vaginal prolapse
Introduction
Introduction to vaginal prolapse The vagina is divided into the anterior wall of the vagina and the posterior wall of the vagina. Therefore, vaginal prolapse is also divided into prolapse of the anterior wall of the vagina and prolapse of the posterior wall of the vagina. Vaginal prolapse is defined as the damage or defect of the pelvic floor support structure. The anterior and posterior wall of the vagina descends from the normal position along the vagina, and severe cases will fall out of the vaginal opening. Vaginal prolapse often combined with uterine prolapse or stress urinary incontinence (cough, exertion, involuntary leakage of urine when running) or dysuria, frequent urination and other symptoms, seriously affecting women's quality of life, causing psychological burden on many women, known as It is "social cancer." Lighter without obvious symptoms. The heavy one consciously falls, the back is sore, and there is a block out of the vagina, which is actually the bulging anterior wall of the vagina. Standing for a long time, after the intense activity or when adding abdominal pressure, the mass increases, and the feeling of falling is more obvious. If only the anterior wall of the vagina merges with the bladder, the posterior horn of the urethra becomes sharp, often leading to dysuria and urinary retention, and even secondary urinary tract infection. If the anterior wall of the vagina is completely bulged, the posterior horn of the urethra disappears. When the cough is increased, the force is increased, and the abdominal pressure is increased. There is urine overflow, which is called tension urinary incontinence. basic knowledge Sickness ratio: 0.1% Susceptible people: women Mode of infection: non-infectious Complications: urinary retention cystitis
Cause
Cause of vaginal prolapse
Trauma factors (30%):
Childbirth injuries, such as delayed labor, dystocia, and surgical delivery, can cause excessive stretching and laceration of the paracervical tissue, pelvic fascia, pelvic floor muscles, and fascia.
Endocrine factors (30%):
Part of early onset menopause (premature ovarian failure) or menopause when ovarian function declines, estrogen levels decline, and the function of the reproductive tract support structure is weakened, prolapse or aggravation of the original prolapse.
Innate developmental factors (20%):
Congenital support for structural dysplasia, chronic cough, etc. can lead to prolapse. Prolapse of the anterior wall of the vagina is mainly caused by excessive stretching or tearing of the pubic cervix and bladder ligament. The posterior wall prolapse of the vagina is caused by the rupture of the pubic caudal muscle fibers.
TCM etiology and pathogenesis : Chinese medicine believes that this disease is caused by insufficient innate genital endowment, or prolific room labor, collateral damage, kidney loss, sealing and dereliction of duty, and no banding; or lack of kidney yang, meridians lost in warmth; Or lack of kidney yin, can not nourish the tendons and cause the yin to fall off. Or the body spleen and stomach weakness, childbirth injury, premature labor, or long-term cough and other spleen weakness, the gas sag, can not take the vaginal wall bulging.
In short, the main mechanism of this disease is qi deficiency, kidney deficiency, due to virtual subsidence, due to depression and dissociation. If the kidney deficiency, qi deficiency affects the function of the cytoplasmic palace, it leads to infertility.
Prevention
Vaginal prolapse prevention
1. Menopause is a transitional period from maturity to aging of female physiological function, and also a transitional period from maturity to old age. During this time, ovarian function gradually declined until it finally disappeared. Therefore, women in the menopause and old age on the one hand due to ovarian function decline, estrogen levels are low, the pelvic floor tissue and uterus suspension device becomes weak, and the tension is reduced. On the other hand, with the increase of age, women's physique is gradually weakened, and the tissue tension of the whole body is also declining. Therefore, women in menopause and old age are prone to vaginal prolapse, so it is extremely important to prevent vaginal prolapse in women's menopause and old age.
Gynecological examination
(1) Women in menopause and old age should pay special attention to work and rest, avoid excessive fatigue, and pay more attention to maintaining a comfortable mood, reduce mental burden, and eliminate tension, anxiety and fear.
(2) Work should be appropriately lightened to avoid heavy physical labor.
(3) Pay attention to nutrition, exercise properly, and insist on doing levator ani exercise to prevent excessive relaxation or premature regression.
(4) Active prevention and treatment of senile chronic bronchitis and habitual constipation, regular systemic and gynaecological examinations, early detection and treatment of various common diseases in menopausal and elderly women.
