Pelvic floor peritoneal hernia

　　Pelvic floor peritoneal hernia is caused by the weakness of pelvic floor muscles, excessive relaxation of pelvic peritoneum, and injury to the fascial support structure of the upper posterior vaginal wall. Under the action of long-term increased intra-abdominal pressure, the Douglas pouch gradually deepens, the pelvic peritoneal cavity expands, and bulges into the normal peritoneum-free rectum and vagina, forming a disease.

　　Patients with pelvic peritoneal hernia often suffer from imbalances in water and electrolyte acid-base balance, toxic shock, and intestinal ischemia and necrosis, and the disease is more common in women than in men, and is often accompanied by complications such as perineal descent, intussusception of rectal mucosa, and rectal prolapse. Some patients may also have symptoms such as irritability, abdominal distension, abdominal pain, nausea, anorexia, lumbar sacral tail pain, etc.

　　The occurrence of pelvic peritoneal hernia is related to many causes, and its common clinical symptoms are as follows:

　　1. Constipation

　　Most patients can have constipation symptoms, manifested as a decrease in defecation frequency or difficulty in defecation, and a few patients have both. According to statistics, about 83% of patients with pelvic peritoneal hernia have obvious symptoms of rectal emptying obstruction constipation, such as the need for excessive force during defecation, a sense of incomplete defecation, anal and rectal distension, repeated defecation, etc. In severe cases of defecation obstruction, manual assistance may be required for defecation, such as some patients feeling a bulge in the vaginal and perineal area during defecation, often requiring massage around the anal canal or the posterior vaginal wall to expel some feces.

　　2. Other symptoms

　　Other symptoms include irritability, abdominal distension, abdominal pain, nausea, anorexia, lumbar sacral tail pain, etc.

　　Patients with pelvic peritoneal hernia should actively correct the imbalance of water and electrolyte acid-base balance, prevent intestinal loop necrosis, and pay attention to the following preventive measures:

　　1. Consume more dietary fiber and drink more water.

　　2. Develop good habits of regular and routine defecation.

　　3. Anal muscle exercises.

　　If necessary, oral Guoda and traditional Chinese medicine for defecation can be supplemented, but刺激性泻剂 containing anthraquinone substances should be used with caution and sparingly, and can be intermittently applied if necessary, otherwise it may damage the intestinal nervous system, leading to colonic atony, and can trigger 'colonic melanosis'.

　　Pelvic peritoneal hernias often manifest as constipation, irritability, abdominal distension, abdominal pain, and can be diagnosed by the following examination methods.

　　1. Defecation imaging

　　Before defecation imaging, contrast agents should be taken orally 2 to 3 hours in advance. When exerting force to defecate, the small intestine and/or sigmoid colon containing contrast agents herniate into the space between the rectum and vagina, compressing the anterior wall of the rectum and the upper orifice of the anal canal, leading to the inability to expel contrast agents in the rectum. Mellgren reported a detection rate of 19.0% of pelvic peritoneal hernias in 2816 cases of defecation imaging, while Lu Renhua and others reported a detection rate of 13.02%. Although taking barium sulfate can help in the imaging of the small intestine and is beneficial for the diagnosis of intestinal hernia, it also increases the weight of the small intestine, making it more likely to enter the pelvic cavity and potentially increasing the rate of false positives.

　　2. Synchronous defecation pelvic imaging

　　Some scholars have found that although contrast agents were taken orally before defecation imaging, there are still difficulties in diagnosing pelvic peritoneal hernias. Fenner reported that among 7 patients with clinical diagnoses of sigmoid colon hernia, 5 were not confirmed by defecation imaging, and among 9 patients diagnosed with sigmoid colon hernia by defecation imaging, only 7 were clinically suspected. Bremmer and others found that in 22 patients with obvious defecation dysfunction, the defecation imaging showed widening of the rectovaginal septum, and synchronous defecation imaging with pelvic imaging showed that, except for 2 cases without peritoneal hernia, the remaining 20 cases had varying degrees of peritoneal hernia, and 9 cases had intestinal intubation into the hernia sac.

　　For patients with pelvic floor peritoneal hernia, the following dietary suggestions can help the disease recover effectively.

　　1. Fat

　　Lack of fats can lead to defects in wound healing. It is recommended that everyone eat more fish oil because fish oil contains a large amount of fatty acids, which have anti-inflammatory effects and are beneficial for wound healing.

　　2. Glucose

　　Sufficient sugar supply is indispensable for wound healing. Therefore, during the period of wound healing, it is recommended that patients eat more fruits, which can not only increase sugar but also supplement a large amount of vitamins.

　　3. Protein

　　Proteins can promote wound healing and reduce the chance of wound infection. Experts suggest that patients can eat more high-protein foods such as lean meat, milk, and eggs.

　　4. Vitamin A

　　Vitamin A can promote wound healing. It mainly exists in fish oil, carrots, tomatoes, and other foods.

　　5. Vitamin C

　　Vitamin C can promote wound healing. Among various vegetables and fruits, dates and chili are among the foods that contain the most vitamin C.

　　The treatment of pelvic floor peritoneal hernia can be carried out by non-surgical treatment and surgical treatment, and the specific method needs to be determined according to the situation.

　　Firstly, Non-surgical Treatment

　　Non-surgical treatment should be the first choice in treatment, mainly using symptomatic treatment to alleviate and/or eliminate the symptoms of chronic constipation.

　　Secondly, Surgical Treatment

　　1. Indications for Surgery: Non-surgical treatment is ineffective, accompanied by rectal prolapse or complete rectal intussusception, with contents entering the hernia sac, and others.

　　2. Selection of Surgical Methods: The focus of surgical treatment is to take measures against the causes of pelvic floor peritoneal hernia, correct its anatomical abnormalities, close the defects of the pelvic floor peritoneum, appropriately elevate and deepen the Douglas depression, for women below 1-2 cm under the uterine sacrotuberous ligament, and for men at the bladder neck level, so that it can recover to its normal position. There are three types of surgical methods, including abdominal pelvic floor peritoneal hernia repair, vaginal pelvic floor peritoneal hernia repair, and abdominal perineal combined pelvic floor peritoneal hernia repair.

　　3. Postoperative Management: In addition to general abdominal surgery treatment, attention should be paid to adjusting diet, cultivating good defecation habits, and performing anal exercises.