Uterine prolapse

Introduction to uterine prolapse The uterus descends from the normal position along the vagina, and the external cervix reaches below the level of the ischial spine. Even the uterus is completely removed from the vaginal opening. It is called uterine prolapse. The uterine prolapse often combines with the anterior wall of the vagina and the posterior wall. The main causes of injury to the cervix, cervical ligament and uterine ligament ligament and the failure of the support tissue after delivery are normal. In addition, during the puerperium, the mother is more likely to be supine, and is prone to chronic urinary retention. The uterus is easy to become posterior. The uterus axis is in the same direction as the vaginal axis. When the abdominal pressure increases, the uterus descends along the vagina and prolapse occurs. Postpartum habitual labor (such as washing diapers, washing vegetables, etc.) can increase abdominal pressure and promote uterine prolapse. Unexpected uterine prolapse, caused by dysplasia of genital support tissues. basic knowledge The proportion of the disease: the incidence rate of women is about 0.003% Susceptible people: women Mode of infection: non-infectious Complications: Bladder bulging Rectal bulging Vaginal wall prolapse

Cause of uterine prolapse

Childbirth damage (30%):

It is the anatomical basis of uterine prolapse. The cause of cervix, cervical ligament and uterine ligament ligament injury and the failure of the support tissue after delivery are the main reasons. In addition, maternal puerperium is more prone to supine, and easy to have chronic urinary retention, uterus is easy to become posterior, uterine axis and vagina The direction of the axis is the same. When the abdominal pressure increases, the uterus descends along the vagina and prolapses. After the birth, the habitual labor (such as washing diapers, washing vegetables, etc.) can increase the abdominal pressure and promote the prolapse of the uterus.

Increased intra-abdominal pressure (25%):

On the basis of the above causes, long-term chronic cough, constipation, ascites or large tumors in the pelvic and abdominal cavity can be caused. Constipation is a common clinical complex symptom, not a disease, mainly refers to the reduction of the number of bowel movements, the reduction of feces, the dryness of feces, and the difficulty of defecation. It is necessary to judge whether there is constipation in combination with the traits of feces, the usual bowel habits and the difficulty of defecation. If it is more than 6 months, it is chronic constipation.

Genital support tissue dysplasia (20%):

Unexpected uterine prolapse, caused by dysplasia of genital support tissues.

Pathogenesis

During the delivery process, the soft birth canal and its surrounding pelvic floor tissue are extremely dilated, the muscle fibers are elongated or torn, and the urogenital hiatus is loosened and expanded, especially the damage caused by the delivery of midwifery, resulting in the pelvic deep ribs maintaining the normal position of the uterus. Membrane and levator ani muscle injury, if the injury is not sutured or sutured poorly, or maternal premature participation in physical labor, especially heavy physical labor, will affect the recovery of pelvic floor tissue tension, weaken the uterus support, so that the old The large uterus moves down to varying degrees.

1, estrogen decreased after menopause, pelvic floor tissue atrophy and weakened, elderly women prone to uterine prolapse.

2, malnutrition caused by weak tissue support the uterus can lead to uterine prolapse, this part of the patient not only uterine prolapse, but also accompanied by other organ prolapse.

3, pelvic floor tissue congenital dysplasia even can be seen without a history of childbirth uterine prolapse.

4, multiple maternal delivery also affect the support of tissue recovery to make the pelvic support tissue weak.

Increased intra-abdominal pressure, acting on the uterus, moving the uterus down, especially within 2 months after birth, any factors that increase abdominal pressure, such as excessive labor, can easily lead to uterine prolapse.

Uterine prolapse prevention

Strengthening women's labor protection

Excessive weight-bearing effect and physical exertion are one of the important reasons for uterine prolapse. Strengthening women's labor protection is a reliable guarantee for preventing and reducing uterine prolapse.

Do a good job in adolescent health

Women are called adolescence between the ages of 12 and 18. Because adolescent ovarian and female reproductive organs are not fully developed, they are susceptible to various diseases and affect women's normal development and reproductive function. A woman with dysplasia has weak muscles and poor ligament tension, often accompanied by a loose abdominal wall and a weakness called a weakness-free physique. This type of person is usually accompanied by sag of internal organs (such as sagging of the kidney, sagging of the stomach, etc.). If the intra-abdominal pressure is increased for some reason, uterine prolapse is prone to occur. Therefore, doing adolescent health care is of great significance to ensuring women's health and normal development and preventing the occurrence of uterine prolapse.

Pay attention to menstrual care

Although the menstrual period is a physiological phenomenon of women in the reproductive period, women's cerebral cortex excitability decreases during menstruation. In addition, due to the influence of endocrine and pelvic congestion, the systemic and local resistance are reduced. If you do not pay attention to menstrual period health care, it is easy to cause women's various acute and chronic diseases, affecting women's health. In particular, women are stimulated by cold during menstruation (mainly cold water), which can easily cause ovarian dysfunction and lead to menstrual disorders and even amenorrhea. At the time of amenorrhea, due to ovarian dysfunction, less estrogen secretion, resulting in decreased pelvic support tissue tension, prone to uterine prolapse, therefore, strengthening menstrual health care, is also of great significance in preventing the occurrence of uterine prolapse.

