Pain in the appendages is observed in inflammatory and purulent processes in the ovaries and fallopian tubes, cysts, benign, transitional and malignant tumors, ectopic pregnancy, fluid accumulation in the fallopian tubes, torsion or apoplexy of the ovary. It can be acute or chronic, constant, intermittent, growing, aching, pulling, pulsating. The cause of the symptom is determined on the basis of complaints, anamnesis data, the results of a gynecological examination, laboratory and instrumental diagnostic procedures. Treatment - antibiotic therapy, oral contraceptives, vitamins, analgesics, surgical interventions.
Inflammation develops against the background of hypothermia, the spread of nonspecific infection from neighboring organs, infection with STIs. It can occur in the form of adnexitis (simultaneous involvement of the ovaries and tubes), oophoritis (ovarian damage) or salpingitis (pathology of the fallopian tubes). Symptoms are the same for all variants. The difference in clinical manifestations is determined by the form of the disease (acute or chronic).
In acute inflammation, the pain is sharp, intense, radiating to the sacrum and anus. Chills, general hyperthermia, intoxication syndrome, dysuria, purulent or mucous discharge are noted. Palpation is sharply painful. In a chronic course during an exacerbation, pain is moderately pronounced, dull or aching. Subfebrile condition, mucopurulent discharge are revealed. Patients often experience menstrual irregularities. When touched, the pain is slight.
In most cases, ovarian cysts are asymptomatic for a long time. With a significant size, constant aching pains, an increase in the circumference and asymmetry of the abdomen are determined. With compression of the intestines and bladder, constipation and dysuria occur. Due to the compression of the veins, varicose veins can develop. With hormonally active formations, menstrual cycle disorders are observed, sometimes hyperandrogenism, hirsutism. There are the following types of cysts:
For cysts of the corpus luteum and follicular cysts, the symptom is uncharacteristic due to their small size.
Drawing, often unilateral pain in the area of the appendages is a typical early manifestation of benign ovarian neoplasms. The pain syndrome is not associated with menstruation. Flatulence, stool disorders and pollakiuria are possible due to compression of the pelvic organs. In 25% of cases, infertility or cycle disorders are detected.
With feminizing neoplasia in adolescence, early puberty is observed, in reproductive - dysfunctional uterine bleeding, in postmenopausal - spotting. In patients with virilizing tumors, signs of masculinization are determined. The appearance of pain syndrome may be due to the following neoplasms:
Borderline ovarian tumors are intermediate between benign and malignant. The most common symptom is pulling dull pain in the appendages and in the navel area, extending to the lumbar region and lower limbs. Rapid fatigue, weight loss, drop in performance, hyperthermia, dyspepsia and dysuria are possible.
Localized ovarian cancer is usually asymptomatic. With the growth of neoplasia, pain, weakness, malaise, increased fatigue, loss of appetite, dysuria, and disorders of the gastrointestinal tract are detected. With granulosa cell carcinoma, symptoms of feminization are observed, with androblastoma - signs of masculinization. The occurrence of ascites indicates peritoneal involvement. Neoplasia metastasize to bones, lungs, liver.
Pain in the appendages
In the vast majority of cases (97%), a tubal pregnancy develops. An ovarian pregnancy is considered a rare occurrence (1-2%). The formation of an ectopic pregnancy is evidenced by a delay in menstruation, pulling pain in the appendages, spotting, nausea, vomiting, loss of appetite, engorgement of the mammary glands. Due to the non-specificity of symptoms, patients often regard their condition as the beginning of normal gestation.
When the fallopian tube ruptures, acute sharp pains occur in the lower abdomen, radiating to the anus, lower back and thighs. There is a discharge of blood or a brownish discharge from the genital tract. Internal bleeding causes a drop in blood pressure, tachycardia, weakness, loss of consciousness. The condition poses a threat to the life of the patient, immediate medical attention is required.
Hematosalpinx is considered a polyetiological pathological condition. With an ectopic pregnancy, it precedes a rupture of the tube, it proceeds acutely. With malformations (atresia) is formed gradually. The severity of pain in the appendages increases with each menstruation. Pain is not eliminated by analgesics; with a significant amount of accumulated blood, it persists in the intermenstrual period.
