Perineal hernia after hysterectomy

　　Perineal hernia after hysterectomy is one of the complications after hysterectomy, which can occur after vaginal hysterectomy or abdominal hysterectomy. The causes of this disease are as follows.

　　1, Injury to the superior vaginal fascia supporting structure:The supporting structure of the superior vaginal fascia includes the sacrotuberous ligament, cardinal ligament, rectovaginal septum, etc., which can be attacked and damaged to varying degrees during hysterectomy, directly causing the anterior pelvic floor to become weak.

　　2, The vaginal fornix was not fixed to the coracohyal ligament and the sacrotuberous ligament during surgery: Some scholars have confirmed that if the top of the vaginal fornix can be sutured and fixed to the sacrotuberous ligament during surgery, the incidence can be greatly reduced.

　　3, Relaxation of pelvic floor and vaginal tissue:In elderly patients, with the increase of age, the pelvic floor tissue gradually undergoes degenerative changes and relaxation, and the vagina also becomes gradually relaxed with the increase of age and menopause.

　　4, Increased intra-abdominal pressure:If constipation, cough, or other diseases that can cause chronic increased intra-abdominal pressure, they can induce this disease.

　　5, Pelvic expansion, pelvic floor lowering after hysterectomy: Unsealed Douglas pouch can lead to pelvic expansion, pelvic floor lowering, a large amount of intra-abdominal contents dropping, and in addition to increased intra-abdominal pressure and a weak pelvic floor, the pelvic peritoneum gradually herniates and becomes pathogenic. Especially those who develop the disease more than 10 years after surgery, are closely related to age, pelvic and vaginal tissue relaxation, and constipation.

　　The contents of perineal hernia after hysterectomy mainly include small intestine, sigmoid colon, omentum, often accompanied by vaginal fornix prolapse. Sometimes, it can coexist with anterior rectal prolapse at the median position. Defecation radiography, synchronous defecation radiography, or pelvic radiography shows abnormal lowering of the pelvic peritoneum, which is of great value for definite diagnosis. Chinese scholars Zhang Lianyang and others have reported 3 cases of synchronous defecation radiography or pelvic radiography, among which 2 cases showed sigmoid colon hernia, 1 case had a distance of 4cm between the rectum and vagina, and 1 case had concurrent median anterior rectal prolapse, 2 cases had concurrent rectal prolapse inside.

　　About 2/3 of perineal hernia after hysterectomy occur in people over 60 years old, and they often have symptoms such as difficulty in defecation, anal坠胀, a feeling of incomplete defecation, defecation interruption, and the need to press around the anal area to expel stool. With the extension of the course, long-term straining during defecation, the increase in age, and the gradual relaxation of the pelvic floor and vagina after menopause, the symptoms gradually worsen, and about 1/4 of the patients develop chronic constipation with rectal emptying obstruction 2-10 years after surgery.

　　Perineal hernia after hysterectomy is a postoperative complication, and attention should be paid to prevention during surgeryInjury to the upper vaginal fascial supporting structure,. If the apex of the vaginal fornix and the sacral ligament of the uterus can be sutured and fixed during surgery, the incidence can be greatly reduced. PatientsIn daily life, it is advisable to eat more vegetables and fruits rich in fiber to keep the stool soft, not to strain too hard during defecation, or sit on the toilet for too long..

　　The main contents of perineal hernia after hysterectomy are small intestine, sigmoid colon, and omentum, often accompanied by vaginal fornix prolapse, and sometimes can coexist with anterior rectal prolapse.Rectum, vagina. Bimanual examinationOr digital rectal examination can palpate the presence of intestinal loops and other hernia contents between the two.. Defecation imaging, synchronous defecation imaging, or pelvic imaging can show abnormal lowering of pelvic peritoneum.

　　For patients with perineal hernia after hysterectomy, the diet should be light, easy to digest, and low in residue to avoid increased frequency of defecation. Patients with habitual constipation or poor defecation should eat more vegetables and fruits rich in fiber in their daily diet to keep the stool soft, not to strain too hard during defecation or sit on the toilet for too long. For adults, the posture should be oblique lying rather than upright during defecation, and attention should be paid to diet adjustment to avoid constipation or diarrhea. Patients should avoid eating刺激性 foods such as chili oil, mustard, and chili. It is not advisable to eat too much greasy food, and it is not advisable to eat foods that may cause allergic reactions such as hairtail fish and crabs. There are several types of therapeutic diets for this disease.

