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About uterine prolapse is vaginal hysterectomy decreased along the normal position, outside the mouth of the cervix below the level of the ischial spine, and even
Graphic 1 normal uterus prolapse in vaginal hysterectomy all extraoral, called uterine prolapse. 2 cause of early pregnancy production, premature birth or excessive production of marriage Yu-pelvic muscle relaxation is the most important reason of this disease. Birth injuries, such as the prolonged labor, emergency products, huge fetus is delivered, operative delivery and other tissues can cause cervical, pelvic fascia, pelvic floor muscle stretch and tear over the main fascia. Especially when the cervix has not opened all the early implementation of the above combination of abdominal surgery or more of these support structures have been damaged and weakened their support or loss of uterine prolapse. Premature to participate in heavy physical labor after childbirth. Especially those who face it together increased abdominal pressure such as lifting Tam labor. Can lead to the Ministry of vertical, more seriously, at the same time can lead to bulging of the rectum and bladder. Menopause or after menopause, due to the decline of ovarian function, estrogen levels decline, weakening support for reproductive tract, uterine prolapse occurs. Congenital pelvic tissue hypoplasia. Slowly the long-term cough, abdominal pressure is too large, poor health can lead to uterine prolapse. 3, the incidence of various parts of Ch


ina, according to census statistics, the incidence of uterine prolapse was 1% -4%, and more mountains than plains, manual workers were more common than mental, more maternal morbidity. 4 clinical manifestations 1. Lumbosacral sacral pain particularly at night especially, and labor is more obvious, after the bed rest can be alleviated. In addition, patients being lower abdomen, vagina, perineum fall, also increased after exertion. 2. Vaginal prolapse tumor patients reported having vaginal prolapse spherical objects since, in walking, manual labor to be more clear on their own after bed rest is also satisfied. Severe prolapse, day out on the outside, not their own is also satisfied, because walking activity, a sense of friction with the underwear is not, well friction ulcer, infection, increased secretions, or bleeding, falling into the local tissue thickening of the angle of. 3. Urinary tract symptoms in most patients with uterine prolapse, when the laughter, severe coughing, and potential force, the sudden increase in abdominal pressure, causing urinary incontinence and overflow. Uterine prolapse is often accompanied by varying degrees of bladder prolapse, stress urinary incontinence but whether there is, depending on the anatomical relationship between the bladder and urethra are changed. A small number of patients with uterine prolapse, difficulty urinating, causing urinary retention, need to move your fingers to prolapse of the bladder after elected in order to urinate. The reason for the severe bladder prolapse, swelling of the bladder is lower than the urethra. 4. Menstrual changes, pelvic organ prolapse in the vaginal and more, resulting in blood circulation disorders, local congestion, affecting the normal menstruation, menorrhagia can. In addition, blood circulation disorder complicated by organ prolapse ulcer, infection, resulting in increased vaginal discharge, accompanied by bloody discharge. 5. Generally does not affect conception, pregnancy and childbirth, but not yet satisfied by uterine prolapse, cervical edema in labor but may appear after the expansion of the difficulties caused by cervical dystocia.
