What are the common causes of pelvic scar tissue. How can pelvic adhesions be diagnosed. What treatment options are available for managing pelvic scar tissue. How do pelvic adhesions impact fertility and overall health.

Understanding Pelvic Scar Tissue and Adhesions

Pelvic scar tissue, also known as adhesions, refers to abnormal bands of fibrous tissue that form within the female reproductive system. These adhesions can develop as a result of the body’s natural healing process following trauma or injury to the pelvic area. Adhesions essentially cause two internal surfaces that are not normally connected to join together, potentially leading to various complications.

The formation of pelvic scar tissue is a common occurrence, with up to 93% of individuals who undergo abdominal surgery developing adhesions. Interestingly, even 10% of people who have never had surgery can develop abdominal adhesions. This highlights the widespread nature of this condition and its potential impact on reproductive health.

What causes pelvic scar tissue to form?

Pelvic scar tissue can develop due to several factors:

• Previous pelvic surgeries
• Pelvic infections, such as pelvic inflammatory disease (PID)
• Advanced stages of endometriosis
• Trauma to the pelvic area
• Radiation therapy

The body’s natural healing response triggers the formation of these adhesions as it attempts to repair damaged tissue. While this process is intended to aid in recovery, it can sometimes lead to unintended consequences, particularly in the delicate structures of the female reproductive system.

Recognizing the Signs and Symptoms of Pelvic Adhesions

Identifying the presence of pelvic scar tissue can be challenging, as many symptoms often overlap with other underlying conditions. However, when adhesions become particularly dense or extensive, they may manifest in various ways:

• Chronic pelvic pain
• Discomfort in the lower abdomen or bowels
• Pain during sexual intercourse (dyspareunia)
• Intestinal obstruction in severe cases
• Fertility issues

It’s important to note that pelvic scar tissue often exacerbates symptoms of existing conditions such as irritable bowel syndrome (IBS) or endometriosis. This interplay between adhesions and other pelvic health issues can make diagnosis and treatment more complex.

Can pelvic adhesions cause infertility?

Yes, pelvic adhesions can indeed contribute to fertility problems. When scar tissue forms around the reproductive organs, it can interfere with the normal functioning of the fallopian tubes, ovaries, and uterus. This interference may prevent the egg from successfully traveling through the fallopian tubes or impede the implantation of a fertilized egg in the uterus. Consequently, women with pelvic adhesions may experience difficulty conceiving or maintaining a pregnancy.

Diagnostic Challenges and Approaches for Pelvic Scar Tissue

Diagnosing pelvic scar tissue presents unique challenges for healthcare providers. Unlike many other conditions, adhesions are not typically detectable through standard pelvic examinations or imaging tests. This elusiveness necessitates a comprehensive approach to diagnosis:

1. Thorough patient history: Physicians will inquire about previous surgeries, infections, or pelvic conditions that may have led to adhesion formation.
2. Pelvic examination: While adhesions themselves may not be palpable, a physical exam can help identify areas of tenderness or restricted movement.
3. Imaging studies: Although ultrasounds, CT scans, and MRI scans generally do not visualize adhesions directly, they can help rule out other potential causes of symptoms.
4. Diagnostic laparoscopy: This minimally invasive surgical procedure allows doctors to directly visualize the pelvic cavity and identify the presence and extent of adhesions.

Why is diagnostic laparoscopy considered the gold standard for identifying pelvic adhesions?

Diagnostic laparoscopy is regarded as the most reliable method for detecting pelvic adhesions because it provides direct visualization of the pelvic structures. During this procedure, a small camera is inserted through a tiny incision in the abdomen, allowing the surgeon to examine the organs and tissues for any signs of scar tissue. This approach not only confirms the presence of adhesions but also enables assessment of their severity and location, which is crucial for planning appropriate treatment.

Treatment Options for Managing Pelvic Scar Tissue

When pelvic scar tissue causes significant symptoms or interferes with reproductive function, several treatment approaches may be considered:

• Adhesiolysis: This surgical procedure involves removing or cutting through adhesions to restore normal anatomy and function.
• Laparoscopic surgery: Minimally invasive techniques are preferred for adhesiolysis, as they typically result in less post-operative scarring.
• Medication: Anti-inflammatory drugs or hormonal treatments may be prescribed to manage pain and related symptoms.
• Physical therapy: Specialized pelvic floor exercises and manual therapy techniques can help improve mobility and reduce pain associated with adhesions.
• Barrier methods: During surgery, special materials or solutions may be used to prevent new adhesions from forming.

How effective is adhesiolysis in treating pelvic scar tissue?

Adhesiolysis can be highly effective in relieving symptoms and improving fertility in many cases. However, it’s important to note that the procedure itself carries a risk of forming new adhesions. The success rate varies depending on the extent and location of the original adhesions, as well as the surgical technique used. Many patients experience significant improvement in pain and function following adhesiolysis, but ongoing management and prevention strategies may be necessary to maintain long-term results.

