Uterine prolapse

　　The main reasons for the injury to the cervix, the main cervix ligament and the sacro-uterine ligament caused by delivery and the failure of the supporting tissues to return to normal after delivery are the main reasons. In addition, postpartum women often prefer to lie on their backs and are prone to develop chronic urinary retention, the uterus is prone to become retroverted, the uterus axis is consistent with the vaginal axis, when abdominal pressure increases, the uterus will descend along the vaginal direction and prolapse. Postpartum habits of squatting labor (such as washing diapers, washing vegetables, etc.) can increase abdominal pressure and promote uterine prolapse. Uterine prolapse in nulliparous women is due to poor development of the supporting tissues of the reproductive organs.

　　Uterine prolapse patients often have vaginal prolapse, or accompanied by cystocele, rectocele. Cystocele patients often have frequent urination, difficulty in urination or incontinence. Rectocele patients often have constipation, difficulty in urination.

　　Acute uterine prolapse can cause severe peritoneal irritation symptoms (severe lower abdominal pain, pale complexion, cold sweat, nausea and vomiting, etc.).

　　Mild retroverted uterus generally does not present with symptoms and does not require treatment. Severe retroverted uterus can cause various discomforting symptoms, including:

　　1. There is an increase in leukorrhea (patients may experience symptoms of increased leukorrhea, and the leukorrhea may sometimes be yellow pus-like, and sometimes it may be bloodwater-like.)

　　2. Feeling pressure in the pelvic cavity and a heavy sensation in the lower abdomen.

　　3. Feeling pain in the lower back.

　　4. Pain during sexual intercourse.

　　5. Because the bladder is in front and the rectum is behind the uterus, once prolapse occurs, it may cause difficulties in urination or defecation. (Frequent urination, urgency, dysuria, and when coughing, laughing, sneezing, or walking, urine may leak uncontrollably from the urethral orifice. Postpartum patients with uterine prolapse may also have symptoms of poor urination, and the rectum may also bulge, curving like an S. This may cause constipation and difficulty in defecation. Some patients can only urinate by raising their buttocks and straining, which is very painful.)

　　6. Severe patients may feel a protruding object in the lower body. (For patients with second or third degree uterine prolapse, the symptoms of postpartum uterine prolapse include the cervix and corpus uteri protruding outside the vaginal orifice, and when lying flat, the cervix and corpus uteri will recede.)

　　7. Severe patients may have difficulty walking due to uterine prolapse.

　　Women go through many special physiological periods in their lives, which are also periods when they are prone to illness. Good health care during these periods can prevent or alleviate the occurrence of uterine prolapse.

　　1. Actively carry out scientific midwifery and continuously improve the technical level of midwives, timely suture perineal and vaginal lacerations, and properly handle difficult deliveries.

　　2. Vigorously promote the practice of postpartum health care and postpartum exercise. Pay special attention to adequate rest in the first three months after childbirth, and avoid heavy physical labor such as prolonged squatting, carrying, and lifting. Pay attention to the smoothness of bowel movements and defecation, and timely treat diseases that increase abdominal pressure such as chronic bronchitis and diarrhea. Breastfeeding should not exceed 2 years to prevent atrophy of the uterus and its supporting tissues.

　　3. Maintain a good and stable sexual lifestyle.

　　3. Ensure that the mother gets sufficient rest after childbirth to allow the pelvic tissues to recover in time. During the rest period, pay special attention to the卧位 posture, and avoid long-term supine position. Alternate between lateral, supine, and prone positions. Starting from the third day after childbirth, some abdominal, limb, and pelvic floor muscle exercises can be done on the bed to promote postpartum recovery. Infection of the pelvis after abortion or due to other reasons, leading to adhesions, can promote the formation of a retroverted uterus, so early and active treatment should be given. Strictly implement postpartum examinations, and correct the uterus recovery in a timely manner for those with poor postpartum recovery.

　　The main basis is the physical signs. In addition, certain examinations should also be carried out. Instruct the patient not to urinate and take the lithotomy position. During the examination, first have the patient cough or strain to increase abdominal pressure, observe whether urine leaks from the urethral orifice, to determine whether there is stress urinary incontinence, and then empty the bladder for gynecological examination.

　　Firstly, pay attention to the condition of vaginal wall prolapse and uterine prolapse without exertion. Also, pay attention to the condition of the vulva and the degree of perineal rupture.

　　Observe the vaginal wall and cervix with a vaginal speculum for signs of erosion, and check for rectouterine pouch hernia.

　　During vaginal examination, attention should be paid to the condition of the bilateral levator ani muscles, determine the width of the levator ani fissure, the position of the cervix, and then clearly identify the size of the uterus, its position in the pelvis, and whether there is inflammation or tumor in the adnexa.

　　4. Finally, advise the patient to use abdominal pressure, and if necessary, take a squatting position, so that the uterus can prolapse and palpate again to determine the degree of uterine prolapse.

　　Patients with uterine prolapse should pay attention to their diet:

　　1. Drink more water and eat more fruits and vegetables. Patients should increase fluid intake and eat more beneficial foods such as nuts, seeds, and grains.

　　2. Eat more foods with the effects of Qi and kidney-nourishing, such as chicken, yam, mung beans, lotus seeds, coix seed, eel, conpoy, chive, and jujube.

　　3. In daily diet, eat more blood and kidney-nourishing foods, mainly those with neutral and warm properties, such as beef, mutton, pork, etc. Various meats should be minced and eaten to facilitate the absorption of nutrients. Eat more vegetables with neutral and warm properties, and the ratio of meat and vegetables should be 1:1.

　　4. Pay attention to eating seaweed foods in the diet of uterine prolapse, including hair seaweed, laver, kelp, seaweed, and kombu, etc. Seaweed contains the most minerals, such as calcium, iron, sodium, magnesium, phosphorus, and iodine. Regularly eating seaweed foods can effectively regulate the acid-base balance of blood, prevent excessive consumption of alkaline elements in the body due to acid neutralization, so the diet of uterine prolapse should eat more seaweed foods.

　　Mild posterior uterine position (Ⅰ-Ⅱ degree) generally does not present symptoms.

　　For patients with symptomatic posterior uterine position, the key to treatment is to realign the uterus. Common methods of uterine realignment include bimanual palpation realignment, three-hand palpation realignment, cervix clamp traction realignment, chest-knee position realignment, and surgical realignment. After manual realignment, patients are required to do 1-2 chest-knee position exercises daily after emptying the bowels and bladder, for 10-15 minutes each time, which is crucial for consolidating the effect of uterine realignment. Chest-knee position exercises can also prevent the occurrence of postpartum posterior uterine displacement, but must be performed after half a month postpartum. If manual realignment is not successful, surgical realignment can be adopted. The main method of surgery is to shorten the round ligament and change the uterus to an anteflexed position.

　　Severe uterine prolapse patients can choose vaginal hysterectomy followed by good fixation of the suspensory ligaments and other supporting tissues, while repairing the pelvic floor muscle group and vaginal wall, including suturing the anterior vaginal wall mucosa to prevent cystocele, and suturing the posterior vaginal wall mucosa to prevent rectocele, etc.