Graphic 56 ectopic ureter. Signs down from the cervix in the uterus from the vagina hymen <14cm to the vaginal prolapse uterus entirely outside. Uterine prolapse can also satisfied that the bladder is often accompanied by rectal prolapse, vaginal mucosal thickening keratosis, cervical hypertrophy and extension of the bladder uterus from the vagina before the dome nest dist 2cm, up to 4 ~ 5cm. With severe bladder prolapse and uterine prolapse, vaginal bladder fold cross-channel disappeared, the bladder can be longer than the lower bound of the cervix, mouth, severe uterine prolapse are bladder, ureter down, and the urethral opening is the formation of " " area. 5 dividing uterine prolapse
6 sub-degree uterine prolapse of the 1981 held in Qingdao, some provinces, municipalities and autonomous regions, "the two diseases," the of scientific research coordination group, check the patient supine forced down under the screen when the extent of the uterus, uterine prolapse into three times: degree: cervical prolapse from hymen <4cm, but not vaginal prolapse outside. Light: from the cervix, mouth hymen edge <4cm, below the edge of the hymen. Heavy: cervical margin reached the hymen, vaginal opening, the cervix can be seen. Grade : part of the uterus cervix and vagina have prolapse outside. Light: Cervical prolapse of the vaginal opening, Palace still in the vagina. Heavy: Some Palace vaginal prolapse. degree: the cervix and uterus prolapse vagina mouth full. 5, mainly based on Western diagnostic signs. Furthermore, it should do some checking. Zhu Huanzhe understand urine, bladder stone patients to take place. Let the patient cough or check into gas in order to increase abdominal pressure, observe whether the overflow of urine from the urethra in order to ascertain whether there is tension incontinence, and emptying the bladder, gynecological examinations. First, note that no force in the case, vaginal wall prolapse and uterine prolapse of the situation. And pay attention to the situation and perineal rupture extent of the vulva. Observation of the vaginal speculum vaginal wall and cervix with or without ulceration, with or without uterine hernia rectal fossa. Patient should pay attention to both sides of the vaginal levator ani muscle, to determine the width of levator ani muscle fracture, cervical position, and then clear the uterus size, position in the pelvic cavity and accessories with or without inflammation or tumor. Finally, Zhu Huanzhe use of abdominal pressure, if necessary, desirable squatting, uterine prolapse further palpation to determine the degree of uterine prolapse. 5 Chinese medicine diagnosis and pathogenesis of this disease is always the true, but should focus on the distinction between clinical deficiency, kidney, or rely on virtual reality in the three syndromes. Shenpi discouraged, abdominal straining, the more the case of Qi; recurrent backache knees soft, abdomen fall urinate frequently, the more the case of kidney; surface ulceration of uterine prolapse, vaginal discharge dripping who is hot and humid and rely on the clinical investigation as carefully identified . 1. Qi Master Card: Uterine prolapse in the vagina or extraoral down, labor is increasing, lying is gone, abdominal straining, weakness, less gas lazy words, looking Shaohua; urinary frequency, vaginal discharge quantity, quality rare color white, pale tongue thin moss, empty pulse fine. Analysis: The spleen in the air, spleen qi deficiency is easily understood in the settlement, so the lower abdomen to fall, the lower uterine off; spleen limbs, yang deficiency in the weak, the weakness, less gas lazy words, looking Shaohua; Ha Yuen Qi is bladder missed appointments, so the frequency of urination; spleen can not be shipped wet, wet muddy bet, then taken off the volume, quality Qingxi. Pale tongue, thin, thin veins are empty signs of deficiency. 2. Kidney main card: removal of uterus, lumbar acid Tuiruan, abdominal straining, frequent urination, particularly at night, dizziness, ringing in the ears, pink tongue, the pulse was weak. Analysis: House of lumbar kidney, kidney essence and the Department of cells, either red kidney is not solid, with a pulse missed appointments that may cause uterine prolapse, backache petrified, abdominal falling; phase table kidney and bladder, kidney bladder Secretary gasification lost, so frequent urination, particularly at night; Kidney essence deficiency, orifices dystrophy, it is dizziness, tinnitus. Pink tongue, the pulse was weak, are due to kidney deficiency. 