Prevention Strategies for Reducing Pelvic Adhesion Formation

While it may not always be possible to prevent pelvic adhesions entirely, certain strategies can help minimize their formation or recurrence:

1. Minimally invasive surgical techniques: Opting for laparoscopic procedures when possible can reduce tissue trauma and the likelihood of adhesion formation.
2. Use of anti-adhesion barriers: During surgery, specialized materials or solutions can be applied to create a temporary barrier between tissues, reducing the chance of adhesions forming.
3. Proper infection control: Promptly treating pelvic infections and following post-operative care instructions can help prevent adhesion-promoting inflammation.
4. Gentle tissue handling: Surgeons can employ techniques that minimize tissue damage and irritation during procedures.
5. Early mobilization: Encouraging patients to move and engage in light activity soon after surgery can help prevent adhesions from forming between immobile tissues.

Are there any natural remedies that can help prevent or reduce pelvic adhesions?

While scientific evidence is limited, some natural approaches may potentially help in managing or reducing the risk of pelvic adhesions:

• Anti-inflammatory diet: Consuming foods rich in omega-3 fatty acids and antioxidants may help reduce overall inflammation in the body.
• Hydration: Adequate water intake can support overall tissue health and potentially reduce the risk of adhesion formation.
• Gentle exercise: Regular, low-impact activities like walking or swimming may help maintain pelvic mobility and circulation.
• Stress reduction: Practices such as meditation or yoga might help manage stress-related inflammation that could contribute to adhesion formation.

It’s important to note that while these natural approaches may offer some benefits, they should not replace medical treatment. Always consult with a healthcare provider before implementing any new health regimens, especially when dealing with pelvic adhesions.

Impact of Pelvic Adhesions on Overall Health and Quality of Life

The effects of pelvic scar tissue extend beyond reproductive health, potentially influencing various aspects of a person’s well-being:

• Chronic pain: Persistent discomfort can lead to reduced physical activity and emotional distress.
• Fertility challenges: Difficulty conceiving may cause significant emotional and psychological strain.
• Gastrointestinal issues: Adhesions affecting the bowel can lead to digestive problems and discomfort.
• Sexual dysfunction: Pain during intercourse can strain intimate relationships and impact self-esteem.
• Increased surgical risks: Future abdominal or pelvic surgeries may be more complicated due to existing adhesions.

How can patients cope with the emotional impact of pelvic adhesions?

Dealing with pelvic adhesions and their consequences can be emotionally challenging. Here are some strategies to help cope:

• Seek support: Joining support groups or speaking with a therapist can provide emotional validation and coping strategies.
• Education: Learning about the condition can help patients feel more in control and make informed decisions about their care.
• Stress management: Techniques such as mindfulness meditation or deep breathing exercises can help manage pain and anxiety.
• Open communication: Discussing concerns with partners, family, and healthcare providers can foster understanding and support.
• Explore holistic approaches: Complementary therapies like acupuncture or massage may offer additional relief when combined with medical treatment.

Advances in Research and Future Directions for Pelvic Adhesion Management

The field of pelvic adhesion research is continually evolving, with scientists and clinicians exploring new approaches to prevention, diagnosis, and treatment:

1. Novel anti-adhesion agents: Researchers are developing new materials and medications to prevent adhesion formation following surgery.
2. Improved imaging techniques: Advancements in medical imaging may soon allow for non-invasive detection and monitoring of pelvic adhesions.
3. Targeted drug delivery: Innovative methods for delivering anti-inflammatory and anti-fibrotic agents directly to affected areas are under investigation.
4. Tissue engineering: Emerging technologies aim to promote healthy tissue regeneration while inhibiting excessive scar formation.
5. Minimally invasive treatments: New tools and techniques for adhesiolysis continue to be developed, focusing on reducing surgical trauma and recurrence rates.

What promising research directions are scientists pursuing for pelvic adhesion management?

Several exciting avenues of research show potential for improving the management of pelvic adhesions:

• Gene therapy: Targeting specific genes involved in the adhesion formation process could lead to more effective prevention strategies.
• Stem cell therapy: Using stem cells to promote tissue repair and regeneration may help reduce scarring and adhesion formation.
• Nanotechnology: Developing nanoparticles that can deliver anti-adhesion agents precisely to affected areas could enhance treatment efficacy.
• Artificial intelligence: Machine learning algorithms may improve the accuracy of adhesion prediction and personalize treatment approaches.
• Immunomodulation: Understanding and manipulating the immune response involved in adhesion formation could lead to novel therapeutic interventions.

As research progresses, these innovative approaches may offer new hope for individuals affected by pelvic adhesions, potentially leading to more effective prevention, diagnosis, and treatment options in the future.

Pelvic Scar Tissue or Adhesions| Tampa General Hospital

Pelvic scar tissue refers to thick bands of tissue within the female reproductive system that result from trauma.  

Adhesions are bands of scar tissue that join two internal surfaces of the body together that are not usually connected. With pelvic scar tissue, the affected surfaces are within the female reproductive organs. Pelvic scar tissue can develop as the body is attempting to repair itself, which is why adhesions can form after surgery, a pelvic infection or as a response to another condition like severe endometriosis.  

Causes of Pelvic Scar Tissue 

Like other forms of scar tissue, pelvic scar tissue or adhesions can occur as the body responds to physical trauma to the affected area. Previous pelvic surgery is the most common cause of adhesions, though pelvic infections such as pelvic inflammatory disease (PID) and advanced stages of endometriosis may also lead to scar tissue.   

Signs & Symptoms of Pelvic Scar Tissue 

Because scar tissue often forms after surgery or other severe trauma, the accompanying signs often go unnoticed, and many individuals mistakenly attribute these symptoms to the underlying cause.  

When scar tissue is particularly dense, however, possible symptoms may include: 

• Pain in the lower abdomen or bowels due to restricted muscle movement 
• Pain during sexual intercourse 
• Intestinal obstruction in severe cases 

Typically, pelvic scar tissue will show its presence by further aggravating the symptoms of another disease, such as IBS or endometriosis. 

Diagnosing Pelvic Scar Tissue 

Diagnosing pelvic scar tissue can be difficult, especially as physicians cannot typically feel the adhesions during a pelvic exam. Tests like ultrasounds, CT scans and MRI scans also do not detect pelvic scar tissue in most cases, so a thorough look into the patient’s history and a pelvic examination may help in determining whether adhesions are present. If scar tissue is suspected, then a diagnostic laparoscopy (a procedure that allows a doctor to view the tissue and remove it if necessary) may be utilized.  

Treating Pelvic Scar Tissue 

When pelvic scar tissue is diagnosed and the symptoms are causing the patient pain or discomfort, then a surgery known as adhesiolysis can be performed to remove the adhesions. During a laparoscopy, which can also be used in the diagnosis of pelvic adhesions, a doctor will make a small incision to better view the scar tissue and remove it through the same opening. This procedure typically yields better results than more invasive methods, which can often lead to further scar tissue developing.  

The gynecologic healthcare professionals at Tampa General Hospital’s Women’s Institute recognize the signs of pelvic scar tissue and can diagnose and manage these adhesions successfully using personalized methods of treatment.   

Adhesions – Better Health Channel

An adhesion is a band of scar tissue that joins two internal body surfaces that are not usually connected. Organs or tissues within the body stick (adhere) to other internal surfaces.

Adhesions develop as the body attempts to repair itself. This normal response can occur after surgery, infection, injury (trauma) or radiation. Adhesions may appear as thin sheets of tissue similar to plastic wrap, or as thick fibrous bands.

Adhesions can affect the female reproductive organs (ovaries, fallopian tubes), the bowel, the area around the heart, the spine and the hand. They can cause a range of problems including infertility, dyspareunia (painful intercourse), pelvic pain and bowel obstruction or blockage. Adhesions can also lead to a complex set of problems called adhesion-related disorder (ARD).

Adhesions are a widespread problem. Up to 93 per cent of people who have abdominal surgery go on to develop adhesions. Abdominal adhesions also occur in 10 per cent of people who have never had surgery.

Risks of adhesions

Adhesions may:

• develop after any kind of pelvic or abdominal surgery – people who have major or multiple procedures are even more at risk
• cause significantly higher post-operative complications (leaks, wound infections, haemorrhages) in people with adhesion-related perforations. This may also lead to a longer stay in hospital
• lead to other risks and complications, including small bowel obstructions, infertility and chronic pelvic pain
• cause increased risk, complexity and complications during subsequent surgery.

The incidence of adhesions has increased with the rise in gynaecological procedures. Up to 90 per cent of women suffer post-operative adhesions following major gynaecological surgery.

Development of adhesions

Adhesions develop as the body attempts to repair itself. This is the body’s normal response after:

• surgery, particularly abdominal surgery
• infection
• endometriosis
• injury (trauma)
• radiation treatment.

Adhesions can also form after inflammation in the abdomen or pelvis.

Symptoms of adhesions

Although most adhesions are painless and do not cause complications, adhesions cause 60 to 70 per cent of small bowel obstructions in adults and are believed to contribute to the development of chronic pelvic pain.

Adhesion-related disorder (ARD) is a group of symptoms that may occur as a result of adhesions. A person with ARD will usually experience chronic abdominal pain.

Typical adhesions form within the first few days after surgery, but symptoms can last for months or even years. Symptoms may be mostly in one area of the abdomen, but are often generalised, vague, ‘crampy’ and difficult to define. This means ARD can be difficult to diagnose.

Symptoms of ARD may include:

• chronic pain
• infertility
• bowel obstruction and an inability to pass gas
• urinary bladder dysfunction
• pain and difficulty having a bowel movement
• pain on movement such as walking, sitting or lying in certain positions
• emotional disorders such as depression, thoughts of suicide or hopelessness.

Other intestinal problems may include constipation, obstruction, or alternating constipation with diarrhoea from partial obstruction.

Women may experience gynaecological problems, which can add to the anxiety and self-esteem problems that may already be experienced by women who suffer with this disorder.

Symptoms of ARD can be mistaken as a sign of another condition. These can include a whole host of other possible diagnoses such as chronic fatigue syndrome, endometriosis, irritable bowel syndrome, fibromyalgia, depression and anxiety.

Diagnosis of adhesions

It is very difficult to diagnose the chronic pain of adhesions correctly. Diagnostic tests such as blood tests, x-ray procedures, CT scans, MRIs and ultrasound will not diagnose adhesions. Hysterosalpingography (an x-ray that views the inside of the uterus and fallopian tubes) may help diagnose adhesions inside the uterus or fallopian tubes.

According to your symptoms, your doctor will order the appropriate diagnostic tests to rule out other medical conditions that may have similar symptoms.

If the results of these tests are normal or negative for abnormal pathology, a diagnostic laparoscopy may be appropriate. This is the only test that can confirm the presence of adhesions. If adhesions are found, you doctor can usually release them during the same surgery.

Treatment of adhesions

Adhesions can be treated either with open or laparoscopic (keyhole) surgery, known as adhesiolysis. The adhesions are cut by scalpel or electrical current.

Open adhesiolysis

As adhesions are likely to form after certain surgical procedures, open adhesiolysis may not be worthwhile, except to remedy serious problems such as bowel obstruction.

In around 70 per cent of cases, the operation to remove the original adhesions will cause more adhesions to develop. Discuss the risks, benefits and alternatives to surgery thoroughly with your doctor before you make a decision.

Laparoscopic adhesiolysis

People with symptoms of adhesions may consider laparoscopic surgery. The advantage of this procedure is that only a small incision (cut) is required, which is why it is also known as ‘keyhole surgery’. Laparoscopy is the preferred method for performing infertility surgery as there is a decreased risk of new adhesions forming.

Laparoscopic adhesiolysis can significantly improve quality of life among women with chronic pelvic pain due to adhesions. This procedure shows similar results to more invasive forms of surgery when it comes to managing extensive adhesions. However, it can be time-consuming (the procedure may take two to four hours), technically difficult and involves some risk. Adhesion barriers (commercially made) that are placed at the time of surgery may reduce adhesion formations.

Adjuvant treatment (using commercially available product such as intercoat) after adhesiolysis is beneficial in preventing the development of intrauterine adhesions.

Most women who choose to have laparoscopic adhesiolysis:

• are discharged on the same day of the procedure
• don’t need to have major abdominal cuts (incisions)
• experience minimal complications
• return to full activity within one week of the procedure.

Non-surgical treatments for adhesions

Alternatives to surgery include:

• medication – this is often the first treatment choice for acute pain and forms part of the treatment for chronic pain
• exercise
• physical therapy
• lifestyle changes
• soft tissue mobilisation (Wasserman et al 2019)

Although they can be helpful, medications are not a cure-all. They can cause side effects or may be ineffective, and are often costly. A pain specialist can advise you on the non-surgical treatment options most suited to your situation.

Where to get help

• Your GP (doctor)
• Nurse-on-Call Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)

Endometriosis | Dikul Center

Endometriosis is an abnormal growth of tissue similar to that lining a woman’s uterus outside the uterus

This tissue acts like normal uterine tissue during menstruation: it breaks down and bleeds at the end of the cycle. But this blood has nowhere to go. Surrounding areas may be inflamed or swollen. It is possible that the woman develops scar tissue and lesions.

Endometriosis most commonly affects the ovaries.

What is endometriosis?

Endometriosis is an abnormal growth of tissue, similar to that which lines a woman’s uterus, outside the uterus.

During menstruation, this tissue behaves in the same way as regular uterine tissue during menstruation: it disintegrates and bleeds at the end of the cycle.

Abnormal tissue growth outside the uterus can lead to inflammation, scarring, and cyst formation and adhesions between the reproductive organs.

Endometriosis affects up to 10% of women aged 15 to 44 years. It most commonly forms on or around the reproductive organs, pelvis, or abdomen, including:

• Fallopian tubes
• Uto-sacral ligaments
• Pelvic mucosa
• Ovaries
• External surface of the uterus
• Space between uterus and rectum or bladder

Less commonly, endometriosis may develop in other areas:

• In the bladder
• In the cervix
• In the intestines
• In the rectum
• Stomach
• In the vagina or vulva

Types of endometriosis

There are three main types of endometriosis, depending on the location of the pathological process:

• Superficial lesions of the peritoneum. This type is most common and the lesions are located on a thin film lining the pelvic cavity.
• Endometrioma – dark cystic formations form inside the ovaries. This type of endometriosis is difficult to treat and can damage healthy tissue.
• Deep infiltrating endometriosis. This type is localized under the peritoneum and can affect organs near the uterus, such as the intestines or bladder.

Causes

The exact causes of endometriosis are still unknown, but there are several theories of its development:

• Transport via the blood or lymphatic system: endometrial tissue, like cancer cells, is transported to other areas of the body via the blood or lymphatic system.
• Direct transplant: Attachment of endometrial cells to the walls of the abdominal cavity or other parts of the body after operations such as caesarean section or hysterectomy.
• Genetic factors: a certain genetic determinism of this condition has been identified.
• Reverse menstruation: endometrial tissue can enter the fallopian tubes and abdominal cavity during a woman’s menstruation, rather than leaving the body
• Transformation: Cells from other tissues in the body can transform into endometrial cells and begin to grow outside the endometrium.

Symptoms

The most common symptoms of endometriosis are pain and infertility. Endometrial pain usually presents as:

• Painful menstrual cramps radiating to the abdomen or lower back.
• Pain during or after sex

Other symptoms may include:

• Diarrhea or constipation during the menstrual cycle
• Fatigue or general weakness
• Heavy or irregular menses
• Pain during urination or defecation during the menstrual cycle
• Bloody discharge between periods

Every woman with endometriosis may have one or more symptoms. Severe pain can be associated not only with endometriosis, but also have other causes.

Risk factors

Studies have shown that there are certain risk factors for the development of the condition:

• Close relatives with endometriosis in the family
• Uterine anomaly
• Early onset of menstruation (before 11 years)
• Shortened menstrual cycles (less than 27 days)
• Heavy menses lasting more than 7 days

There are also factors that reduce the risk of developing endometriosis:

• Pregnancy and breastfeeding
• First menses after 14 years
• Consumption of fruits, especially citrus fruits

Prevention

Endometriosis is considered an idiopathic disease and the exact cause is unknown. Therefore, there are no specific methods for preventing the disease. But analyzing symptoms and risk factors can help a doctor make a timely diagnosis and prescribe treatment.

Endometriosis and infertility

Endometriosis is one of the main diseases associated with female infertility. Studies in reproductive medicine have shown that almost 50% of women with infertility are diagnosed with endometriosis. Mild to moderate forms of endometriosis can lead to temporary infertility. Surgical removal of endometrial tissue can help a woman become pregnant.

Physicians do not know the exact mechanism by which endometriosis affects fertility. It is hypothesized that scar tissue in endometriosis may interfere with the passage of eggs from the ovaries or block the passage of an egg through the fallopian tube into the uterus. Endometriosis can also have a damaging effect on sperm or fertilized eggs before they implant in the uterus.

There are various options for treating infertility in women with endometriosis, including in vitro fertilization (IVF), which allows them to become pregnant. To make a clinical diagnosis, the doctor may prescribe the following examinations:

• Laparoscopy: This minimally invasive procedure uses an endoscope to visually assess the morphological changes in the tissues in and around the uterus and identify foci of endometrial tissue growth.
• Biopsy: If the physician finds suspicious tissue, they may take tissue for further analysis of cell morphology in the laboratory. A biopsy is needed to make a diagnosis of endometriosis.

There are currently no disease-specific laboratory tests or imaging tests that can reliably confirm this condition. However, imaging techniques may be of some use in identifying signs of endometriosis. The following diagnostic methods are most commonly used:

• Ultrasound: using a transvaginal transducer, the doctor can assess the condition of the tissues of the uterus, pelvis and reproductive organs.
• MRI: this study allows you to detect morphological changes in the pelvic cavity and abdominal region.

Stages of endometriosis

Endometriosis has stages:

• Stage I (minimum). The woman has several small lesions but no scar tissue.
• Stage II (mild). More lesions, but no scar tissue.
• II stage (moderate). The lesions are more pronounced. A woman may have scar tissue around her ovaries and fallopian tubes and endometrioma.
• Stage IV (severe). The ovaries have many lesions and may have large cysts. In a woman, scar tissue can form around the ovaries and fallopian tubes, or between the uterus and lower intestines.

There is no clear correlation between disease stages and symptoms. With endometriosis I, a woman may have severe pain, while another woman with stage 4 may not.

Treatment

Conservative treatment in certain cases may help in the treatment of this condition. But often it is necessary to resort to operational methods of treatment (sometimes repeated).

Conservative treatment

The most common conservative treatments for endometriosis are hormone therapy and pain management.

Endometriosis tissue is affected by hormones in the same way as endometrial tissue inside the uterus. Hormonal changes that occur during the menstrual cycle can lead to increased pain from endometriosis.

Hormonal treatment can change the level of hormones or stop their production. Hormone therapy affects fertility and is not suitable for all women.

Hormone therapy can be given by tablet, injection, or nasal spray. The most common options are:

• Oral contraceptives with estrogen and progesterone for hormone control
• Progestins to stop menstruation and growth of endometrial tissue
• Gonadotropin-releasing hormone antagonists to limit ovarian hormones
• Gonadotropin-releasing hormone agonists to stop ovarian hormones

Pain medications, including (NSAIDs) such as ibuprofen, may be effective in treating endometriosis pain. Your doctor may prescribe prescription drugs if needed.

Surgical treatments

Laparoscopy

For advanced endometriosis, persistent pain or infertility, laparoscopy may be recommended.

With this minimally invasive operation, using endoscopic equipment, the surgeon removes endometrial tissue (excision) or destroys pathological tissues using heat (ablation).

If scar tissue is present, the surgeon will excise it. Laparoscopic surgery allows faster recovery and leaves little scarring.

Laparotomy

In some cases, a laparotomy may be necessary instead of laparoscopy. In this operation, a large incision is made to remove endometriosis tissue.

Laparoscopy or laparotomy does not always provide complete relief from pain.

Hysterectomy

Hysterectomy – this surgical procedure removes the uterus. Your doctor may recommend removing your ovaries (oophorectomy) with or without a hysterectomy. This allows you to stop the release of hormones and completely cure endometriosis, but such treatment will lead to menopause.

In addition, the removal of the ovaries will be accompanied by a decrease in the level of estrogen and this is already associated with disorders in various organs and systems. For these reasons, the decision to perform oophorectomy should be based on a clear clinical indication.

A woman will not become pregnant after a hysterectomy.

Women who have had an oophorectomy (removal of the ovaries) but retain their uterus can become pregnant with IVF. Doctors can collect eggs before surgery and save them for fertilization and implantation in the uterus. Donor eggs can also be used.

Prognosis

Many women manage to get rid of the symptoms of endometriosis with treatment. However, recurrences of endometrial tissue growth are possible, even after surgery. A woman needs to be under the constant supervision of the attending physician.

causes, symptoms, diagnosis and treatment

I confirm

More

• org/ListItem”> INVITRO
• Library
• Disease Handbook
• Fibrosis

Scar

Scar

Keloid

Pneumosclerosis

Heart attack

Scleroderma

Cystic fibrosis

Cirrhosis

8521

05 August

Fibrosis: causes, symptoms, diagnosis and treatment.

Definition

Fibrosis is a special pathological condition in which an abnormal overgrowth of connective tissue occurs with the appearance of cicatricial changes in various organs. As a result of active cell growth, which is preceded by an inflammatory process, scars form in the affected tissues if the healing mechanisms are disturbed. Fibrosis is considered as a reaction of the body, aimed at isolating the focus of inflammation from the surrounding tissues and systemic blood flow and preventing its further spread throughout the body.

Scar tissue consists predominantly of collagen and differs from the tissues it replaces by reduced functional properties. For example, scars on the skin are more sensitive to ultraviolet radiation, they lack sweat glands and hair follicles, and a scar in the heart muscle after a myocardial infarction does not participate in heart contraction and can lead to heart failure.
Fibrosis can affect any tissue and organ, but the most common is fibrosis of the lungs, liver, kidneys, and heart.

Causes of fibrosis

Fibrosis can be caused by infectious and viral diseases, metabolic disorders, allergic reactions, radiation, trauma, surgery, inflammation, exposure to certain drugs, toxic substances, and certain genetic and non-infectious diseases (for example, fatty liver disease can lead to liver fibrosis).

Pulmonary fibrosis

Pulmonary fibrosis (pneumosclerosis) refers to conditions in which the elasticity and extensibility of the lung tissue decreases, the passage of oxygen and carbon dioxide through the wall of the alveoli (lung vesicles, in which the inhaled air comes into contact with blood) becomes more difficult. It can occur as a secondary condition in other diseases, but in most cases its underlying cause is not clear, so the term idiopathic pulmonary fibrosis is used.

Liver fibrosis

Liver fibrosis is scar tissue and nodules that replace liver tissue and impair liver function. The condition usually accompanies alcoholism, fatty liver disease, hepatitis B or C. Every time the liver is stressed or injured, the process of regeneration starts and scar tissue forms.

As scar tissue grows, liver function deteriorates, and as fibrosis progresses, cirrhosis develops.

Cardiac fibrosis

Fibrosis forms in those areas of the heart that have been damaged as a result of myocardial infarction. Cardiac fibrosis increases the risk of heart failure.

Mediastinal fibrosis

This form of fibrosis is characterized by calcified fibrosis of the lymph nodes, which can block the airways and blood vessels.

Fibrosis of the retroperitoneal cavity

Refers to fibrosis of the soft tissues of the retroperitoneal space – the aorta, kidneys and other structures.

Bone marrow fibrosis

Myelofibrosis is a scar in the bone marrow that prevents the normal formation of blood cells.

Skin fibrosis

The scar tissue that forms on the skin in response to injury is called a keloid.

Scleroderma, or systemic sclerosis

Scleroderma is an autoimmune connective tissue disease that primarily affects the skin, but can also occur in other organs such as the kidneys, heart, and lungs.

Fibrous bone dysplasia

It is believed that fibrous dysplasia of bone develops due to a mutation in the genes. Basically, the disease shows itself at birth, although rare cases are described when its first manifestations were diagnosed in adult patients.

Fibrotic changes in the new coronavirus infection COVID 19

The problem of fibrosis has gained particular relevance in the light of the consequences of the spread of the new coronavirus infection. In 27-45% of patients who have had an infection, fibrosis occurs in the respiratory and cardiovascular systems, which can be associated with most of the adverse outcomes of the disease.

A feature of this infection is hypoxia, oxygen starvation. The systemic inflammatory response induced by a viral infection and implemented, including through a cytokine storm, can also affect the brain, nasopharynx, eyes, heart, blood vessels, liver, kidneys and intestines, that is, literally all vital organs.

Disease classification

Fibrosis is classified according to the organ it affects.

Pulmonary fibrosis:

• fibrothorax;
• pulmonary fibrosis:
• cystic fibrosis,
• idiopathic pulmonary fibrosis;
• radiation-induced lung injury (after cancer treatment).

Liver fibrosis:

• Transient fibrosis is an advanced stage of liver fibrosis that occurs during progressive forms of chronic liver disease,
• cirrhosis.

Fibrosis of the brain:

• glial scar.

Cardiac fibrosis:

• Myocardial fibrosis:
• interstitial fibrosis described in congestive heart failure, hypertension and aging,
• replacement fibrosis, which indicates a past myocardial infarction.

Other fibroses:

• arterial stiffness,
• fibrous dysplasia of bone,
• arthrofibrosis (knee, shoulder, other joints),
• chronic kidney disease,
• Crohn’s disease,
• Dupuytren’s contracture,
• keloid scars of the skin,
• mediastinal fibrosis,
• myelofibrosis of the bone marrow,
• fibrotic changes in the mammary gland,
• Peyronie’s disease,
• nephrogenic systemic skin fibrosis,
• progressive massive pulmonary fibrosis – a complication of pneumoconiosis of coal miners,
• retroperitoneal fibrosis,
• scleroderma / systemic sclerosis,
• some forms of adhesive capsulitis.

The classification of fibrosis is based on the spread of the pathological process throughout the organ.

• Local proliferation of connective tissue – focal fibrosis. Pathology has clear boundaries; several foci of fibrosis may appear on one type of tissue. Focal fibrosis can also be considered as the initial stage of diffuse fibrosis.
• Total, or diffuse fibrosis – characterized by extensive damage to the tissue of various organs. It is diagnosed at the later stages of the development of the process.
• Cystic fibrosis. It is considered by experts as a separate pathology that develops as a result of metabolic disorders.

Symptoms of fibrosis

Depending on the localization of fibrosis, a different clinical picture develops.

Pneumofibrosis is most often manifested by shortness of breath, which at first occurs only during active physical exertion, and as the process progresses, even at rest. The patient’s condition is characterized as moderate: there are complaints of weakness and fatigue. With a pronounced pathological process, a concomitant disease develops – cor pulmonale. Most often, fibrosis is formed in the roots of the lungs and large bronchi.

Liver fibrosis is manifested by the development of hypertension of hepatic origin (portal hypertension). This type of hypertension is poorly controlled, the patient develops edema, ascites (accumulation of fluid in the abdominal cavity), enlarged liver and spleen. Patients complain of a feeling of heaviness in the right side, severe itching. In the future, various skin rashes manifest.

Fibrosis of the mammary gland (develops only in women) is characterized by well-palpable seals in the mammary gland. Outwardly, such fibrosis can be manifested by hyperemia of the skin over the site of the lesion.

In uterine fibrosis (uterine fibromatosis), its structural layers are replaced by connective tissue. A woman may be disturbed by spotting in the middle of the cycle, more severe pain during menstruation, discomfort during intercourse.

Joint fibrosis is characterized by stiffness and pain in the knees, wrists, and hips.

Fibrosis of the tendons can lead to conditions such as Dupuytren’s contracture (palmar fibromatosis), which causes deformity of the fingers.

Diagnosis of fibrosis

Depending on the location and cause of fibrosis, different diagnostic procedures may be required:

• radiography;
• computed tomography and
  Magnetic resonance imaging;
• mammography;

Examination of both mammary glands in two projections (direct and axial) – 4 images

Examination of the mammary glands, which allows to evaluate the structure of the organ, for the diagnosis and detection of breast diseases in women at an early stage.

RUB 3,190

Sign up

Echocardiography

Examination to assess functional and organic changes in the heart, its contractility, as well as the state of the valvular apparatus.

RUB 4,190

Sign up

FibroTest

A complex of calculated tests to determine the degree of histological activity in the most common forms of liver pathology. Diagnosis is carried out WITHOUT …

Up to 2 business days

Available with house call

RUB 16,635

Add to cart

SteatoScreen

A complex of calculated tests to determine the degree of histological activity in the most common forms of liver pathology. Diagnosis is carried out WITHOUT…

Up to 2 business days

Available with house call

7 835 RUB

Add to cart

NASH-FibroTest, non-invasive diagnosis of non-alcoholic steatohepatitis and liver fibrosis

Synonyms: Biochemical study for NES-Fibrotest; NashTest.

NashTest; SteatoTest, ActiTest, NashTest-2; NashTest. AshTest. FibroTest; Nashtest.

Independent laboratory INVITRO in 2010 p…

Up to 2 business days

Available with house call

RUB 20,275

Add to cart

Profile Primary myelofibrosis

Panel composition:
No. 777731 Cytogenetic analysis of bone marrow cells (karyotype) Cytogeneticanalysisofbonemarrow (karyotype)

Cytogenetic study of bone marrow cells…

Up to 23 business days

Available with house call

RUB 19,145

Add to cart

Bronchial lavage tests

Research material. Modern endoscopic devices have special devices for taking material for morphological examination. At …

Up to 2 business days

Available with house call

RUB 1,030

Add to cart

Antinuclear antibodies, IgG, screening, ELISA (Antinuclear antibodies, Antinuclear antibodies, ANAs, EIA)

Synonyms: Antinuclear antibodies, Antinuclear factor; ANF.

Antinuclear Antibody; ANA; antinuclear factor; ANF.

Brief description of the test “Antinuclear antibodies, IgG, screening, I…

Up to 3 working days

Available with house call

RUB 915

Add to cart

Which doctors to contact

Depending on the symptoms and nature of the lesions, the patient is referred to a specialized specialist to determine a set of diagnostic and therapeutic measures.

Fibrosis treatment

In modern medicine, conservative and / or surgical methods for the treatment of fibrosis are used. First of all, regardless of the choice of method, it is necessary to stop and exclude the causes that led to the development of this pathology.

The choice of one or another conservative method of therapy depends on the localization of the fibrous tissue and the prevalence of the process.

The surgical method of treatment is resorted to, if necessary, excision of the affected tissues.

Complications

Fibrous replacement of tissues leads to a gradual loss of their specific functions and dysfunction of the affected organ. Over time, the tissue in which fibrosis develops loses its original structure, causing decompensation of the organ in which it is located.

Prevention of fibrosis

The main role in preventive measures is played by timely and effective treatment of diseases that increase the risk of fibrous tissue formation.

Sources:

1. Henderson, N.C., Rieder, F. & Wynn, T.A. Fibrosis: from mechanisms to medicines. Nature 587, 555–566 (2020).
2. Golovkin A.S., Kudryavtsev I.V., Dmitriev A.V., Kalinina O.V. Fibrotic changes in the cardiovascular and respiratory systems after suffering COVID-19: contribution of immune system factors and genetic predisposition. Russian journal of cardiology. 2020;25(10):4087.
3. Interim guidelines. Prevention, diagnosis and treatment of novel coronavirus infection (COVID-19). Ministry of Health of the Russian Federation, version 15 dated. 02/22/2022.
4. Cystic Fibrosis Clinical Guideline (Cystic Fibrosis). Developed by: Union of Pediatricians of Russia, Association of Medical Geneticists, Russian Respiratory Society, Russian Transplant Society, Association of Children’s Doctors of the Moscow Region. – 2021.
5. Clinical guidelines “Idiopathic pulmonary fibrosis”. Developed by: Russian Respiratory Society. – 2021.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

Recommendations

• Pathologies of the aorta

  6198

  May 31

• Dupuytren’s contracture

  6169

  24 May

• Molluscum contagiosum

  6282

  24 May

Show more

Acne

Cyst

Scar

Hyperkeratosis

Polycystic ovary syndrome

Acne

Acne: causes, symptoms, diagnosis and treatment.

More

Fibrosis

Scar

Cough

Shortness of breath

Cyanosis

Tuberculosis

Pneumoconiosis

Pneumoconiosis: causes, symptoms, diagnosis and treatment.

More

Eruptions

Plaque

Peeling

Scar

Hyperpigmentation

Parapsoriasis

Parapsoriasis: causes, symptoms, diagnosis and treatment.

More

Amyloidosis

Wegener’s granulomatosis

Scar

Stridor

Shortness of breath

Dysphonia

Hoarseness

Stenosis of the trachea and bronchi

Stenosis of the trachea and bronchi: causes, symptoms, diagnosis and treatment.

More

Cytomegalovirus

Herpes

Rubella

Toxoplasmosis of pregnancy

Pneumofibrosis

Pneumosclerosis

Primary immunodeficiency

Primary immunodeficiency: causes, symptoms, diagnosis and treatment.