Outlines of the diseases of women / by John Phillips.

  • Phillips, John.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

    144/332 (page 124)
    The uterus is usually enlarged in these cases, and may be acces- sory to the production, but is not a direct cause of prolapse. Causes of Prolapsus Uteri. Direct.—i. If we consider the utero-sacral ligaments and the anterior vaginal wall as the chief supports of the uterus, any weakening or relaxation of the pelvic floor, such as stretching of the utero-sacral or broad ligaments and the levator ani, as after labour, will be an important cause. 2. Increase in the intra-abdominal pressure, as by chronic cough, constipation, tight-lacing, or hard work, as wash- ing. 3. Prolapse of the vaginal walls. 4. Traction from below by instruments—i.e., application of forceps with an undilated cervix, or volsellaj to the cervix in supra-vaginal amputation. 5. Atrophy of the parts in old age. Indirect.—1. Increased size of the uterus, as from fibroids or sub-involution. 2. Injury to the perineal body (lacerated perineum). Symptoms.—In the incomplete or partial prolapse, the patient may have bearing-down and weight in the pelvis worse on stand- in o- or exertion, irritation of the bladder and constipation, monorrhagia and leucorrhcea; she is usually easier lying down. In the complete form, she feels many of the above symptoms, and has in addition the inconvenience of a large extruded mass, preventing her either sitting or walking in comfort: the urethra being distorted and a cystocele present, much vesical and urinary trouble results. . The extruded mass is subject to pressure, and the mucous surface becomes skin-like and ulcerates in places, giving rise to fetid dis- charge and haemorrhage. Diagnosis.—The only condition likely to be mistaken for early prolapse is hypertrophic elongation of the cervix (Fig. 76): in this latter, the sound usually passes beyond the normal owing to in- creased length of the cervix, but the fornices are normally situated: in a prolapse, the sound may pass farther than normal but the fornices are obliterated, and examination by rectum allows the finder to be pushed into the sac of the rectocele, while by means of the sound the posterior bladder wall is found to oe partially prolapsed (cystocele). Treatment. 1. Palliative; 2. By pessaries; 3. Operative.