3. Heat the main card: uterine prolapse vagina mouth, surface ulceration, yellow water dripping or burning sensation during urination, or dry mouth, mouth pain, tongue red, or yellow greasy fur, weak pulse, or sink. Analysis: As the depression or kidney qi deficiency is not solid, long-term result of uterine prolapse in the vagina mouth by friction and damage clothes, easy to heat cult poison attack, Accumulation in the next, so the surface ulceration, yellow water dripping; hot and humid in the next Yun Jiao, the burning sensation during urination; steam is hot and humid day on hard, dry mouth, red tongue, yellow greasy moss. As prolapse caused by the deficiency or kidney deficiency, so the pulse was weak. 4 differential diagnosis of uterine prolapse should be differentiated from the following diseases. 1. Vaginal wall prolapse bladder tumor or tumor removal in patients who have vaginal, vaginal bimanual examination mass (cystic or solid) in the vaginal wall, the boundary clear, activity, or fixed. Visual examination of bladder prolapse no cervix, leaf pulling groove forearm lifted up the vagina, the cervix can be seen, DRE palpable cervical and uterine body. 2. Cervix without uterine prolapse that extended the simple extension of the cervix, sometimes accompanied by mild vaginal anterior and posterior wall prolapse. A simple extension of the cervix can identify by palpation and uterine prolapse. Bimanual examination of the vaginal part of the extension of the cervix, uterus in the pelvic cavity, the breath is not down. Many patients with uterine prolapse accompanied by cervical extension. 3. Submucous fibroids menorrhagia patients with a history of fibroids with the smaller exposure glimpse Yam estuary mouth of the cervix can be seen in red, hard and tough texture, prolapse of the mass. Outside the larger population of cervical prolapse to submucosal fibroids, depending on the patient is no mass cervix, bimanual examination cervical mass at the top surrounded by there. 4. Uterine inversion is chronic intrauterine turn, is extremely rare. See pulls the uterus inside the vagina body, covered dark red velvet like endometrial, easy bleeding, their is no cervix, fallopian tubes can be seen on both sides of the opening, or triple bimanual pelvic examination without attending the uterus. When necessary, supplemented by abdominal B-ultrasound.
Vaginal vault prolapse combined hernia DRE Figure 75. Vaginal vault prolapse in patients with history of more than a number of production or history of pelvic surgery such as hysterectomy, hernia and more posterior fornix associated with uterine prolapse. Soft tumor patients complained of genital prolapse is usually accompanied by constipation. Visual examination showed obvious swelling of the vaginal wall, cervix not visible. Hernia sac is greater, visible and within the intestinal peristalsis. Bimanual pelvic examination dome hernia can be returned (no such feeling of vaginal anterior and posterior wall prolapse), pelvic bimanual examination there is no uterus. Line in patients with orthostatic thumb (in the vagina) - index finger (in the rectum) to check the small intestine within the hernia sac can be touched tube. Uterine prolapse and vaginal vault prolapse generally easy to identify. 7 Complications of uterine prolapse vaginal prolapse often, or with bladder prolapse, rectal prolapse. Bladder prolapse who often frequent urination, difficulty urinating or incontinence. Rectal prolapse are often constipation, difficulty urinating. Acute severe uterine prolapse occurs when the peritoneal irritation symptoms (abdominal pain, pale, cold sweats, nausea and vomiting, etc.). 8 preventive health care 1. Menopausal women mature physiological function of aging from a period of change, but also mature into old age from the birth of the transitional period. During this period, the decline of ovarian function until the end disappears. Thus, women in menopause and old age, on the one hand the decline of ovarian function, low estrogen levels, so that the pelvic floor tissue and uterine suspension systems become weak, and hypotonia. On the other hand, with age, women's body is gradually weakening the body's tissue tension have become increasingly eroded. Therefore, menopause and old age for women prone to uterine prolapse. So, good women, menopause and old age health care, the prevention of uterine prolapse is also extremely important. (1) menopause and old age, women should pay special attention to work and rest to avoid fatigue, while maintaining ease of mind to pay more attention to reduce the mental burden, eliminate stress, anxiety, fear, feelings. (2) should be appropriately reduced to avoid any heavy physical labor participation. (3) to pay attention to nutrition, proper physical exercise, sticking to the levator ani muscle exercise, relaxation or to prevent the premature excessive tissue