Gynecology And Obstetrics-

Uterine inflammation

Special forms of endometritis - senile endometritis
Special forms of endometritis - puerperal endometritis
Prevention of cervical and uterine inflammation

Definition of uterine inflammation

The uterus (uterus) of a non-pregnant woman is approximately 7 cm long and shaped like a pear. From an anatomical point of view, three sections of the uterus can be distinguished:

The body of the uterus (Corpus uteri) including the dome (Fundus uteri) and the branches of the fallopian tubes,
The isthmus uteri, a narrow intermediate piece, which with its lower end forms the inner cervix,
The cervix (Cervix uteri), which opens into the vagina at the lower end with the so-called portio vaginalis; this end corresponds to the external cervix

At a Uterine inflammation different areas can be affected.
A distinction is made between inflammation of the corpus uteri and inflammation of the cervix uteri, i.e. the cervix.

Inflammation of the body of the uterus is known in technical jargon as Endometritis, Endomyometritis or Myometritis designated. The name depends on which layer of tissue in the uterine body is affected.
Is the lining Uterine lining affected, one speaks of one Endometritis.
If the muscle layer is affected, the gynecologist speaks of one Myometritis. A Myometritis comes only in connection with a purulent Endometritis in front. Since both parts are infected, this is called Endomyometritis declared.

If inflammation affects the cervix rather than the body of the uterus, this is called Cervicitis designated.

Signs of uterine inflammation

Depending on where the uterine infection is, the signs or symptoms may vary. If you have a cervical infection (Cervicitis) it is more likely to result in a whitish-bloody discharge. The discharge is usually unpleasant or smelly. Cervicitis can also manifest itself as vaginal pain and / or itching.

Also read our topic: Cervical pain.
The uterine lining inflammation (Endometritis), which in most cases is caused by an infection of the vaginal mucosa, is mainly noticeable as atypical or irregular menstrual periods. In some cases, menstruation becomes heavier and menstrual pain occurs. In general, severe pelvic pain and tenderness in the lower abdomen can indicate an inflammation of the uterine lining. Fever and a general feeling of illness may also occur.

Causes of inflammation of the body of the uterus

A uterine infection can affect different sections.

Inflammation of the body of the uterus is most often caused by a rise of Germinate through the vulva (female shame) and the vagina (Scabbard) triggered.
The most common germs include staphylococci, streptococci, Chlamydia and anaerobes, so bacteria that do not need oxygen.
Usually, the internal cervix forms a barrier between the cervical and uterine body tissues and protects the body of the uterus from infection.
However, this protection mechanism can be activated by the Menstrual period, one birth, one Miscarriage, one Prolapse of the uterus or be affected by vaginal surgery. As a result, staphylococci, streptococci, Chlamydia and anaerobes come.

In addition, inflammation can also be from inflammation of the Fallopian tubes go out or the inflammation can spread to the uterine body via the bloodstream.

Symptoms of inflammation of the body of the uterus

If the lining of the uterus becomes inflamed (Endometritis) there are menstrual abnormalities, such as a prolonged menstrual period (Menorrhagia), Bleeding outside the normal menstrual cycle (Metrorrhagia) or spotting.
If the inflammation has spread to the muscle layer, fever and pain in the lower abdomen add to the bleeding disorders.

Back pain as a symptom

At persistent lower back pain should be at (especially boys) Women are always thought of a gynecological cause. Namely, the pain of inflammation of the internal female organs like the uterus can radiate in the back and mimicking back pain. These pains are mostly called lower back pain Lumbar region and in the Sacrum region perceive. In the case of chronic back pain in this area and if a spinal problem is excluded, the cause can also be a chronic uterine inflammation be.

Diarrhea as a symptom

A uterine infection can in rare cases either by Inflammation of the bowel (Chronic Inflammatory Bowel Disease) or cause inflammation of the bowel. This can be seen as a symptom of uterine inflammation diarrhea occur. Crohn's disease patients who suffer from chronic diarrhea should therefore use bloody, vaginal discharge uterine inflammation should be considered.

Please also read our topic Chronic Inflammatory Bowel Disease.

Nausea as a symptom

The inflammation of the uterus can- As already mentioned- in severe cases it can also spread to other internal organs such as the intestine. In addition to symptoms such as diarrhea, constipation or Stomach cramps also to nausea come.
The body can also respond to the inflammation in general nausea and malaise react. Particularly severe pain is often accompanied by nausea. Therefore should always considered all symptoms become.

When the nausea occurs only with antibiotic treatment uterine inflammation, it should be taken into account that the drug may not be tolerated. A change to another antibiotic should then take place here.

