WOMEN’S BODIES: UTERINE PROBLEMS. ENDOMETRITIS AND PROLAPSE
Endometritis
Endometritis is infection of the lining of the uterus. It can occur after childbirth or after spontaneous or induced abortion, especially if the uterus is not completely empty of all fragments of the placenta. It is treated by antibiotics and, if necessary, removal of any retained placental tissue.
Endometritis is also part of PID.
Prolapse
When the structures that hold the uterus in place become weakened or abnormally stretched (usually during pregnancy or delivery), the uterus may drop down from its normal position. This is called uterine prolapse. The cervix may move further down in the vagina, and may even protrude through the entrance to the vagina.
As the uterus moves downwards, it pulls the vaginal walls and often the bladder and rectum with it. When the front wall of the vagina and part of the bladder sag downwards, it is called a cystocoele. When the back wall of the vagina and part of the rectum sag downwards, a rectocoele has formed. Either or both may bulge outside the vagina. If the perineum has been torn during delivery and not repaired, cystocoele and/or rectocoele can occur without uterine prolapse.
Not all women who develop prolapse of the pelvic organs have had children. Anything that increases pressure in the abdomen, such as chronic cough, chronic constipation and obesity, puts excessive strain on the pelvic supports and can lead to prolapse. Also, the pelvic supports weaken with age and with reduced production of oestrogen. Many women with prolapse find that symptoms will begin or are aggravated after the menopause.
Symptoms depend on which organs are prolapsed and how much. A mild prolapse may not cause any problems.
Prolapse of the uterus can cause a dragging feeling in the lower abdomen and back, increased vaginal discharge and perhaps the feeling that something is coming out of the vagina. Symptoms are usually relieved by lying down.
If cystocoele is present, symptoms include difficulty in starting and stopping urination, urinary frequency, feeling that
the bladder needs emptying again soon after you’ve been to the toilet, and problems controlling the bladder. Recurrent urinary infections can result if the blade never empties properly.
Rectocoele can cause difficulty emptying the bowel, in spite of a constant feeling that the rectum is full and needs to
be emptied. Constipation can become a problem.
Treatment of prolapse
This depends on how severe the symptoms are and the extent of the prolapse Slight prolapse of the uterus without symptoms needs no treatment. Moderate uterine prolapse can often be helped by wearing a strong ring pessary in the vagina to hold up the uterus and to help lift associated cystocoele and rectocoele. If the supports of the uterus are so stretched that the uterus protrudes from the vagina, surgical repair is usually needed.
Mild and moderate degrees of cystocoele and rectocoele are often greatly helped by exercises and other physiotherapy to strengthen the muscles of the pelvic floor and improve emptying and control of the bladder and bowel. However, if these muscles are not only weak but also badly torn or otherwise damaged, surgery may be the only answer.
*249/31/5*
