Femina, A Work for Every Woman

by John A. Miller

“If these cords were so important as the advocates of the Alexander-Adams operation try to make us believe, in binding the uterus forward, and, as we are recently informed, have a strength equal to support four and one-half pounds weight, a great deal of uneasiness, if not actual pain, would be felt and located along the inguinal canal, following this structure to its points of insertion, in sudden dislocations of the uterus backwards. This is, however, not the case; when sudden painful symptoms arise, they are invariably referred to the sacral region. In sudden retroversions or flexions, as in the pregnant uterus, occurring accidentally or those retroverted or flexed uteri which are so often met with in a state of subinvolution after confinements, there are no symptoms pointing to a tension of these cords at all, but all symptoms point to uterine pressure on the posterior pelvic wall, which can be precisely located. And these pains disappear as soon as the offending member is put right.”

There is no doubt that the uterus retains its abnormal retroflected position by the same forces that keep it in a normal or anteflected state; these are (1) intra-abdominal pressure, and (2) the force of gravitation of its own weight.

In some women there are certain predispositions to the occurrence of a retroflexion. If the walls of the uterus are weak and relaxed, especially that portion where the cervix unites with the body of the womb, then the body may fall in any direction, and, as the bladder is liable to be distended, and thus raise the body of the uterus upwards, folds of intestine are likely to intervene, so that the organ is inclined backwards, and the abdominal pressure, now falling on the anterior surface of the body, presses the womb backwards and downwards into a flexion.

A fall backwards or a violent push or jump may cause retroflexion any time during life. Retroflexions of this nature are not as a rule injurious, and if the circulation is not compromised, nor the uterine canal obstructed, women may go through life without feeling any the worse because their womb occupies an abnormal position. It is only when the organ is congested and swollen, so that its own tissue is painfully sensitive, and the surrounding tissues are compressed by the foreign body, that it requires measures for relief.

In those women who have borne children, and those who have gone through a miscarriage, retroflexion is frequently met. A little reflection will make this clear, for when we remember how the pregnant uterus at any time from conception to final delivery becomes congested and the seat of a corresponding growth of its own tissue to accommodate the growing fetus, we at once perceive that either after an abortion or on delivery at full term, the enlarged and congested uterus is in the best possible condition, to lose its normal place and sink backwards. The pernicious custom in vogue in most countries, of keeping a woman on the flat of her back after delivery, has never been as vehemently opposed by the intelligent members of the profession, as the gravity of the subject demands. Some women have an idea that the longer and quieter they remain on their backs, the surer they are to make an excellent recovery from the lying-in chamber. American and English practitioners are inclined to recommend this as the most proper way to lie, but there is no doubt that this not only favors the occurrence of retroflexion, but that it actually causes it.

The woman who rests on her back gives to the heavy body of the womb an opportunity to sink backwards, after the distended bladder has pushed the organ high enough up so that its own weight may throw it over, until it finds resistance on the posterior wall of the pelvic cavity. Many nurses insist on the dorsal position for days, and never permit the patient the privilege of lying upon one or the other side. Aside from the injurious effect that this has on the position of the uterus, it is exceedingly tiresome to be compelled to remain for several days in one position. Women should be allowed to lie on all sides, after delivery, and no longer on one side than on another. And to insure against a retroversion or flexion, she must also lie on the abdomen a certain length of time during each twenty-four hours.

Tight bandaging after delivery, for “preserving the figure,” greatly aggravates the displacement; the binder should be so applied that it feels comfortable but not too tight, its purpose being to offer a gentle support to the suddenly relaxed abdominal muscles, and thus stimulate them to contract to their normal form.

The symptoms of retroflexion are greatly varied by the pathological conditions that affect the uterus, or by the complications that may have caused the flexion.

It is indisputable that the uterus may be retroflected for an indefinite length of time without causing any inconvenience. From this it may be inferred that the retroflection itself does not constitute the disease, but the inflammatory processes, in which the organ is involved, or the relaxation of the adjacent structures, as we find them immediately after confinement, constitute the actual diseased conditions.

One of the most constant symptoms is pain in the back, and this is severe in proportion to the swelling and sensitiveness of the organ, when it presses on the sacral nerves and rectum.