Anterior vaginal bulge
Introduction
Introduction to vaginal anterior wall bulging The bulge of the anterior wall of the vagina (bulgeofpariesanteriorvaginase) is very common, in fact, the bladder and urethra bulge often combined with dysuria. Mild bulging usually does not have any symptoms; when it is severe, clinical symptoms appear, and then treatment is needed. In order to remove urine, women often need to compress the vagina or use the hand to return the prolapsed tissue. basic knowledge Sickness ratio: 0.05% Susceptible people: women Mode of infection: non-infectious Complications: Bladder bulging Cystitis Hydronephrosis
Cause
Cause of vaginal anterior wall bulging
(1) Causes of the disease
The reason for the bulging of the anterior wall of the vagina is not completely clear. The individual factors of bulging vary according to the individual, which may be caused by congenital or acquired factors. The maintenance of the normal structure of the vaginal and surrounding pelvic organs is As a result of the interaction between the pelvic muscles and the connective tissue, the upper part of the vagina is located on the levator ani muscle and remains stable through the connective tissue connected to it above and behind; the central part of the vagina is connected to the arched ligaments on both sides of the pelvis, due to Normally supporting nerves, muscles or connective tissue lose normal function, such as pelvic muscles, connective tissue or both, which can lead to loss of vaginal support structure, massive childbirth, prolific or surgical delivery, prolonged labor causes pubic bladder cervix The fascia stretches, thins and tears, causing part of the posterior wall of the bladder and the triangle of the bladder to fall into the anterior wall of the vagina, causing the bladder to bulge. The urethral bulge is often accompanied by bladder bulging, which is the fetal head to the urethra during childbirth. Caused by the shearing effect of the pubic symphysis under pressure, such as during the delivery process, when the fetal head passes through the vagina, as shameful Cervical fascia, bladder and cervical ligament of levator ani muscle pubococcygeus excessive stretching or tearing, postpartum recovery is not yet scheduled, so that the bottom of the bladder loses support forces, gradually bulging front wall of the vagina, causing vaginal prolapse.
(two) pathogenesis
The anterior vaginal bulging is divided into two types: dilatation type and displacement type. The expansion type is caused by excessive pulling and thinning of the anterior wall of the vagina. The causes of vaginal delivery are related to vaginal delivery and age and menopausal vaginal atrophy. One type is characterized by the disappearance of vaginal folds due to thinning of the anterior wall of the vagina or loss of the midline vaginal fascia. The displacement type is due to the pathological separation and elongation of the vaginal support tissue to the pelvic wall of the pelvic wall. It can be unilateral or bilateral, often associated with varying degrees of bladder bulging and excessive urethral movement, with a pathological downward shift of the anterior wall of the vagina and the medial side of the bladder.
Prevention
Vaginal anterior wall bulging prevention
Should prevent birth trauma, menopausal women should actively exercise to increase the function of the pelvic muscles.
Complication
Vaginal anterior wall bulging complications Complications, bladder swelling, cystitis, hydronephrosis
Vaginal anterior wall bulging often accompanied by bladder bulging, urethral obstruction, poor urine discharge, severe urinary dysfunction, residual urinary tract easily with cystitis, and frequent urination, urgency, dysuria, a small part of prolapse Women with hydronephrosis.
Symptom
Symptoms of vaginal anterior wall bulging Common symptoms lumbosacral pain, sexual intercourse, difficulty in urinating, sphincter dysfunction, vulva, urinary incontinence
The anterior wall of the vagina can be asymptomatic, and the urinary tract swell is a serious manifestation. The most common symptom of women with vaginal anterior wall bulging is the vaginal prolapse or related symptoms, and the self-consciousness of the vaginal prolapse. When labor, coughing, exertion and other abdominal pressure increase or bladder accumulation, the substance increases and there is urine overflow; bed rest or urination shrinks, or even disappears, the patient has vaginal fullness, pelvic fall, pressure urinary incontinence Or urinary insufficiency, lumbosacral pain increased after a long period of time and difficulty in sexual intercourse, etc., often patients need to push the vaginal vaginal to urinate.
Clinical indexing:
1.I degree (mild) The anterior wall of the vagina has reached the virgin margin and has not yet exited the vaginal opening.
2. II degree (moderate) Part of the anterior wall of the vagina has bulged out of the vaginal opening.
3. III degree (severe) The anterior wall of the vagina has all bulged out of the vaginal opening.
Signs include vaginal masses, stress urinary incontinence, and 39% of pressure urinary incontinence in the anterior wall of the vagina.
In the case of bladder filling, the patient first takes the bladder lithotomy position to check the external genitalia. If no corresponding signs are found or the degree of maximal prolapse is not certain, the standing position is checked. If no obvious exfoliation is found, gently expose the labia minora. The vestibule and hymen, assessing the integrity of the perineal body, and estimating the size of the exfoliated tissue, using the posterior stalk of the speculum to compress the posterior wall of the vagina helps to expose the anterior wall of the vagina, and then let the patient forcefully hold the breath or cough hard to observe the pelvic organ's prolapse. And help to identify the sidewall defect and the central defect, the former manifests as the disappearance or separation of the vaginal canal; and the midline bulge is the presence of the vaginal sulcus, the vaginal wall declines the bladder, accompanied by or not With excessive movement of the urethra, such as concurrent urethral bulging, when the abdominal pressure increases, the urethra is downward, and the front is rotated and slides.
Studies have shown that women with severe prolapse urinary dysfunction is attributed to urethral obstruction, when the prolapse is reduced, urinary tract dysfunction is exposed, accompanied by stress urinary incontinence, women with severe prolapse, will After the prolapsed material is still in place, it is very important to check the function of the urethra. After the bulge is returned, if the patient has normal urination, but there is still leakage of urine by forced cough or Valsalva exercise, it indicates urinary sphincter dysfunction.
Examine
Examination of vaginal anterior wall bulging
1. Except for urine routine examination, patients have urinary tract infections.
2. Vaginal cytology scraping, estimated maturity index, evaluation of estrogen levels in patients.
3. Urodynamic examination Before the urodynamic test, the pessary should be placed in the vagina to reduce prolapse. If there is stress urinary incontinence or emptying, the test should be performed.
4. Endoscopy examines the function of complete emptying of the bladder, usually after urination, to measure residual urine in a timely manner.
5. Ultrasound examination measures residual urine.
Diagnosis
Diagnosis and differentiation of anterior vaginal wall bulging
1. Urethral and bladder tumors The bladder bulge is soft and can be retracted while the tumor side is hard and fixed.
2. Urethral diverticulum Although the huge urethral diverticulum resembles bladder bulging, it tends to be biased to one side, with tenderness, and the compressive mass can overflow purulent secretions from the urethra.
3. Small intestine bulging Very few patients after hysterectomy, the small intestine can bulge from the anterior wall of the vagina, the probe can be inserted into the bulging area of the bladder through the urethra, and then the top of the probe can be touched by the hand through the vagina, and the bladder wall and the vagina can be felt. There is thickened tissue between the walls.