(5) Early acceptance of estrogen replacement therapy. In the case of systemic diseases such as gynecologic oncology, cardiovascular disease, breast cancer, hyperlipidemia and hepatobiliary disorders, estrogen replacement therapy should be promptly received. It can prevent osteoporosis from alleviating and alleviating menopausal symptoms and improving menopause. And the physiology of vaginal prolapse and vaginal wall bulging due to ovarian dysfunction or even disappearance in older women.
2. Women have to undergo many special physiological periods in their lifetime, and they are also prone to illness during these periods of health care. They can avoid or reduce the pathological basis of vaginal prolapse, and prevent vaginal detachment in menopausal and elderly women. The key to hanging.
(1) Strengthening women's labor protection: Excessive weight-bearing effect and physical exertion are one of the important reasons for vaginal prolapse. Strengthening women's labor protection is a reliable guarantee for preventing and reducing vaginal prolapse.
(2) 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, women who are susceptible to various diseases and affect normal development and reproductive dysplasia are affected by the external and internal environment. Their muscles are weak and ligament tension is poor. There is a loose abdominal wall and the powerless body is called a weakness. This kind of person is usually accompanied by sag of internal organs (such as sagging stomach, etc.). If the intra-abdominal pressure is increased for some reasons, vaginal prolapse is easy to occur. Therefore, doing adolescent health care to ensure women's health and normal development, prevention The occurrence of vaginal prolapse is of paramount importance.
(3) Pay attention to menstrual period health care: Although the menstrual period is a physiological phenomenon of women in the reproductive period, women's cerebral cortex excitability is reduced during menstruation, and the pelvic congestion is affected by endocrine, so 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, leading to menstrual disorders or even amenorrhea. The ovarian function is closely related to the tension of pelvic support tissue, due to ovarian dysfunction, female Less hormone secretion causes the pelvic support tissue to decrease in tension and prone to vaginal prolapse. Therefore, strengthening menstrual period health care is also of great significance in preventing the occurrence of vaginal prolapse.
(4) Do a good job of health care during pregnancy: do a good job of women's pregnancy care, timely detection and correction of abnormal fetal position to prevent fetal dystocia, is also one of the important measures to prevent vaginal prolapse.
(5) Correct treatment of labor delivery: Childbirth injury is an important cause of vaginal prolapse. The longer the labor, the higher the incidence of vaginal prolapse, which is related to the greater chance of injury to the suspension device and pelvic soft tissue supporting the uterus. The damage caused by the first delivery is even more critical. Among patients with vaginal prolapse, the first postpartum incidence is about 30%. Therefore, it is the most important link to prevent vaginal prolapse by correctly handling the various labor processes of childbirth and preventing birth injury.
(6) Careful preparation of puerperal health care: It takes 6-8 weeks for the mother to return from the placenta to the non-pregnant state. This recovery process is called puerperium. During the puerperium, the anatomical and physiological changes of women are larger. If the period is not taken seriously, vaginal prolapse is most likely to occur. According to reports, the incidence of vaginal prolapse during puerperium was significantly higher than that of other patients during the first month. The incidence of vaginal prolapse was the highest, accounting for more than 85% of all cases. This is due to the physiological and pathological changes caused by the uterus and its supporting structure during the puerperium due to pregnancy and delivery. It is easy to cause vaginal prolapse due to premature labor (including heavy housework) before it has been fully restored. Therefore, conscientiously doing the puerperium health care is of great significance in preventing vaginal prolapse.
(7) Do a good job in lactation care: ovarian function decline 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 vaginal prolapse. Within 1 year, the vaginal prolapse patients only account for 9% or less, and the lactation period of more than 1 year accounts for more than 90%. It shows that the incidence of vaginal prolapse is significantly increased in those who have been breast-feeding for more than one year. In addition, it is found that the uterus position of women after abdominal pressure in lactation is lower than that in non-lactation period. Therefore, it is an important measure to prevent vaginal prolapse.
Complication
Vaginal prolapse complications Complications, urinary retention, cystitis
1, vaginal anterior wall prolapse
The heavy one has a feeling of falling, and the bulging material increases when tired or exerting force. Gradually, dysuria may occur, and the urine may not be exhausted; if there is urinary retention, cystitis often occurs. When the urethra bulges, tension urinary incontinence may occur, because the posterior horn of the urethral bladder disappears, and the internal pressure of the bladder exceeds the pressure of the urethra when coughing or increasing abdominal pressure causes the urine to involuntarily overflow.
