intercourse, lifting weights or exercising, during bowel movements, overflowing or emptying the bladder.

The presence of at least one of this group of symptoms supports the diagnosis of chronic pelvic pain syndrome.

Violation of gestation and infertility

The adhesion process of the small pelvis during pregnancy is able to somewhat limit the mobility of the uterus and its increase. At the same time, stretching of fibrous adhesions can be accompanied by frequent and sometimes almost constant pain in the lower abdomen, urge to urinate frequently, constipation, discomfort during bowel movements, bloating and forced restrictions on a woman's nutritional status. Symptoms depend on the localization and severity of the adhesive process.

The danger is that the strands can lead to disruption of innervation and blood circulation in various parts of the uterus and its associated hyperactivity. The latter can cause spontaneous abortion or premature birth.

But the adhesive process has an even greater influence on the possibility of fertilization. Deformation of the fallopian tubes, a change in position in relation to other organs, a decrease in their lumen, occlusion (closure) of the fimbrial or ampullary sections with the development of hydrosalpinx (accumulation of fluid in the fallopian tube), impaired mobility of the fimbriae - all this can cause impairment of transport through these sections of the egg or / and sperm, lack of fertilization or the occurrence of the latter, but with the subsequent development of an ectopic pregnancy. In addition, the presence of adhesions suppresses the growth of follicles, which is associated with a decrease in the adequacy of the blood supply to the ovaries.

Adhesions cause obstruction of the fallopian tubes and, as a result, infertility

Diagnosis of the disease

Based on:

  • symptomatology and clarification of the anamnesis data (survey): the presence in the past of inflammatory processes in the small pelvis, abortions, surgical interventions, endometriosis, intrauterine device;
  • data of a vaginal examination by a gynecologist, during which the location of the uterus and its mobility, the presence of pain, size, degree of mobility and displacement of the appendages and other organs are determined;
  • data, hysterosalpingography or ultrasound hysterosalpingoscopy, to assess the patency of the fallopian tubes, and, if necessary, laproscopic examination.

Treatment principles

Treatment of adhesions in the small pelvis is carried out by such conservative methods as diet therapy, the use of ultrasound, high-frequency currents, iontophoresis with enzyme preparations, magnetotherapy, mud therapy and others. However, any conservative therapy in order to eliminate adhesions is ineffective. To some extent, it helps in eliminating the symptoms of adhesions in chronic intestinal obstruction, chronic pelvic pain syndrome and, even less, in infertility.

In the event of acute obstruction, only surgical dissection of adhesions and restoration of bowel function is indicated, if necessary, its resection.

For the treatment of infertility, it is possible to try to restore the location of the fallopian tubes by dissecting the adhesions by the laparoscopic method and their subsequent hydrotubation (flushing the tubes with solutions), which is also ineffective.

Most often, with infertility, modern assisted reproductive technologies (ART) have to be used, including stimulation of the ovaries in order to obtain single mature follicles (induction of ovulation), methods of artificial introduction of selected and processed sperm into the uterus (artificial insemination) and in vitro fertilization (IVF) ...

The female organs located in the abdominal cavity and the pelvic area are covered with a smooth membrane - the peritoneum. This smooth shell allows the uterus, fallopian tubes, ovaries to move freely, which ensures their normal functioning. If an infection or pathogenic organisms enter the organs, an inflammatory process occurs, which is called peritonitis. Inflammation - peritonitis - is a rather serious disease in which a woman can even be admitted to the hospital for the purpose of complex treatment and surgery.

When peritonitis begins in a woman's body, there is a response of the body's defensive reaction and the production of fibrin (a protein that helps to localize the focus of inflammation by gluing adjacent areas). Adhesions are just the process of gluing together areas in order to limit the spread of infection.

Adhesions: causes of occurrence

The predisposition of the female body to adhesions is an individual feature of each person. Basically, adhesive disease depends on the immune system. Inflammation of the appendages in women - adnexitis - often leads to the appearance of an unpleasant complication - adhesions. You will be surprised, but the complication of adhesions after operations is possible due to the ingestion of small particles from the doctor's gloves, fibers from gauze, cotton wool into the abdominal cavity. And if a woman has endometriosis, then during critical days a small amount of menstrual blood may enter the abdominal cavity.

If the body is strong and the functioning of the immune system is well established, then foreign particles are destroyed by the body on its own and the appearance of adhesions is excluded, otherwise, the presence of small multiform particles can lead to complications in the form of adhesions.

The reasons for the appearance of adhesions in women:

  • inflammation of the genitals;
  • operations on the abdominal cavity and small pelvis;
  • endometriosis;
  • childbirth with complications.

Why are adhesions dangerous?

Adhesions are dangerous because, if they are present, the normal functioning of internal organs is impeded, namely, mobility is impaired, as was mentioned at the beginning of the article. Also, blood circulation, lymph flow is disturbed, spasms occur, which causes problems in the inflow and outflow of blood and leads to stagnation of blood. Also, adhesions in women are fraught with ectopic pregnancy or infertility, since the egg cannot get into the fallopian tube, the movement of sperm through the fallopian tube or the movement of the embryo into the uterine cavity is difficult. This is due to the fact that adhesions can block the lumen of the fallopian tube and change its diameter.

How to suspect adhesions

If you experience pain in the lower abdomen while changing body position, or if you experience pain when going to the toilet in a big way, it is likely that there are adhesions in the body.

Only laparoscopy (in which, with the help of special optical devices, it is possible to diagnose the presence of adhesions in the abdominal cavity, as well as to dissect them), and not an ultrasound, will help to accurately determine whether or not there are adhesions in a woman's body.

During laparoscopy, a woman is made 3 small punctures (do not worry, they do not injure muscle tissue at all) in the anterior abdominal wall and a tiny video camera with a light source is introduced. And the other two holes serve as micromanipulators for performing the operation.

Alternative to surgery

For the treatment of adhesions after laratoscopy, the gynecologist can prescribe a gynecological massage, which takes a lot of the doctor's time. Therefore, not every gynecologist will want to prescribe it. Gynecological massage lasts about 30 minutes and requires preliminary anesthesia. Anti-adhesion course - at least 10 sessions. Massage with both hands, with the fingers of one hand acting from the side of the vagina, and the fingers of the other hand from the side of the abdomen.

The positive effect of gynecological massage is as follows:

  • rupture of adhesions
  • elimination of uterine bend
  • improvement of blood circulation and lymph outflow in the pelvic organs
  • strengthening the abdominal muscles and pelvic floor.

If a woman is not sexually active or suffers from infertility, uterine fibrosis, amenorrhea, salpingitis, muscular hypotonia of the uterus, prolapse of the uterus, as well as after an abortion or difficult childbirth, gynecological massage is indicated and very useful.

Thank you for your help in preparing the material of the obstetrician-gynecologist of the Kiev maternity hospital No. 3 Baksheev Sergey Nikolaevich.