Chronic ooforit – is long the current inflammatory process affecting ovaries. The exacerbation of a disease is characterized by the stupid or aching pains in the lower part of a stomach and inguinal area, mucous and mucopurulent belyam. In a phase of remission frustration of an ovarialno-menstrual cycle, disgormonalny violations, infertility is observed. For diagnosis of a disease use bimanualny inspection, ultrasonography of pelvic bodies, a laparoscopy, methods of laboratory diagnostics. The scheme of treatment includes etiotropny antibacterial medicines, anti-inflammatory, immunocorrective and enzymatic means.
The chronic form of an ooforit as independent pathology meets extremely seldom. Usually the inflammation of ovaries is combined with defeat of fallopian pipes, carries the name of a chronic salpingooforit (adneksit). In most cases ooforit is secondary and develops as a result of distribution of infectious process from other bodies. Both both ovaries, and one of them can be involved in an inflammation. The disease arises at women at the age of 18-28 years which are sexually active more often. Value of timely identification and treatment of an ooforit is caused by the high frequency of secondary infertility. According to various researches in the field of gynecology, violation of reproductive function is observed in 60-70% of cases.
Reasons of a chronic ooforit
Inflammatory reaction in tissues of ovaries usually arises in response to influence of infectious agents. Can be direct activators of process:
- Infections, sexually transmitted. Most often gonokokk, hlamidiya, trichomonads, mycoplasmas become the reason of a chronic ooforit. At the same time the disease usually is bilateral.
- Opportunistic microorganisms. Streptococci, staphylococcus, colibacillus, anaerobe bacterias, etc. can cause an inflammation. In case of activation of nonspecific flora process can be bilateral or unilateral.
- Mikobakteriya of tuberculosis. One - or bilateral specific ooforit in the form of tubercular hillocks or kazeoma is observed at 1/3 patients of a ftiziatrichesky profile.
Thanks to features of an anatomic arrangement and existence of the dense external capsule ovaries are well protected from hit of microorganisms. Emergence in them chronic inflammatory process requires a combination of several contributing factors, basic of which are:
- Female inflammatory diseases. Most often the inflammation is revealed at women with vaginity, tservitsity, an endometritis and salpingity.
- Inflammatory processes in a small basin. Can lead an acute appendicitis and other pathological states with involvement of a peritoneum to development of a chronic ooforit.
- Invasive interventions. Distribution of activators is promoted by abortions, the complicated childbirth, a scraping and other medical and diagnostic procedures.
- Chaotic sex life. Frequent change of partners and the unprotected sex increase probability of infection of STD, tropny to tissue of ovaries.
- The accompanying pathology and decrease in immunity. The risk of emergence of symptoms of a disease is increased at patients who have obesity, diabetes, chronic diseases, have stresses or accept immunosupressivny medicines.
Extremely seldom the inflammation develops owing to a trauma of body at accidents and band operations. In some cases secondary inflammatory process arises at good-quality and malignant new growths of ovaries.
The chronic inflammation can gradually develop (for example, at gonorrhea or the asymptomatic course of clamidiosis) or to become result of an undertreated sharp ooforit. There are four main ways of hit of activators to tissues of ovaries: ascending (from a vagina, the tservikalny channel, a uterus, fallopian pipes), descending (on a peritoneum), lifmogenny (from nearby bodies) and hematogenic (at tuberculosis). Often the inflammation extends from external covers of body to cortical and brain substance. At limfogenny and hematogenic infection the first are involved in process Strom and follicular fabric. Usually the inflammation is serous or serous , is much more rare – purulent.
The chronic course of a disease is promoted by the accruing endogenous intoxication, decrease in immune responsiveness, local disorders of microcirculation and change of a rheology of blood. In process of involvement in process of cortical substance endocrine function is broken that is shown by signs hypo - or giperestrogenemiya. Synchronization of an ooforit is followed by turning on of autoimmune mechanisms as a result of which antibodies to tissues of ovaries are developed. The combination of the listed violations to action of specific infections, especially clamidiosis, exhausts an ovarialny reserve that increases risk of infertility and worsens the prospects of extracorporal fertilization.
The disease proceeds cyclically: the aggravation period with the clinical symptomatology expressed in that or degrees, is replaced by remission. The process aggravation is usually promoted by overcooling, a stress, changes of a hormonal background at pregnancy or before periods, catarrhal diseases, decrease in immunity.