2, vaginal posterior wall prolapse
A lump or bulge in the vagina or outside the vagina can cause a feeling of heaviness and discomfort, and can cause back pain. Especially after lifting heavy objects or muscles, the symptoms of back pain will occur. In some cases, tension urinary incontinence symptoms may occur, but in other cases, prolapse may have the opposite effect, making dysuria difficult. If the back wall of the vagina hangs down, you will find it difficult to have a bowel movement. Forced defecation can cause further vaginal wall prolapse, making the problem more serious.
Symptom
Vaginal prolapse symptoms common symptoms, backache, vulva
Lighter without obvious symptoms. The heavy one consciously falls, the back is sore, and there is a block out of the vagina, which is actually the bulging anterior wall of the vagina. Standing for a long time, after the intense activity or when adding abdominal pressure, the mass increases, and the feeling of falling is more obvious. If only the anterior wall of the vagina merges with the bladder, the posterior horn of the urethra becomes sharp, often leading to dysuria and urinary retention, and even secondary urinary tract infection. If the anterior wall of the vagina is completely bulged, the posterior horn of the urethra disappears. When the cough is increased, the force is increased, and the abdominal pressure is increased. There is urine overflow, which is called tension urinary incontinence.
Examine
Examination of vaginal prolapse
Physical examination:
The vaginal opening is slack, or there is an old laceration in the perineum. The anterior wall of the vagina is spherically bulging, soft to the touch, can be reduced when lying down, increased or moved downward when holding the breath, the transverse urethral tract disappears when the urethra bulges, and when the bladder bulges, there is a large bulging when the urine is urinating. Zoom out, visible urethral transverse groove depression, palpation and vaginal wall and bladder wall space; the posterior wall of the vagina is spherical bulging, the mass increases when holding the breath, insert the index finger into the anus, fingertips forward, you can Bend into the cavity of the bulge.
Vaginal prolapse can be divided into three degrees according to the degree of its prolapse: 1 mild, vaginal anterior wall or posterior wall bulging has reached the hymen margin, has not been bulged out of the vagina; 2 moderate: part of the anterior or posterior wall of the vagina has been inflated Out of the vagina; 3 severe: the anterior or posterior wall of the vagina has all bulged out of the vagina.
Special inspection
1. Prolapse of the anterior wall of the vagina: 1 metal catheter examination, catheter can be touched in the anterior wall of the vagina during catheterization. 2 Bladder urethra angiography, urethral posterior horn and urethral tilt angle are within the normal range.
2. Prolapse of the posterior wall of the vagina: When the anus is examined, the fingertips can extend into the blind bag of the rectum.
Diagnosis
Diagnosis of vaginal prolapse
First, the diagnosis points
(1) Medical history: There are often physical weaknesses such as physical weakness, prolificacy, delayed labor, midwifery, dystocia or birth injury.
(B) clinical manifestations: light asymptomatic, severe patients with backache, falling sense and increased after the standing, feeling that the vagina has a mass of prolapse, increased secretions, sometimes bloody or purulent, abdominal distension, difficulty in discharge.
(3) Physical examination: the vaginal opening is slack, or there is an old laceration in the perineum. The anterior wall of the vagina is spherically bulging, soft to the touch, can be reduced when lying down, increased or moved downward when holding the breath, the transverse urethral tract disappears when the urethra bulges, and when the bladder bulges, there is a large bulging when the urine is urinating. Zoom out, visible urethral transverse groove depression, palpation and vaginal wall and bladder wall space; the posterior wall of the vagina is spherical bulging, the mass increases when holding the breath, insert the index finger into the anus, fingertips forward, you can Bend into the cavity of the bulge.
Vaginal prolapse can be divided into three degrees according to the degree of its prolapse: 1 mild, vaginal anterior wall or posterior wall bulging has reached the hymen margin, has not been bulged out of the vagina; 2 moderate: part of the anterior or posterior wall of the vagina has been inflated Out of the vagina; 3 severe: the anterior or posterior wall of the vagina has all bulged out of the vagina.
(4) Special inspection
1. Prolapse of the anterior wall of the vagina: 1 metal catheter examination, catheter can be touched in the anterior wall of the vagina during catheterization. 2 Bladder urethra angiography, urethral posterior horn and urethral tilt angle are within the normal range.
2. Prolapse of the posterior wall of the vagina: When the anus is examined, the fingertips can extend into the blind bag of the rectum.
Second, differential diagnosis
1. Prolapse of vaginal anterior wall prolapse and middle renal cyst, anterior vaginal mass, and uterine prolapse.
2. The posterior wall prolapse of the vagina is differentiated from intestinal bulging or rectal bulging.