recession. (4) to prevent and treat senile chronic bronchitis and chronic constipation, regular general and gynecological examinations, early detection and treatment of menopausal and older women of a variety of common diseases. (5) Early estrogen replacement therapy. Other than gynecological in cancer, cardiovascular disease, breast cancer, hyperlipidemia, and liver and gallbladder diseases and other systemic diseases, should be promptly treated with estrogen replacement therapy, it can not only prevent osteoporosis, reduce and alleviate menopausal symptoms, but also menopausal and elderly women with ovarian dysfunction or even disappear as a result of uterine prolapse and vaginal wall prolapse of the physiological basis. 2. In addition, many women go through life special physiological period, but also their vulnerability to the disease during the period of good health, prevent or alleviate the pathological basis have uterine prolapse, menopause and old age is to prevent women the key to uterine prolapse. (1) strengthen the protection of women's work: the role of excessive weight-bearing force and body posture is a major reason for uterine prolapse, strengthening women's labor protection, prevention and reduction of uterine prolapse is a reliable guarantee. (2) good adolescent health care: women between the ages of 12 to 18, referred to as puberty. Because adolescent ovary and female reproductive organs have not yet fully mature, vulnerable to external and internal environment and the occurrence of various diseases which affect the woman's normal development and reproductive functions. Dysplasia of the woman, muscle weakness, poor ligament tension, often accompanied by abdominal wall relaxation type of physical weakness and are unable to say. Such people usually accompanied by prolapse of internal organs (such as renal ptosis, ptosis of the stomach, etc.) If for some reason leaving intra-abdominal pressure increases, it is easy to uterine prolapse. Therefore, to do adolescent health, to ensure the normal development of women's health and to prevent the occurrence of uterine prolapse has very important significance. (3) Note that the menstrual period health care: menstrual stage a growth period of a physiological phenomenon of women, but women during menstruation decrease the excitability of the cerebral cortex. Additionally, under the influence of endocrine pelvic congestion, so the systemic and local resistance are reduced. If not pay attention to the menstrual period health-care, easy to cause women to a variety of acute and chronic disease that affects women's health. Especially women during menstruation by cold stimulation (mainly water), easily lead to ovarian dysfunction caused by menstruation, or amenorrhea. Present the that ovarian function and pelvic support tissue was significantly related to the tension. Amenorrhea, due to ovarian dysfunction, low estrogen, resulting in decreased pelvic support tissue tension, prone to uterine prolapse, therefore, strengthen the menstrual period health care, the prevention of the occurrence of uterine prolapse also have great significance. (4) really good job in health care during pregnancy: do women, prenatal care, to detect and correct abnormal fetal position, fetal position to prevent the occurrence of dystocia, uterine prolapse is an important preventive measure. (5) to correctly handle the delivery of the birth process: birth injury is an important cause of uterine prolapse. The longer the production process, the higher the incidence of uterine prolapse, which is the suspension device and support the uterus and pelvic floor soft tissue injury in a greater chance of being relevant. Currently considered the first injury caused by childbirth is even more critical. In patients with uterine prolapse, a maximum incidence of first child birth, about 30%. Therefore, to correctly handle the delivery of the birth process, to prevent birth trauma, prevention of uterine prolapse is the most important part. (6) do a good job postpartum care: maternal reproductive organs from the placenta after delivery to return to non-pregnant state, which normally takes 6 to 8 weeks, this recovery process, said the puerperium. In the puerperium, women's anatomical and physiological changes are large, if not pay attention to this period, the most prone to uterine prolapse. It is reported that the incidence of postpartum uterine prolapse was significantly higher than the other of mostly the participation of workers within 1 month, the highest incidence of uterine prolapse, accounting for more than 85% of all cases. This is due to postpartum care and its support structure of the uterus due to pregnancy, childbirth and the physiological