Symptoms During Pregnancy

There is inflammation of the uterus during pregnancy very rare. If inflammation does occur, it is usually triggered by bacteria that are located in the vaginal mucosa and have migrated upwards. The inflammation can then be relative few symptoms run, so that an inflammation only in ultrasound notices.

The main symptom of uterine inflammation during pregnancy is vaginal bleeding. A doctor should be consulted as soon as possible for a Miscarriage or premature birth (Imminent abortion) to prevent. More symptoms can be Pain and fever be.
To prevent inflammation of the uterus during pregnancy, one should start early Smear of the vaginal flora be made to eliminate pathogens from the vaginal mucosa.

Symptoms after childbirth / in the puerperium

Postpartum uterine inflammation during the puerperium is mainly caused by the Weekly flow (also called Lochien) certainly. The weekly flow is usually still in the first few days bloody, it will then brownish, then yellowish and whitish after three to four weeks.

With an uterine inflammation, the weekly flow is foul smelling. Also make up Bleeding noticeable from the uterus beyond the first few days. The pressure on the lower abdomen or on the inflamed uterus is also painful. Since this is an inflammation, can fever occur. The worse the infection, the higher the fever can rise.

Diagnosis of inflammation of the body of the uterus

An initial indication of inflammation of the uterine body can be Menstrual Period abnormalities especially if these occur, for example, in connection with surgical vaginal interventions.
If the myometrium is affected, the uterus is also painful and enlarged and palpable during the clinical examination.

The smear (the so-called native preparation), which should be performed as part of the gynecological examination, shows a discharge rich in leukocytes, which is an indication of inflammation.
In addition, the swab can also be sent to a laboratory in order to determine the causative pathogen through cultivation.

Taking a blood sample to check the inflammation parameters usually does not help with the diagnosis.

However, real evidence of inflammation of the uterine body is only possible by taking a tissue sample. This tissue sample can be used as part of a curettage (Curettage or abrasion) be won.
At Menstrual cycle disorders this should definitely be carried out, as these are not only symptoms of inflammation, but may also be an indication of cancer.

Illustration of the uterus

Uterus -
uterus
Uterine tip -
Fundus uteri
Uterine lining -
Tunica mucosa
Uterine cavity -
Cavitas uteri
Peritoneum cover -
Tunica serosa
Cervix -
Ostium uteri
Uterine body -
Corpus uteri
Uterine constriction -
Isthmus uteri
Sheath - vagina
Cervix - Cervix uteri
Ovary - Ovary
Fallopian tubes - Tuba uterina

You can find an overview of all Dr-Gumpert images at: medical illustrations

Therapy for inflammation of the body of the uterus

Inflammation of the muscular layer of the body of the uterus (Myometritis) and endometritis caused by ascending pathogens antibiotic be treated.
Is just that Uterine lining affected (Endometritis) is the rejection of the mucous membrane that occurs every month under the Menstruation anyway, promoted by the administration of hormones.
These are preparations that are labeled with the "pill“Are comparable. This is known as hormonal abrasion.

Complications of inflammation of the body of the uterus

If the body of the uterus is inflamed, this can in rare cases affect the Fallopian tubes or even expand the ovaries. This so-called Salpingitis or. Adnexitis ensures a strong feeling of illness in the affected patients.

Please also read our pages Fallopian tube inflammation and Inflammation of the ovaries.

Special forms of endometritis - foreign body endometritis

Foreign body endometritis can develop in women who have an intrauterine device (IUD), i.e. wearing a spiral. Women who have not had children and are under the age of twenty are at the highest risk of developing inflammation.
But even after giving birth there is an even higher risk. This is further increased by a promiscuous lifestyle.

The type of IUD also has an influence on the risk of infection. So are carriers of a spiral wrapped with copper wire (Copper spiral) significantly more at risk than women with an IUD (e.g. Mirena).

As a prophylaxis against an infection caused by a coil, a genital infection should be excluded before the coil is inserted. If an infection is found, the IUD may only be inserted after adequate treatment and complete healing.

After successfully positioning the coil, localization and inflammation parameters should be checked. If there are abnormalities that suggest inflammation, the intrauterine device must be removed.

Since the risk in adolescents is significantly higher, the insertion of a coil should not be carried out easily.

Special forms of endometritis - senile endometritis

Senile endometritis occurs at an advanced age.
In half of the patients there is inflammation as well as the Uterine lining a Cancer of the lining of the womb (Endometrial cancer).

One cause of senile endometritis is one Adhesion of the inner cervix, for example after an inflammation of the cervix or due to new growths, whereby the drainage of the secretion from the uterine body is obstructed.
As a result, this accumulates in the body of the uterus. In this case one speaks of a Serometra.

If it is a purulent secretion, it is no longer called a serometra, but as a Pyometra designated.