Symptoms of a chronic ooforit
The clinic of a disease depends on its phase. In the period of an aggravation the patient is disturbed by the stupid or aching pain in the bottom of a stomach and in inguinal area. Irradiation in a sacrum, strengthening of painful feelings at a physical tension and sexual intercourse is possible. If other genitals are involved in an inflammation, the number of vaginal allocations, usually mucous increases, is more rare – mucopurulent. The general symptomatology is, as a rule, expressed slightly, is in rare instances shown by temperature increase to subfebrilny figures, nausea, sometimes vomiting.
In remission pain usually is absent. At the woman the dream can worsen, decrease working capacity, arise bystry fatigue and irritability, to be broken a menstrual cycle, sexual and reproductive functions. At a chronic ooforit monthly become irregular, at the same time the menstrual cycle is usually extended, emergence of intermenstrual bleedings, morbidity and plentiful menstrual allocations is possible. Some patients note the expressed PMS. At 50-70% of women sexual desire that is often accompanied by a dispareuniya (painful feelings decreases during sex). In certain cases the impossibility to become pregnant at regular sex life becomes the only sign of a chronic inflammation.
As at a chronic current ooforit usually it is combined with salpingity, the most serious complication of a disease is the adhesive disease. Plastic pelvioperitonit and violation of endocrine function of ovaries usually lead to emergence pipe infertility. Besides, at such patients the risk of extra-uterine pregnancy and not incubation of a fruit significantly increases. At an aggravation ooforit can be complicated by purulent-inflammatory processes, from purulent fusion of ovaries (pioovar) before formation of tuboovarialny abscess and development of peritonitis.
At diagnosis it is necessary to consider that the symptomatology, characteristic of a chronic ooforit, is rather not specific and can confirm other gynecologic diseases. Therefore include methods which authentically confirm localization of an inflammation in the plan of inspection and allow to reveal the activator:
- Survey on a chair. At bimanualny inspection appendages pastose, condensed or tyazhisty. At a palpation morbidity and restriction of mobility is noted.
- Transvaginal ultrasonography. Ovaries are increased, their surface is maleficiated. The Ekhogenny structure is strengthened due to existence of sites of fibrosis. There can be an echo signs of an inflammation of uterine tubes and endometrium.
- Laparoscopy. The endoscopic method is considered the gold standard of diagnostics of an inflammation in ovaries. During the procedure it is possible not only to confirm inflammatory process, but also if necessary to take biomaterial for a histologic research.
- Laboratory diagnostics. The microscopy, crops of vaginal allocations, PTsR, RIF, IFA and other analyses allow to define the activator of an ooforit.
- Tuberkulinovy test. It is shown in the presence of extensive inflammatory process in a small pelvis with poor clinical symptomatology.
Differential diagnostics is carried out with other inflammatory gynecologic diseases and volume processes in a pelvic cavity. According to indications the patient is directed to consultation to the gynecologist-reproduktologu, an onkoginekologa, to the phthisiatrician.
Treatment of a chronic ooforit
The choice of the therapeutic scheme depends on a process phase. At an aggravation and the revealed activator of an inflammation are shown:
- Etiotropny antibacterial therapy. Medicines select taking into account sensitivity of pathogenic flora. If necessary before obtaining results of crops appoint antibiotics of a broad spectrum of activity.
- Resolvents. Nonsteroid medicines allow to reduce a pain syndrome and expressiveness of inflammatory changes.
- Enzimoterapiya. Use of enzymatic medicines is directed to prevention of an adhesive disease and a rassasyvaniye of already available solderings.
- Immunocorrection. For strengthening of own protective forces of an organism immunostimulators, interferonogena, vitamin and mineral complexes are recommended.
During remission the leading role is played by the therapy directed to immunity strengthening, restoration of reproductive and endocrine functions. At this stage appoint immunoregulators, enzymes, eubiotik, biogenous stimulators, hormonal medicines. The combination of drug treatment to physical therapy and a balneolecheniye is effective. Surgical techniques apply in the presence of complications. Operations are shown at detection of a serious pyoinflammatory illness (a pioovar, tuboovarialny abscess, peritonitis, etc.) and the adhesive disease leading to a pipe peritonealnomu to infertility.
Forecast and prevention
At an uncomplicated current and the correct treatment forecast favorable. For prevention of a chronic ooforit it is recommended to visit each 6 months the gynecologist, to reasonably carry out invasive procedures, to refuse abortions, it is timely and in sufficient volume to treat infectious and inflammatory diseases of the reproductive sphere. It is important to exclude casual sexual communications, to use barrier contraceptives, to observe personal hygiene, to lead a healthy lifestyle with sufficient physical activity, refusal of smoking and abuse of alcohol. It is necessary to avoid overcoolings, considerable psychoemotional and physical activities.