Femina, A Work for Every Woman

by John A. Miller

Elongation or hypertrophy of the cervix of the uterus is the third variety of prolapses that Professor Schroeder includes in the group. This form is consequent upon a falling or prolapse of the vagina, and it occurs in the following manner. The body of the uterus being retained by its natural supports or by adhesion of a former inflammatory process in the pelvic cavity, remains stationary where it naturally belongs, while the upper end of the vaginal canal being attached to and surrounding the cervix or neck of the womb, gradually draws or stretches the cervix out, so that it grows one or two inches longer than it is natural for it to be. The cervix of the womb projects under these circumstances down into the vagina, and in some cases it may be seen between the lips of the vulva. This condition is mistaken for falling of the womb, when in reality it is a falling of the vagina with an incidental lengthening of the cervix of the womb. To recognize and make these distinctions is of the greatest practical importance, for thus alone can the measures adopted for the relief of these distressing complaints be successful.

The symptoms of prolapsus grow principally out of the changed relations of the uterus to the surrounding organs and tissues. The mechanical interference and pressure of the womb on neighboring parts, and the changes that are induced in the organ itself by the altered circulation in its tissues, cause the inflammatory enlargement or hypertrophy that is characteristic of one variety of the affection.

In some persons the development of the disease is so gradual that it has progressed for years without any serious inconvenience and the symptoms that did exist were generally attributed to other causes. In the course of time there is such a combination of morbid processes, like painful menstruation, inflammatory enlargement of the womb and erosions of the cervix with profuse leucorrhœa, as to render the parts painful and sensitive to pressure and friction. These symptoms excite in the end suspicion, so that the sufferer may seek advice that will reveal to her the real condition of her case.

Other signs of these affections are a dragging down or a feeling as though a weight pulled the pelvic organs downwards; there is also traction on the bladder, making this viscus exceedingly irritable, so that there is a frequent desire to micturate; the rectum suffers also from similar traction. There is another sign that is very often present, and particularly in the early stages, and this is a feeling as if the vagina was open; this is due to the relaxation of the vaginal walls. Walking for any distance becomes burdensome and causes great fatigue; pain in the back and loins is hardly ever absent. There is an inability to lift weights, because the pelvic floor cannot endure the extra strain that is superimposed on the intra-abdominal pressure; ascending or descending stairs aggravates the symptoms much more than walking on the level floor.

TREATMENT.

This must be directed to the accomplishment of two ends, without which no relief, much less a cure, is possible, and these are, first, to return the displaced organ to its normal position, and, secondly, to retain it there. The course first indicated is, as a rule, not difficult to follow out; in fact, if the patient is placed in a favorable position, the uterus replaces itself through the natural forces of traction and gravitation, unless it has become so enlarged that it is a physical impossibility.

The “knee-chest” or “knee-elbow posture” is the term that has been given to this position, and it is assumed in the following manner.

The woman gets down on her knees, the thighs being kept in an upright or vertical line; the object of this is to keep the pelvis as high as possible, while the chest is bent or inclined forwards until the head rests on the floor; the shoulders must be as low to the floor as it is possible for the patient to endure.

This position at once reduces the intra-abdominal pressure on the pelvic floor to the least degree, and besides this, the abdominal viscera gravitating towards the diaphragm, the prolapsed uterus and surrounding tissues are drawn upwards and forwards with it. If the prolapse was complete or nearly so, so that the organ almost protruded through the vulva, then the patient should retain this posture for ten or fifteen minutes before an attempt is made to replace the organ; for the intense congestion should be first allowed to subside.

No sudden or violent force should be employed, but a gentle, steady pressure. In cases where the organ has simply descended into the vagina, the knee-chest posture alone will replace the uterus. Those displacements that are due to a chronic catarrh of the vagina are particularly suitable for home treatment, because the patient can surely cure her vaginal catarrh, and combining with this the knee-chest posture, which should be practiced night and morning, for at least ten minutes, and until the catarrhal inflammation has entirely subsided, she has at her command the most useful and beneficial resource to accomplish a cure.