In addition, a Radiation inside the uterus (intrauterine) Be a reason for withholding secretions. Affected patients complain about intense pelvic painwhich can have a labor-like character.
Also fever, one tender uterus and a purulent-bloody discharge can be observed with partial drainage of the secretion.

The therapeutic goal is to restore the drainage of the secretion. This is achieved by expanding and inserting a so-called Fehling's tube in the cervix.
Also one antibiotic treatment is indexed. After the signs of inflammation have disappeared, a scraping (Curettage or abrasion) to rule out cancer.

Special forms of endometritis - puerperal endometritis

Puerperal endometritis is inflammation of the Uterine lining the in Puerperium, i.e. in the period immediately after the birth up to six to eight weeks afterwards.
Puerperal endometritis can also be caused by a Miscarriage or one that was not carried out properly Termination of pregnancy be conditional. She is the number one cause of one Postpartum fever.

Puerperal endometritis is caused by bacteria caused by the Scabbard ascend into the body of the uterus. Most often the infection is caused by a combination of different bacteria (Mixed infection) triggered. The most common are ß-hemolytic streptococci, staphylococci, enterococci, Escherichia coli and Proteus.

The following are beneficial for the rise of bacteria:

a premature rupture of the bladder,
constant vaginal examinations,
a surgical vaginal delivery,
a caesarean section,
the retention of placental residues,
a jam of the weekly river.

Patients with endometritis in the puerperium complain of one malodorous weekly flow. In the further course there is also one high fever.

Complications arise from the spread of inflammation. This takes place locally at the beginning and then systemically throughout the body, which in extreme cases leads to a Blood poisoning (sepsis) With shock, Blood clotting disorders and one Multiple organ failure can come.
Adequate therapy is essential because of these potentially serious complications.

In puerperal endometritis, this is initially done with contraction agents that encourage the uterus to contract. One such contraction agent is Oxytocinwhich is also responsible for the contractions of the uterus during delivery.

If there is any material left in the uterus, there is a curettage (Curettage or abrasion) necessary to remove these remains.

You may also need one Widening of the cervixso that the weekly flow can flow off without any problems.

With mild puerperal endometritis, no antibiotic administered. However, if the inflammation has spread to surrounding structures, it must Broad spectrum antibiotics are used, which among other things prevent further spread.
In extreme cases with a Blood poisoning (sepsis), Coagulation disorders and multiple organ failure is one intensive care monitoring and therapy indexed.

Inflammation of the cervix (cervicitis)

The cervix uteri is anatomically also used uterus counted. For this reason, inflammation of the cervix is also a form of uterine inflammation.
Inflammation of the cervix is known in technical jargon as Cervicitis designated.

You can choose between a pathogen-related, so infectious and one not infectious Distinguish cervicitis.
Depending on the timing of the cervical infection, between one acute and chronic Inflammation of the cervix differentiated.

Causes of inflammation of the cervix

After diagnostic and therapeutic interventions on the uterus, such as scraping or removing tissue (biopsy), a non-infectious inflammation of the cervix can occur.
Non-infectious cervicitis can also occur in the context of a malignant tumor.
Acute inflammation of the cervix is possible due to a chlamydial infection with Chlamydia trachomatis of serotype D-K. Chlamydia is the most commonly detected bacteria in inflammation of the cervix and is sexually transmitted. 10-25% of young and sexually active women suffer from a chlamydial infection, but about 30-50% of it runs without clinical symptoms.
Other pathogens that can cause cervicitis are, for example, gonococci (Neisseria gonorrhoeae) - the disease is known as gonorrhea - and the cell wallless bacteria of the genus Mycoplasma and Ureaplasma. In addition to bacteria, cervicitis can also be caused by viruses. Viruses that cause inflammation of the cervix are primarily herpes simplex viruses.
Recurring and long-lasting inflammation is called chronic cervicitis. They are caused by changes in the anatomical conditions of the cervix, such as tumors (polyps). But also the numerous hiding places of the cervical mucous membrane favor the persistence of the pathogenic germs.
In addition to all of the above-mentioned favorable factors, an intrauterine device (spiral) for contraception, vaginal delivery, vaginal surgical interventions or ectopia, i.e. a displacement of tissue from the cervical canal to the surface of the portio, are also conditions that can promote cervicitis.

Symptoms of inflammation of the cervix

The predominant symptom of this type of uterine infection is discharge (fluorine). This is yellowish-purulent and foul-smelling. If the cervicitis is caused by an infection with gonococci (Neisseria gonorrhoeae), the discharge can also take on a yellowish-green color. Occasionally there are discomforts during intercourse with contact bleeding.
If the urethra is also affected by the inflammation (urethritis), urination is difficult and / or painful. Affected patients usually hardly feel any impairment of their general condition.

