Prolapse of the uterus, and repair of cystocele, rectocele,
There are several different types of vaginal prolapse:
When the uterus falls down, it is called Uterine Prolapse. The uterus
is the muscular organ at the top of the
vagina. In uterine prolapse, your uterus
moves from its normal position down into
your vagina. The uterus may be only slightly
out of position, or it may descend so
far that it can be seen outside the vagina.
The severity of uterine prolapse is classified
by degree:
In first-degree uterine prolapse, the cervix is visible when the perineum
is depressed.
In second-degree prolapse, the cervix is visible outside of the vaginal
introitus, while the uterine fundus remains inside.
In third-degree prolapse, or procidentia, the entire uterus is outside of the vaginal
introitus.
Uterine prolapse is associated with:
• incontinence,
• vaginitis,
• cystitis,
• pelvic pressure and pelvic pain.
If the anterior vaginal wall and bladder fall down, it is called a Cystocele.
A cystocele occurs when the tissues between the bladder and the vagina
weaken, leading to a herniation of the bladder.
If the posterior vaginal wall and rectum fall down it is called a Rectocele.
The patient may report having to manually reduce the Rectocele before
defecation.
Sometimes, a space develops between the vagina and rectum into which
small bowel, usually the sigmoid colon,
can bulge. This is referred to as an Enterocele.
Some time after hysterectomies, the vaginal vault may prolapse as well.
Such Vault Prolapse may or may not cause
symptoms. The position of the vagina relative
to the rest of the body is somewhat like
the finger of a surgical glove, which
is tucked inside the rest of the glove.
In this way, the vagina is surrounded
by an enclosed area. If the pressure in
that area is increased as, the vagina
tends to be pushed downward and to protrude
outward creating a vault prolapse.
Although surgical repair of certain pelvic support defects offers most
of the time a permanent solution, some patients may elect to use a pessary
as a temporary solution.
The pessary is most commonly used in the nonsurgical management of pelvic
support defects. Multiple vaginal deliveries can weaken the musculature
of the pelvic floor. Hysterectomy or other pelvic surgery can predispose
a woman to weakness of the pelvic floor, as can conditions that involve
repetitive bearing down, such as chronic constipation, chronic coughing
or repetitive heavy lifting. As the geriatric population continues to
increase, more patients are presenting with pelvic floor defects. While
many of these patients are poor candidates for surgery, most of them
can safely use a pessary.
If interested in learning more call Dr. Marcovici at 860-409-1930 for
an appointment!!!
|
