Uterine prolapse . It occurs more frequently between the sixth and seventh decades of a woman’s life, but it is not exceptional in women of reproductive age.
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- 1 Clinical picture
- 2 They are divided into three compartments
- 3 Causes
- 4 Symptoms
- 5 Diagnosis
- 6 Treatment
- 7 Sources
First-degree uterine prolapse may be asymptomatic or produce only sensation of vaginal weight or difficulty with intercourse, depending on the descent of the uterus and its mobility. In second and third degree prolapse, the main symptom is the descent alone or accompanied by the hernia descent of the Bladder or the Rectum in the vulva, which causes pain or a sensation of weight.
In addition to genital symptoms, there are extragenital, especially urinary, ranging from incontinence to difficulty urinating. Cystitis caused by infection of the urine that is retained in the bladder is frequent. Constipation, hemorrhoids, and rectal discomfort are almost always associated , especially when there is a large rectocele. Since in the second and third degree prolapse the neck projects to the outside, erosions can occur that frequently become infected and cause little bleeding. In cases of long evolution, cervical and vaginal wall ulcerations of considerable extension are presented, requiring admission and intensive treatment.
They are divided into three compartments
Previous: Vaginal prolapse of urethra or bladder or both (cystocele, urethrocele).
Medium: descent of the uterus or vaginal dome (uterine prolapse, enterocele). Posterior: prolapse of rectum into vagina (rectocele).
Uterine prolapse occurs in women who have had one or more vaginal deliveries.
- Another cause of prolapse may be normal aging and estrogen deficiency after menopause.
- Chronic cough and obesity increase pressure on the pelvic floor and can contribute to prolapse.
- Uterine prolapse can also be caused by a pelvic tumor, although this is rare.
- Feeling of sitting on a small ball
- A difficult or painful sexual relationship
- Frequent urination or sudden, urgent need to empty the bladder
- Pain during sexual intercourse
- Protrusion of the uterus and cervix through the vaginal opening
- Repetitive bladder infections
- Feeling of heaviness or pulling in the pelvis
- Vaginal bleeding or increased vaginal discharge
Many of the symptoms are made worse by standing or sitting for long periods.
It is performed from the interrogation where the patient reports the symptoms indicated in the clinical picture. With the physical examination it is easily verifiable, from the degree of intensity that shows different clinical characteristics:
First grade . Physical examination for first-degree uterine prolapse shows the relaxed pelvic floor and the greater or lesser output of a portion of the vaginal walls. The uterus is usually retroviated, and the cervix is very low and forward, near or in the vaginal opening; When the patient coughs or pushes, the uterus and vaginal walls protrude more.
Second grade . The neck appears in the vulva and protrudes when the patient pushes; it is accompanied by the vaginal walls and, sometimes, the Bladder. There may be erosions on the neck to a greater or lesser degree and sometimes ulcers.
Third degree . A tumor almost as large as the fist is seen, protruding from the vulva and placed between the thighs. In the lower portion is the cervix.
When diagnosing uterine prolapse, confusion may arise with any mass found in the Vagina.or it projects outside (cystocele or rectocele, described above) or with a pediculated fibroid that is in the vagina or protrudes outwards. The idiopathic elongation of the cervix is also characteristic, in which the uterine body is almost in a normal position in the Pelvis and the hysterometry is increased; in uterine inversion, the uterus is inverted and palpated as a mass of the vagina, with the uterine body absent in its normal place. Finally, it must be remembered that the Gartner cyst is cystic in consistency and located in the vaginal wall.
It can be conservative or surgical, depending on the following factors:
1. Degree of prolapse.
2. Age of the patient.
3. Desire to have more children or not.
4. General state of health and presence of associated diseases.
In those cases in which there is an operative contraindication, the reduction of prolapse and its maintenance can be applied by means of circular ring pessaries that, inserted in the vagina, serve as a support for the uterus .
Surgical treatment aims, first of all, to reconstitute the perineal floor whenever possible, with the aim of creating a
firm support base and restoring the anatomical situation of the pelvic organs, not only of the uterus but of the bladder and the straight.
In those cases of first-degree prolapse, no treatment is required, unless it is accompanied by a rectocistocele, and then it resolves with colpoperinorrhaphy.
There are different surgical techniques that depend on the degree of the prolapse, on the age of the woman, on whether she has sexual relations and, in the case of the woman of reproductive age, on her interest in having new children.
In second degree prolapse, the so-called Manchester operation may be considered (neck amputation with ligamentous hysteropexy and colpoperinorrhaphy; in third degree prolapse, the indicated operation is vaginal hysterectomy , since it is very rare to occur in patients of reproductive age and a conservative technique would have to be considered.Older
patients who do not have sexual intercourse and their general condition is precarious, can undergo a Le Fort type colpocleisis.