and pathological changes, yet to be fully restored until early participation in the labor (including heavy housework), easily lead to uterine prolapse. So do a good job postpartum care, the prevention of uterine prolapse has very important significance. (7) really good job in nursing care: decreased ovarian function during breast-feeding. In particular, long-term post-natal breast-feeding may be due to the long-term ovarian function resulting in a low state of uterine contraction, uterine suspension device support structure and relaxation weakness, pelvic floor muscle tone and flexibility decline, in this case, as experience increased abdominal pressure external force such as body posture or conditions, could induce uterine prolapse. Breast-feeding less than 1 year who, uterine prolapse accounted for only 9% of patients, while breast-feeding more than 1 year, accounting for more than 90%. That breast-feeding in a year or more, the incidence of uterine prolapse increased significantly. Another found that women bear the abdominal pressure during lactation, the uterus was significantly decreased compared with non-lactating, so a really good job on the health of women breast-feeding is an important measure to prevent uterine prolapse. 9 treatment of patients with uterine prolapse should adopt integrative medicine, and treatment, nutrition, rest a combination of comprehensive measures. In the treatment can be divided into: use of pessaries, internal medicine, acupuncture, fumigation and other non-surgical therapy and surgical repair. Again due to vaginal delivery after surgery have an impact, it is only for serious cases, surgery and women no longer give birth. Surgical therapy 1. Indications are commonly used second weight, three times, and / or moderate vaginal wall prolapse, or non-surgical treatment fails and symptoms of heavy patients. 2. Contraindication of cardiac dysfunction, renal insufficiency, cirrhosis, or liver damage, active tuberculosis, pulmonary insufficiency, diabetes, psychosis, severe anemia, chronic cough and bleeding disorders, cancer, infectious diseases and other systemic . Urinary tract inflammation, severe erosion, should be implemented in the treatment of control after surgery. 3. Operation Selection vaginal anterior and posterior wall repair: for no obvious cervical extension and cervical, Palace of patients without pathological changes. Man City surgery (partial resection of the vaginal cervix and vagina anterior and posterior wall repair): suitable for patients with cervical extension. vaginal hysterectomy and vaginal wall before and after repair: suitable for elderly patients with uterine prolapse, uterine prolapse, and associated with cervical dysplasia, dysfunctional uterine bleeding, small or uterine prolapse associated with uterine fibroids back corner of the vagina can not be satisfied by a serious. vaginal longitudinal (methyl) diaphragm plasty: for postmenopausal women, cervical smooth, asexual life demands, and moderate or severe vaginal anterior and posterior wall prolapse patients. 4 non-surgical treatment
Pessary placement diagram 10 pessary pessary treatment and its role - the pessary has long been used to treat uterine prolapse. The provinces and cities in the prevention and treatment of uterine prolapse work constantly to improve, have received better results. This method is simple, patients can control their own, very popular among the rural patients welcome, can be used for the degree of uterine prolapse. Pessary wide range of the commonly used pessary for the plastic mushroom style. Issued by the tray size for large, medium, small 3 (diameter or diameter, respectively 6,5,4 cm). Tray is divided into two kinds of circular and oval. Most used for the medium. ADS handle about 5 cm, forward bending to fit the curvature of the vagina. Pessary treatment is the use of the levator ani muscle of the pubic coccygeal muscle bundle to support the tray in the vaginal fornix uterus to prevent cervical drop, maintaining the level of cervical muscles in the ischium, care handle Pingyin crossing. Mild, need not plus other supporting material, if the vagina is too loose, with the support shall be entrusted with the menstrual handle, or wear a top handle with care or plastic rope, fixed on the belt before and after, so as not to fall out. No care choice - slightly larger in the reproductive (pubococcygeus) fracture is appropriate, generally cracks up to 4 cm in diameter in order, so use more medium pessary. Over time, pubococcygeus gradually restoring its elastic, extrusion department edema disappeared after reset, the weight of the uterus can no longer emerge. use of time - usually early morning before the release of labor