Adhesions in the pelvis

Disease Description

Adhesive process — formation of “films” between the pelvic organs and the peritoneum, which leads to tension or displacement of the pelvic internal organs, pain syndrome, and infertility (more often due to obstruction of the fallopian tubes). It occurs in one quarter of women of reproductive age.

The provoking factors are inflammatory processes, endometriosis, and surgical interventions. In 90% of cases, adhesions form in women after pelvic surgery.

Symptoms indicating the need to seek diagnosis and treatment

Symptoms depend on the type of process: in the acute course, pain is intense and worsens with changes in body position and physical exertion; in the chronic course, there is discomfort when lifting the torso and during sexual intercourse.

In addition to pain syndrome, gynecological problems are possible: menstrual cycle disorders, infertility, and miscarriage.

If the intestines are affected, additional symptoms appear:

• Abdominal pain
• Flatulence
• Bowel movement disorders (frequent urges or constipation)

Methods of diagnosis and treatment

Diagnosis

Experienced highly qualified gynecologists are able to detect adhesion bands during superficial palpation, as well as during vaginal examination (the uterus and adnexa become less mobile). Further, ultrasound and MRI are prescribed to determine the stage of adhesive disease.

In the case of an adhesion process in the fallopian tubes, obstruction develops, which can lead to ectopic pregnancy or infertility.

Sonohysterography is the preferred method for diagnosing fallopian tube obstruction, in which ultrasound is used to assess the movement of a specially introduced fluid through the uterus and adnexa. False-positive results with this method are excluded.

Treatment

In early detection, conservative treatment methods are used: antibiotics to suppress the infectious process and modern fibrinolytics to dissolve adhesions.

In advanced stages, surgical adhesiolysis is indicated. In leading global clinics, therapeutic laparoscopy is the main method of surgical access.For the treatment of fallopian tube obstruction, leading gynecological clinics worldwide use the method of balloon tuboplasty of the intramural section of the tube. The procedure is performed without incisions or punctures, and all manipulations with the tubes are carried out through the vagina and uterine cavity. The probability of pregnancy after balloon tuboplasty increases to 90%.

Innovations of global clinics

The formation of adhesions is regarded by physicians as “plus tissue,” therefore, an innovative antiangiogenic technique is used to curb this growth. Its essence lies in the effect on proangiogenic growth factors, the main of which is bFGF (basic fibroblast growth factor).