Do a good job of pregnancy care

Doing a good job of women's pregnancy care, timely detection and correction of fetal position abnormalities, prevention of fetal dystocia, is also one of the important measures to prevent uterine prolapse.

Correctly handle the various labor processes of childbirth

Childbirth injury is an important cause of uterine prolapse. The longer the labor, the higher the incidence of uterine prolapse, which is related to the greater chance of injury to the suspension of the uterus and the soft tissue of the pelvic floor. The damage caused by the first delivery is even more critical. Among patients with uterine prolapse, the first postpartum is the highest incidence, accounting for about 30%. Therefore, correctly handling the labor process of childbirth and preventing birth injury is the most important link to prevent uterine prolapse.

Do a good job in puerperium

The maternal delivery from the placenta to the reproductive organs to return to non-pregnancy, usually takes 6 to 8 weeks, this recovery process is called the puerperium. In the puerperium period, women's anatomical and physiological changes are relatively large, and if this period is not taken seriously, uterine prolapse is most likely to occur. Therefore, conscientiously doing the puerperium health care is of great significance for preventing uterine prolapse.

Do breastfeeding care

Ovarian function declines during lactation. In particular, long-term breastfeeding after childbirth can cause uterine atrophy due to long-term ovarian function, the support structure of the uterus and the suspension device are weak, and the tension and elasticity of the pelvic floor muscles are reduced. In this case, if the abdominal pressure is increased, Or external factors such as body posture and force can induce uterine prolapse. If the lactation period is less than 1 year, the patients with uterine prolapse only account for less than 9%, and those who have lactation for more than 1 year account for more than 90%. It shows that the incidence of uterine prolapse is significantly increased in those who have breast-feeding for more than one year. In addition, it was found that when women were subjected to abdominal pressure during lactation, the position of uterus decreased significantly compared with non-lactation period. Therefore, it is an important measure to prevent uterine prolapse.

Uterine prolapse complication Complications, bladder bulging, rectal bulging, vaginal wall prolapse

Uterine prolapse often has vaginal bulging, or accompanied by bladder bulging, rectal bulging, bladder bulging often urinary frequency, dysuria or incontinence, rectal bulging often constipation, dysuria.

Acute uterine prolapse can cause severe peritoneal irritation (low pain in the lower abdomen, pale, cold sweat, nausea and vomiting, etc.).

Uterine prolapse symptoms common symptoms lumbosacral pain, lower abdomen, bulging, backache, menstrual flow, multiple cervical edema, dysuria

1, lumbosacral pain

Especially in the crotch, it is more obvious after labor, and can be relieved after bed rest. In addition, the patient feels lower abdomen, vagina, and perineum fall, and it is aggravated after exertion.

2, vaginal prolapse

The patient reported that the spherical object was removed from the vagina. It was more obvious during walking and physical labor. After bed rest, it was self-contained. If the prolapse was severe, it would fall outside and could not be repaid. Because of walking activities, it was rubbed with the clothes. Feeling uncomfortable, ulceration, ulceration, infection, increased secretions, and even bleeding, local tissue thickening and keratinization.

3, urinary tract symptoms

Most patients with uterine prolapse, when they laugh, cough, and exert a strong force, the abdominal pressure suddenly increases, causing urinary incontinence and urine overflow. Uterine prolapse is often accompanied by varying degrees of bladder bulging, but whether there is stress Urinary incontinence depends on whether the anatomical relationship between the bladder and the urethra changes. A small number of patients with uterine prolapse have difficulty in urinating, leading to urinary retention. The bulging bladder needs to be pushed forward with a finger before urinating. The reason is bladder bulging. Severe, swollen bladder position is lower than the urethra.

4, menstrual changes, more leucorrhea

Due to pelvic organ prolapse, leading to blood circulation disorder, local congestion, affecting normal menstruation, can make more menstruation, in addition, due to blood circulation disorders, the organ is released from ulcers, infection, resulting in increased vaginal discharge, accompanied by bloody secretions.

5, generally does not affect pregnancy, pregnancy and childbirth, but uterine prolapse can not be returned, after the birth can occur cervical edema and difficulty in cervical dilatation caused dystocia.

6, signs

The uterus moves down from the cervix in the vagina from the hymen <14cm to the uterus completely out of the vaginal opening. The uterine prolapse that can not be returned is often accompanied by rectal bladder bulging, vaginal mucosa thickening and keratinization, cervical hypertrophy and prolongation, bladder The distance from the uterine fossa to the anterior vagina is >2cm, which can be as long as 4~5cm. When severe uterine prolapse with bladder prolapse, the vaginal and bladder transverse groove folds disappear, the lower bladder boundary can be longer than the external cervix, and the severe uterine prolapse has bladder. The ureter moves down and forms a positive "" with the urethral opening.

