PROLAPSED UTERUS DIAGNOSIS & A PHYSICIAN'S GUIDE TO TREAT HER
There is no difificulty in making a diagnosis for prolapsed uterus except in the early stage. An inverted uterus might be mistaken, or a polypus hanging down from the uterus, or a cyst or other tumour in the vagina. The presence or absence of the external os will determine whether the swelling is the uterus or not.
Three conditions have to be distinguished :
Prolapse Uterus must be diagnosed from
Giving way of the uterine ligaments ;
From laceration or relaxation of the pelvic floor ;
A combination of both these ;
Elongation of the supravaginal cervix, in which prolapse is more apparent than real.
If a patient with symptoms of prolapse is found on examination to have the uterus in position and an intact perineum, she is probably suffering from descent of the pelvic floor. When lying on her side the perineum can be observed as a groove between the buttocks descending slightly during inspiration. Under normal conditions a strong bearing-down effort will cause a descent of ^ to 1 inch, but when there is undue relaxation of the pelvic floor this may extend to two or more inches.
This condition is not nearly so common as the other forms of prolapse. The cases most likely to be overlooked are those of incipient prolapse, where the descent of the uterus is slight, unless the patient is examined while standing, and told to bear down as much as possible.
Success in Diagnosis will depend upon an intelligent appreciation of the actual condition of the patient. If, for instance, the prolapse is due to a giving way of the uterine ligaments, a tear in the perineum, sewing up the latter will not cure the patient, althoiigh it will do good. There are three principal methods of treating patients, viz., medical, mechanical, and surgical.
A cold hip-bath every morning, followed by a brisk rubbing with a rough towel, is an excellent tonic. Fresh air, plain food, and early hours should be enjoined. Any tendency to constipation must be most carefully corrected.
The choice of aperient will depend on the type of case, but for most patients there is nothing to equal cascara sagrada combined with a little hyoscyamus and oil of peppermint, to prevent griping.
A glass of good burgundy, port, or stout in non-gouty patients does much good.
Astringent vaginal douches help matters.
That which I prefer consists of two parts of alum to one of sulphate of zinc ; a drachm of this is added to a quart of tepid or cold water and used morning and evening.
During menstruation the water must be hot instead of cold, and the patient should also keep her feet up. In the intermenstrual period she can go out in a bath-chair or a carriage, but must not stand or walk much. On account of the general relaxation of the tissues pessaries are not of much service at first.
PATIENT'S TREATMENT FOR PROLAPSED CONDITION
TREATMENT :The patient should have everything constricting the waist loosened or removed.
Lying on her back with the knees flexed and the legs drawn up in an easy and unconstrained position, so as to relax the abdominal muscles, the physician will find the cervix pointing up- wards and forwards, and from this point will be able to trace the cervix into the body of the uterus to the fundus as it lies behind the posterior vaginal wall.
With the left hand over the abdominal wall he will be able to assure himself of the absence of the fundus from its usual position behind the pubes or further back.
The swelling in Douglas' pouch will also be very tender if it is the fundus; but it is also tender when due to perimetritis