　　Prescription 1

　　Composition:60 grams of green peppers, 300 grams of celery, 400 grams of apples, and an appropriate amount of salt and pepper.

　　Preparation and usage: Do not remove the green tips of green peppers. Cut the above vegetables and fruits into fine pieces and put them into a juicer to make juice, season with salt and pepper, and drink.

　　Indications: Hernia.

　　Prescription 2

　　Composition:50 lychee seeds, 9 grams of tangerine peel, 9 grams of sulfur.

　　Preparation and usage: Grind the above ingredients into fine powder, mix with salt water to make paste, and form into pills the size of mung beans. Take 10 pills each time, twice a day.

　　Indications: Hernia.

　　Prescription 3

　　Composition: Loquat seeds.

　　Preparation and usage: Roast and grind the loquat seeds (skin removed) into powder, 5-10 grams each time, taken with sorghum wine in the morning and evening. For those who do not drink alcohol, half soup and half wine can be taken. Alternatively, 14 dried longan seeds and 20 grams of fresh Ficus carica roots can be decocted together for consumption, taken 3-4 times consecutively.

　　Indications: Hernia.

　　Prescription 4

　　Composition: 10-20 grams of loquat seeds.

　　Preparation and usage: Decoct the above ingredients with water, twice a day.

　　Indications: Hernia.

　　Prescription 5

　　Composition:60 grams of Wumei new roots.

　　Preparation and usage:Wumei new roots should be cleaned, chopped, and decocted in water. Adjust with wine and brown sugar for consumption.

　　Indications: Hernia.

　　Prescription 6

　　Composition: Litchi kernel, fennel, longan kernel, cimicifuga.

　　Preparation and usage: The above ingredients are ground into powder after drying. Take 3 grams on an empty stomach, and then take 3 grams of cimicifuga decocted in water and wine.

　　Indications: Hernia sagging, small intestine pain.

　　Prescription 7

　　Composition: Tangerine kernel, fennel.

　　Preparation and usage: The above ingredients are separately fried and ground into powder, mixed evenly. Take 5-10 grams each time, taken with hot yellow wine before going to bed.

　　Indications: Small intestine hernia, testicular tumor.

　　Prescription 8

　　Composition: 3 litchi pedicles.

　　Preparation and usage:Dried and ground litchi pedicle, take appropriate amount of yellow wine.

　　Indications: Hernia pain.

　　Prescription 9

　　Composition: 60 grams of cherry kernel, vinegar.

　　Preparation and usageCherry kernel fried with vinegar, ground into powder. Take 15 grams each time, taken with boiling water.

　　Indications:Hernia pain.

　　About 2/3 of perineal hernias after hysterectomy occur in people over 60 years old. The usual treatment measures for this disease are as follows.

　　First, non-surgical treatment

　　It is suitable for those who cannot tolerate surgery or have a small hernia sac. Including eating more fiber-rich foods (such as fresh vegetables, fruits, coarse grains, etc.), drinking more water, developing good defecation habits, and kegel exercises. If necessary, it can be supplemented with herbal medicine for moistening intestines and defecation or laxatives.

　　Second, surgical treatment

　　All hernias that exceed the vaginal orifice, have formed ulcers, or have severe symptoms should be treated surgically.

　　1. Traditional surgical approach:There are three methods of repair: vaginal, abdominal, and combined vaginal and abdominal repair, and the key points are as follows.

　　(1) Vaginal surgery: including separation and high ligation of the hernia sac, and hernia repair using the uterosacral ligament, rectovaginal septum tissue, and levator ani fascia.

　　(2) Abdominal surgery: including incision of the Douglas pouch, closure of the rectovaginal space, and fixation of the vaginal fornix to the sacrum.

　　(3) If there is simultaneous rectal prolapse and rectal intussusception, simultaneous surgical correction is required, such as functional rectal suspension treatment.

　　2. Laparoscopic perineal hernia repair surgery:The operation is completed under laparoscopy, including high ligation of the hernia sac, repair of pelvic floor defect, and fixation of the vaginal fornix to the sacrum and rectal suspension. This operation has been particularly popular in Europe and America in recent years, and there have been no reports in China. It is a good choice for those who have the conditions.