According to the opinions of the two diseases scientific research collaboration group held in Qingdao in 1981 in Qingdao, the uterus prolapse was divided into three degrees according to the degree of uterine decline when the patient was lying down and down the screen:

I degree: the subcerebral hypoglossal hymen <4cm, but did not come out of the vaginal opening.

Light type: the outer cervix is at a distance of 4 cm from the hymen, which is not up to the hymen.

Heavy: the cervix has reached the hymen, and the cervix is visible in the vaginal opening.

II degree: the cervix and part of the uterus have been removed from the vaginal opening.

Light: The cervix is pulled out of the vaginal opening, and the palace is still in the vagina.

Heavy: Part of the palace body is pulled out of the vaginal opening.

III degree: the cervix and uterus are all pulled out of the vaginal opening.

Examination of uterine prolapse

patients do not understand urination, take the bladder lithotomy position, first let the patient cough or suffocate to increase abdominal pressure, observe whether there is urine overflow from the urethra to determine whether there is tension urinary incontinence, and then empty the bladder , for gynecological examination.

First of all, pay attention to the situation of vaginal wall prolapse and uterine prolapse in the absence of force, and pay attention to the vulva situation and the degree of perineal rupture.

The vaginal speculum observes whether the vaginal wall and the cervix are ulcerated, and whether there is a uterus rectal fossa.

In the vaginal internal examination, attention should be paid to the levator ani muscles on both sides, determine the width of the levator ani muscle fissure, the position of the cervix, and then determine the size of the uterus, and the location and attachment of the pelvic cavity with or without inflammation or tumor.

Finally, the patient is treated with abdominal pressure, and if necessary, the sputum can be taken to make the uterus prolapse and then percussion to determine the degree of uterine prolapse.

Diagnosis of uterine prolapse

diagnosis

Mainly according to the signs, in addition, should also do a certain check, sputum patients do not understand urination, take the bladder lithotomy position, first check the patient cough or sputum to increase abdominal pressure, observe whether there is urine overflow from the urethra, To determine whether there is tension urinary incontinence, and then empty the bladder, gynecological examination, first pay attention to the situation of vaginal wall prolapse and uterine prolapse in the absence of force, and pay attention to the vulva situation and the degree of perineal rupture, vaginal speculum observation Whether the vaginal wall and the cervix are ulcerated, whether there is uterine rectal fossa, the vaginal internal vaginal should pay attention to the levator ani muscles, determine the width of the levator ani muscle, the position of the cervix, and then the size of the uterus, the position and attachment in the pelvis There is no inflammation or tumor, and finally the patient is treated with abdominal pressure. If necessary, the sputum can be taken to make the uterus prolapse and then percussion to determine the degree of uterine prolapse.

Differential diagnosis

1, vaginal wall mass or bladder bulging

The patient has a vaginal mass loss, double examination to check the vaginal wall mass (cystic or solid) in the vaginal wall, the boundary is clear, active or fixed, the bladder bulge is not seen in the uterus, the single leaf pull ditch will The vaginal forearm is lifted up, and the cervix can be seen. The doctor can touch the cervix and the uterus.

2, cervical extension

Refers to the simple cervix extension without uterine bulging, sometimes accompanied by mild anterior and posterior wall bulging, simple cervical extension can be identified by palpation and uterine prolapse, double examination to check the vaginal part of the cervix, uterus In the pelvic cavity, the breath does not move down, and many patients with uterine prolapse are accompanied by cervical extension.

3, uterine submucosal fibroids

The patient has a history of menorrhagia, and the smaller fibroids are exposed to the cervix. The cervix is red, the texture is hard and tough, and the larger submucosal fibroids are removed to the external cervix. There is no cervix, double examination and examination of the cervix around the mass.

4, uterus inversion

For chronic uterine inversion, it is rare, the uterus is seen in the vagina, covered with dark red velvet endometrium, easy to bleed, no cervix on it, canal opening on both sides, double or triple examination There is no uterus in the pelvis, and if necessary, it is supplemented with abdominal B-ultrasound.

5. Vaginal bulging

Patients have a history of pelvic surgery such as prolific history or hysterectomy. After the iliac crest is accompanied by uterine prolapse, the patient complains of vulvar soft mass prolapse and constipation. The vaginal wall is obviously bulged and there is no cervix. It can be seen that the larger of the sac, the visible and the intestinal peristalsis, double examination and examination of the iliac crest can be sent back to the pelvic cavity (vaginal anterior wall bulge without this feeling), double examination examination of the pelvic cavity without uterus, patient standing The thumb (in the vagina) - the index finger (in the rectum) is examined to reach the small intestine in the hernia sac, and uterine prolapse and vaginal bulging are generally easy to identify.

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