Diagnosis of inflammation of the cervix

After the anamnesis, where the person concerned complains of the symptoms described above, the doctor can usually find typical signs of cervicitis in the clinical examination. These include, for example, a swollen and reddened portio, the portio is the vaginal part of the uterus. In addition, a purulent discharge from the cervix may drain. This cloudy secretion is an important indicator of cervicitis.
The taking of a smear, the creation of a native preparation and the cultivation of a bacterial culture are decisive for the diagnosis. If bleeding occurs when the smear is obtained (so-called contact bleeding), this shows the fragility of the inflamed tissue and thus represents a further indication of cervicitis.
Depending on the suspected pathogen, other detection methods can be used to determine the causative pathogen. For example, the genetic makeup of chlamydia can only be detected with the help of a urine sample.

Therapy for inflammation of the cervix

An acute inflammation of the cervix is treated with antibiotics that are applied systemically into the vein.
If the inflammation is caused by a chlamydial infection, a single dose of a tetracycline such as doxycycline for 7 days or a macrolide such as erythromycin or clarithromycin and azithromycin is given. Resistance to tetracyclines and erythromycin has not yet been described. When using the macrolide azithromycin, a single dose of 1g is sufficient. In the case of a chlamydial infection, treatment by the partner is necessary in order to prevent the healed patient from being infected again in the untreated and thus infectious sexual partner.
If the cervicitis is caused by gonococci, antibiotic substances are also used. The treatment of first choice for a gonococcal infection (gonorrhea) is the one-time administration of a combination consisting of the cephalosporin ceftriaxone, which is administered into the vein or muscle and another antibiotic, more precisely azitromycin, which is administered by mouth. Even with a gonococcal infection, the partner must undergo therapy.

Duration of an uterine infection

Depending on which part (Cervix or uterine lining) or how much of the uterus is affected by the inflammation, the time it takes to heal can vary. Is it a mild to moderate uterine inflammation, shows antibiotic treatment in most patients after 1-3 days Effect. It takes up to a full recovery a few days.

At severe inflammation longer treatment may be necessary. This is then assessed under the supervision of the attending gynecologist and, depending on the situation, antibiotic treatment is extended. If acute uterine inflammation is left untreated, it can turn into a permanent (chronic) Status pass over and further genital organs (for example fallopian tubes) infested. This must be done with a prolonged treatment and one longer duration until recovery be expected. However, under normal conditions and with adequate treatment, most uterine infections will heal quickly and without complications out.

Prevention of cervical and uterine inflammation

Appropriate hygiene in the intimate area and sensible sexual hygiene, which prevent the use of Condoms includes.

Inflammation of the uterus after scraping

A scraping is the surgical removal of the lining of the uterus. This is at Miscarriages, Abortions or for diagnostics carried out. Since instruments are inserted into the uterus from the outside, the uterus can catch fire if there are germs on the tools used. But that only comes Rare in front.

If inflammation develops after the scraping, a Antibiotic treatment usually eliminate these without complications. After scraping, the uterus can simply become inflamed because Tissue removed has been. This inflammation usually goes away on its own back.

Uterine inflammation after a caesarean section

A uterine infection can be triggered by surgical procedures such as a caesarean section. This happens when Germs get into the wound. Since this risk of infection exists with every caesarean section, antibiotics are given in most cases to prevent infection. In spite of this, in rare cases a colonization of germs and subsequent infection can occur, which is then associated with symptoms such as pain and vaginal bleeding beyond the actual weekly flow.

In addition, the seam be closely observed. Interpret here Pain, Redness and pus on the wound for inflammation and should be examined and treated by a doctor as soon as possible to prevent the inflammation from spreading. However, since a caesarean section is a routine procedure in which a high standard of hygiene is observed, such infections occur very rare in front.

Uterine inflammation after childbirth / in the puerperium

The uterine inflammation during the puerperium is also called Puerperal endometritis designated. This type of uterine infection is that too most common form of acute endometritis. The uterine inflammation is caused by an infection that is triggered by germs either during or after the birth.
Mainly these are so-called mixed infections, in which different bacteria trigger the inflammation. These include, for example Streptococci, Staphylococci, Enterococci or the intestinal bacterium Escherichia coli.

The uterine inflammation makes itself through one unpleasant smelling weekly flow, vaginal bleeding and a Tenderness in the lower abdomen noticeable. In addition, uterine inflammation during the puerperium is the most common trigger for the so-called Postpartum fever. The fever often exceeds 40 degrees.
In the ultrasound one does enlarged uterus noticeable. If these symptoms occur during bed, a doctor should be seen for an examination. With slight inflammation Antibiotics given. If the inflammation has spread, the patient may need to be admitted to the hospital as an inpatient. In very rare and serious cases the only option left is this Removal of the uterus.