Uterine prolapse is defined as the descent of the uterus from its normal position along the vagina, with the external cervical opening reaching below the level of the sciatic spine or even prolapsing completely outside the vaginal opening. It is an abnormal protrusion of the uterus through the pelvic floor fissure or genital fissure. Uterine prolapse is often accompanied by bladder bulge, rectal bulge and bowel bulge.
In 752 A.D., Wang Toi’s book “The Secret Essentials of Wai Tai” called “Yin Ting”, “Yin Fungus”, and “Yin Xie De”. “In 1237 A.D., Chen Ziming wrote the “Good formula for women” and called it “yin jing xiaodu”. Our folklore is commonly called “hanging eggplant”, “falling bag disease”, “falling urine bag” and so on.
Uterine prolapse is often due to causativeevent (such as birth injury, systemic disease asthma, chronic bronchitis, etc.) causing weakness of the supporting fascia (uterosacral ligament, main ligament, rectovaginal fascia and pubic cervical fascia) in the uterus and vaginal pelvis, and with the aging and degenerative weakness of these structures, uterine prolapse occurs.
According to traditional Chinese medicine, uterine prolapse occurs mainly because of weakness of qi and blood and inability to take in, or qi deficiency and sinking, and lack of consolidation of punching. At this time, if combined with other causes, such as childbirth injury, excessive labor, room labor, etc..
The main manifestations of uterine prolapse are
1.Self-consciousness of perineal swelling, vaginal dislodgement of foreign body.
2. The foreign body may increase in size when standing or holding the breath, and shrink or return when lying down.
3. It is often accompanied by back pain, abdominal drop, drop when walking, bladder irritation and difficulty in urination.
4.Lower back pain, more so in the deep lumbosacral region, but no pressure points.
5. Increased leucorrhea, sometimes in the form of yellow pus-like blood and water, and itching of vulva may be present.
Posteriorly inclined uterus is prone to uterine prolapse, and the factor uterine body and vaginal axis are in a linear relationship, such as the enhanced intra-abdominal pressure produces a piston-like effect.
There is no significant difference between residual cervical prolapse (in patients undergoing subtotal hysterectomy) and intact uterine prolapse.
In premenopausal uterine prolapse, the cervix is often hypertrophic, congested, and flaccid; in postmenopausal ones, the vaginal mucosa is thickened and keratinized, and decubitus-like ulcers often occur.
The prolapsed uterus can cause cervical lesions and even cancer due to long-term inflammation and mechanical stimulation. If the intrapelvic fascia and its denseness are maintained, genital fissure and levator muscle insufficiency only cause cervical lengthening.
Simple cervical lengthening means that the cervical opening moves down or prolapses beyond the vaginal opening, but the body of the uterus remains in its normal position. This determination is important.
Identification can be assisted by anal fingering. The finger in the rectum first feels the uterine body in the pelvis and then makes the patient burst downward or gently pulls the cervix downward, if the uterine body remains in the original position, then it is simple cervical lengthening. If the uterine body descends with traction, the uterus is prolapsed or the cervix is prolonged.
Based on the interpretation of the modern intergaltheory of pelvic floor reconstruction, a “three-chamber system” was established to locate pelvic connective tissue defects.
Anterior: pubourethral ligament, vagina below the urethra (hammock), and external urethral ligament
Middle: pubocervical fascia, cervical ring, pelvic tendon arch fascia
Posterior: uterosacral ligament, rectovaginal fascia, perineal body
Connective tissue defects of uterine prolapse, which can occur singly or in combination.
It is important to identify the cause of each defect before treating patients with uterine prolapse —— This determination is important.
Modern pelvic floor reconstruction surgery based on the holistic theory of pelvic floor dysfunction aims to repair and reconstruct pelvic floor defects and restore the anatomical structure and normal function of pelvic floor tissues. The application of various new materials and surgical methods, especially the application of mesh and slings, has greatly improved the efficacy of pelvic floor repair and reconstructive surgery and effectively reduced the recurrence rate in the medium and long term after surgery.
With the gradual increase in the elderly population, uterine prolapse disorders are becoming more and more common. Elderly patients do not need to treat uterine prolapse as a disease they are ashamed to talk about. Timely treatment and repair of uterine prolapse is necessary to improve the standard of living and ensure quality of life.