care, night out, wash. Menstrual period not the best. Smooth surface plastic care, case of acid-base non-perishable, the organization irritation. On the care, the symptoms disappear, may participate in the labor without pain. If acupuncture, traditional Chinese medicine, the better. Over-relaxation of severe uterine prolapse who should not use vaginal care. put care method - wash hands first, the patient Banwo in bed or squat on the ground, legs apart, one hand gripping the handle care, will handle close to the perineum, anus care, so that the level of the tray to take place into the vagina. Such as care for the oval shall be so narrow end of the first tray into the vagina mouth gradually rotated to prop up the handle, so that all trays into the vagina, and then turn the handle to bend forward care. 2. Note attention to self-treatment of bed rest and sleep should be boosted when the buttocks or feet, raise the height of two bricks. get out of bed too early postpartum, especially too early to participate in heavy physical labor. avoid prolonged standing or squatting, breath holding and other actions to increase abdominal pressure. to keep urine in the open. timely treatment of chronic bronchitis, diarrhea, increased abdominal diseases. breast-feeding should not exceed two years, so as not to shrink the uterus and supporting structures. appropriate physical exercise, improve their physique. increase nutrition, more food there is qi, kidney and the role of food, such as chicken, yams, lentils, lotus seed, Gorgon, loach, mussels, leeks and dates. sexual restraint. 3. Buzhongyiqi self healing medicine pills - 6 grams each time, 3 times a day. Ginseng Spleen Pill - 6 grams each time, 3 times a day. Information spleen pills - 9 grams each time, 3 times a day. 4. Prescription treatment The Rosa laevigata from the root 60 grams, Shuijianbi, 2 times a day. 30 grams of white dorsal root, Shuijianbi, 2 times a day. take 30 grams of Citrus aurantium, Chong Wei sub 15 grams, brown sugar amount. Shuijianbi 2 times a day. white before, yam, Campanulaceae, soil bidentata, wide wood, Salvia, pollen of 30 grams, Hill eggplant, rhubarb, 15 grams of soil, iron, 60 grams of water chestnuts. Shuijianbi 2 times a day. 5. Diet Diet The pig intestine 250 grams, 100 grams of black sesame seeds, cohosh 9 grams. Wash first pig intestine, Cimicifuga with gauze wrap, with black sesame seeds into the intestine together, turn on the water stew casserole overripe home to Cimicifuga add spices, 2 times to eat and drink soup. Week 2 - 3 times. 1000 grams with litchi, rice wine 1000 ml. Total immersion for 7 days, daily morning and evening drinking 30 ml. take Tuan Yu (turtles) the first 5 - 10, washed, chopped, set pan fried yellow, Yan Mo, every night before going to sleep for 3 grams, with rice wine or rice wine delivery service. eggs 1, 30 grams of fleece-flower root. The decoction Shouwu, take gravy, eggs were re-entry cook until cooked, eggs soup, 2 times a day. The external treatment self-treatment from May 60 grams of Ukraine, first smoked by hot water to cook, after washing, 2 times a day. The Radix, gall 9 grams each. 60 grams of water to cook the vinegar after the fumigation. take honeysuckle, purple in D, dandelion of 30 grams, Cnidium, matrine and films, cork 15 grams, 10 grams of alum orange, berberine 6 grams, decoction fumigation. For uterine prolapse were associated with the infection of yellow water flow. with 6 grams of Gallus gallus domesticus, Chi Shizhi 9 grams, 6 grams of gall, borneol 0.6 grams, joint research to fine sealed bottle storage stand. First vulva with gall decoction of fumigation, the dry, apply medication last flutter, and prolapse of the uterus into the vagina, with a lift up with menstruation, sooner or later 1. 7. Taijiquan other self-treatment, so that means, gas, form one. hands on the bed, two in close together, for the squat action 5 - 15 times, 2 times a day to help the uterus contract. for the levator ani exercise. That a reduction of a loose anal action, a day for 2 times, each time about 10 minutes. to do knee-chest position, sooner or later 1. Every 10 minutes. 8. Love Tip severe uterine prolapse, not by hand into the vagina, should not use the pessary, the menstrual period is also not advisable to use pessaries. Long-term severe uterine prolapse, drug treatment ineffective, in order to avoid aggravating the infection, causing it to disease, not only by self-treatment, should go to the hospital. Some swelling and pain, such as prolapse, ulceration stream of yellow water, or there are the bloody discharge, foul smell bear who can not make up abuse, should be the main heat dampness. 11


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