The formation of hydrosalpinx is preceded by specific or nonspecific inflammation of the appendages, operations in the pelvic area. Sometimes the pathology is asymptomatic. In clinically significant forms, there are pulsating, bursting or pulling pains, fever, weakness, weakness, copious watery discharge.
Saktosalpinks develops in inflammatory processes, endometriosis, adnexal cancer. The acute form is rare, characterized by unilateral or bilateral throbbing or bursting pain, general intoxication, fever to subfebrile or febrile figures. For chronic sactosalpinx, an asymptomatic course is more typical. Pain syndrome often worries when combined with adhesive disease.
The occurrence of pyovar, as a rule, is due to the spread of infection from nearby foci in inflammatory diseases of the appendages, body or cervix. The clinical picture develops acutely, includes intense throbbing pain, aggravated by defecation, any physical effort. Chills, severe weakness, severe hyperthermia, hectic fever, purulent leucorrhoea, dyspeptic and dysuric disorders are detected.
With pyosalpinx, similar manifestations are observed. The combination of purulent lesions of the ovary and fallopian tube may be complicated by the formation of a tubo-ovarian abscess. The pain syndrome is strong, acute, paroxysmal, with an epicenter in the projection of the left or right appendage. Possible irradiation to the rectum, lower back, inner thigh. Severe intoxication is detected, the condition is serious. The discharge is yellow-green, yellowish or whitish. Diarrhea, pain during micturition are possible.
Appendicular-genital syndrome is an inflammatory lesion with simultaneous involvement of the appendages and appendix. The clinic is determined by the variant of the course. For the appendicular form, manifestations of acute appendicitis are characteristic, for the genital form - signs of acute adnexitis. Common symptoms are pain in the appendages and over the womb, dyspepsia, significant hyperthermia. The secondary syndrome is especially difficult against the background of pelvioperitonitis.
In patients with ovarian torsion, severe cramping or stabbing pains in the appendage occur suddenly, accompanied by irradiation to the groin, back, or side surface of the body. The pains increase, are supplemented by fever, nausea, vomiting, constipation, heart palpitations, skin pallor, dysuria. With incomplete torsion, the pain is dull, moderate, disturbing periodically.
Torsion of the pedicle of an ovarian tumor is observed in neoplasia with high mobility: paraovarian and dermoid cysts, fibromas, cystomas. With complete torsion, the pain is sharp, paroxysmal. Cold sweat, hyperthermia, tachycardia, hypotension are detected. Patients with incomplete torsion complain of intermittent mild to moderate soreness.
A mild degree of ovarian apoplexy is manifested by short-term pain and nausea. With an average degree of pain in the projection of the epididymis, intense, weakness, mildly pronounced peritoneal symptoms are noted. A severe degree is characterized by very strong constant pain, bloating, collaptoid state, shock, and clear signs of peritoneal irritation.
Diagnostic measures are carried out by a gynecologist. During the survey, the specialist finds out when and under what circumstances pain in the appendages appeared, how the symptom changed over time, what other manifestations it was accompanied by. As part of a physical examination, the doctor evaluates the general condition, reveals hyperthermia, tachycardia, decreased blood pressure, shock, positive peritoneal symptoms. The examination program includes such diagnostic measures as:
Gynecologist's consultation
The treatment regimen is made taking into account the nature of the lesion of the appendages. In purulent, inflammatory diseases, antibiotic therapy is central. First, broad-spectrum drugs are used, then the appointments are adjusted taking into account the sensitivity of the pathogen. Drug therapy also includes painkillers, anti-inflammatory and desensitizing agents.
In ovarian cysts, conservative management is possible in the absence of complications. Two-phase or monophasic oral contraceptives, vitamin complexes, exercise therapy, balneotherapy, acupuncture are recommended. In patients with borderline or malignant neoplasms, chemotherapy and radiation therapy may be indicated.
Depending on the cause of the pain, the following operations are performed: