The causative agent of tuberculosis is Koch's bacillus. Once in the body, for some time it may remain inactive. In this case, nonspecific symptoms appear in the form of increased fatigue and weakness. Often they are attributed to overwork and do not pay due attention to them. Women learn about the presence of the disease when the first difficulties with conception appear. Thus, uterine tuberculosis manifests itself. The first signs and symptoms of the disease will be discussed in today's article.
Medical certificate
Uterine tuberculosis is an infectious disease. It affects mainly the mucosa and myometrium. In rare cases, the pathological process spreads to the cervix. It has several forms of the course: subacute, acute and chronic. It is generally accepted that infertility is considered a necessary consequence of the disease. The disease is also dangerous for the fetus. Due to adhesions, the organ changes shape, which can provoke a halt in the development of the child inside the womb.
Pathology classification
By the nature of the course, uterine tuberculosis can be subacute, acute and chronic. The acute form of the disease is detected extremely rarely and, as a rule, with the addition of a secondary infection. In 15-17% of cases, subacute tuberculosis is observed when the inflammatory process is not so active. The chronic version of the disease occurs most often.
Different activity of the Koch bacillus in the genitals is also isolated. For example, in the first 2 years, the bacterium behaves most actively. The remission phase can last from 2 to 4 years, after which the inactive form sets in. The last stage is also called the consequence of the disease. If in the first 4 years after infection the signs of uterine tuberculosis become more pronounced, then an exacerbation is observed. When such a phenomenon is diagnosed after the first 4 years, it is a relapse.
Separately, it is necessary to consider the classification for the localization of the pathological process. Tuberculosis of the uterus is found in 70% of cases. This is due to the fact that the fallopian tubes receive nutrition from two arteries - the uterine and ovarian. They, in turn, have an extensive network. The blood flow in such vessels is rather slow, which allows the Koch bacillus to settle in tissues fed by arteries of small diameter.
Tuberculous lesions of the uterine body are recorded in 20% of cases. The disease can affect only a portion of the inner membrane of the organ, the entire endometrium, and even spread to the muscle membrane. Inflammation of the remaining structures (neck, ovaries, vagina) is rare.
Depending on the histological picture of pathological foci, the disease occurs:
- Chronic with productive changes. Elements in the focus of inflammation are constantly expanding and dividing. Therefore, characteristic tubercles or lupomas appear on the mucosa.
- Subacute. Cells not only actively divide, but also secrete an inflammatory fluid - exudate.
- Caseous. Dead tissue areas look like a white curd mass.
- Finished. The foci of inflammation are saturated with calcium salts and are independently limited to the capsule.
Determining the form of the disease helps to choose therapy and prevent the development of complications.
Main reasons
Tuberculosis is a secondary pathology. Bacteria enter the uterus from other foci, which may be the lungs and intestines. How is uterine tuberculosis transmitted? Koch's wand spreads through the air. Many people have immunity to it, but in 10% of the world's population the infection takes root.
The uterus is a field for complications and the resumption of the pathological process. At first, Koch's bacillus is not active due to the increased work of the immune, endocrine and cardiac systems. However, with weakened immunity, it rapidly spreads through the body through the blood and lymph.
Among the risk factors, doctors distinguish the following conditions:
- diseases of the chronic course;
- surgical interventions on the organs of the reproductive system;
- functional impairment;
- frequent stress;
- hormonal changes.
With the combination of several factors, the likelihood of developing the disease increases several times.
General clinical picture
In most cases, severe symptoms of uterine tuberculosis are absent. A woman may complain of general weakness, fever to subfebrile marks, excessive sweating. With significant changes in the uterine mucosa, amenorrhea occurs. This is a condition in which menstruation is absent.
Tuberculosis is characterized by prolonged and acyclic uterine bleeding. Infertility usually develops after the first birth or another abortion. Moreover, it is primary. Its main cause is the obstruction of the fallopian tubes.
In the case of a neglected form of the disease, deformation of the uterine cavity is observed against the background of fusion, synechia or fibrosis. The organ can be filled with curd tumors.
The severity of symptoms of uterine tuberculosis depends on the general health of the woman, external factors and the stage of the disease. In total, there are three of them: subacute, acute and chronic. Each of them will be described in more detail below.
Acute course of the disease
Pathology is manifested by severe pain in the lower abdomen. In addition, there is an increase in temperature and weakness.
The pain syndrome with uterine tuberculosis can be so strong that doctors do not always immediately make the correct diagnosis. Usually suspected appendicitis, ectopic pregnancy or ovarian apoplexy, prescribed surgery. If the uterine sites die out during surgery, they are removed and sent for histological examination. Otherwise, tuberculosis may not be diagnosed for a long time.
Subacute variant of the disease
The first symptoms of uterine tuberculosis of the subacute course manifest as pain over the pubis. This is due to inflammatory processes. In addition, the intestines and other organs of the small pelvis become difficult to contract due to the large number of adhesions and cicatricial changes.
The temperature is usually maintained at subfebrile values or within normal limits. General weakness and loss of appetite alert the woman. However, many simply do not notice these first signs and symptoms of uterine tuberculosis, and therefore do not go to the doctor.
Chronic process
In the chronic course of the disease, a woman usually does not bother. Minor fatigue and fever are attributed to frequent stress and a hectic rhythm of life. Only unsuccessful attempts to conceive a child can induce you to see a doctor and undergo examination. Typically, the problem is preceded by several abortions or even childbirth.
The pathogenesis of infertility is quite simple. Due to the peculiarities of local circulation, Koch's wand first falls on the fallopian tubes, causing inflammation. It causes a narrowing of the oviducts. As a result, the egg cannot enter the uterine cavity and attach. Pregnancy also does not occur if the disease contributed to partial or complete infection, scarring of this cavity.
Tuberculosis of the cervix is considered a complication of inflammation of the body of the organ. The disease develops mainly in older women. He does not have specific symptoms, but is diagnosed during colposcopy.
Diagnostic Methods
Diagnosis of this disease is very difficult due to the low awareness of the population about the first signs and symptoms of uterine tuberculosis in women. In addition, it is rarely detected by standard vaginal backseeding.
It is possible to suspect an illness only after prolonged monitoring of the patient's health, studying her medical history and contacts. The following instrumental and laboratory diagnostic methods also help:
- gynecological examination;
- X-ray or CT of the lungs;
- conducting a tuberculin test;
- hysterosalpingography;
- diagnostic curettage of the endometrium;
- laparoscopy.
After receiving the results of a comprehensive examination, a TB consultation may be required.
Conservative therapy
Treatment of uterine tuberculosis is carried out in a specialized clinic. This is a rather insidious disease. Koch's wand can withstand the effects of many drugs. Therefore, for its destruction, complex therapy is selected using several medications simultaneously. Typically, preference is given to Isoniazid, Streptomycin, Rifampicin and Ethambutol. If the listed drugs are ineffective, prescribe a new generation of drugs (Kanamycin, Ofloxacin, Amikacin).
Chemotherapy is carried out using at least three of these drugs. Its duration can vary from 6 months to 2 years. It all depends on the severity of the pathology, the presence of concomitant health problems and the state of the immune system.
Given the negative effect of chemotherapy on the liver, hepatoprotectors and vitamin complexes are additionally prescribed. For menstrual irregularities, hormonal medication may be needed. To eliminate adhesions and scars that form against the background of tuberculosis in the uterus and ovaries, absorbable drugs are prescribed.
To consolidate the results of the therapy, a spa vacation is useful, where, depending on the initial diagnosis, specialists select a set of physiotherapy procedures.
Surgical intervention
If conservative treatment does not give the desired result, caseous areas or purulent formations, adhesions appeared in the uterine cavity, surgical intervention is indicated. The operation is possible in two ways:
- complete removal of the uterus;
- excision of the affected area with the preservation of the organ.
The technology of the operation may also vary. In each case, the doctor determines the amount of intervention. In modern medical practice, the following options for eliminating pathology are used:
- Abdominal surgery. Her help is resorted to in case of extensive organ damage, when a good overview is required to identify pathological sites. It is performed using general anesthesia.
- Laparoscopy. This is a minimally invasive technique, during which the doctor performs several punctures on the skin in the affected area. Through them, he introduces tools for subsequent manipulations and a video probe. The image from the latter continuously enters the computer monitor. In this way, the doctor can constantly monitor his work. After excision of the pathological areas, sterile dressings are applied to the punctures. Recovery from laparoscopy is quick and the risk of complications is minimal.
- Endoscopic intervention. It implies the use of a hysteroscope with a camera. The procedure is performed with minor lesions of the endometrium, for the purpose of diagnostic curettage or to stop bleeding.
Removal of the uterine cavity may also be complete or partial. If a woman has not yet given birth and is planning a pregnancy in the future, the doctor tries to preserve the reproductive organ.
Possible complications
The lack of timely treatment for uterine tuberculosis often leads to complications. Among them, the most common are the following:
- bleeding
- spread of infection to adjacent organs;
- the formation of abscesses in the chest cavity;
- the formation of fistulas and adhesions;
- the transition of the disease into genital tuberculosis.
Tuberculosis treatment is a long and complex process. Moreover, full recovery does not always occur. Often, Koch's wand is insensitive to prescribed antibiotics. As a result, the reproductive organs completely lose their ability to bear children.
In the presence of such complications, only a few can try on the role of the mother. Therefore, a doctor should be consulted for suspected uterine tuberculosis. Suspicions can often literally save a woman's life.
Tuberculosis often appears too late. Therefore, doctors are advised to undergo fluorography annually and visit a gynecologist for preventive purposes.
Prevention Methods
To avoid uterine tuberculosis, contact with sick people should be avoided, do not use personal hygiene products. In addition, for preventive purposes, doctors advise to adhere to the following recommendations:
- Eat correctly and fully, take vitamin complexes.
- It is necessary to observe the regime of work and rest. Useful is a daily eight-hour sleep.
- Timely treat respiratory diseases, receive annual flu vaccination.
- It is important to maintain immunity at a high level. To this end, it is necessary to temper the body and abandon addictions.
- To avoid chronic gynecological diseases that create a favorable environment for the propagation of pathogenic flora, you need to visit a gynecologist every year.
- Parents should monitor the vaccination of the child to maintain a high resistance to illnesses. Against tuberculosis, the vaccine is given immediately after the baby is born, then at 7, 12 and 17 years old. Every year it is necessary to do a Mantoux test.
Uterine tuberculosis is a very serious disease. It is dangerous in that for a long time it can be almost asymptomatic. Even with timely detection and proper treatment, the ailment often leaves behind unpleasant complications. Among them, the most common problem is infertility. Relapses occur in every tenth woman. If the patient retains the ability to conceive, the pregnancy itself is very difficult. Often spontaneous miscarriages occur, a frozen pregnancy is diagnosed, and premature births occur. Therefore, even at the stage of conception planning, all women, without exception, must undergo a comprehensive examination of the body.