In some few instances there is complete inability to pass water until the patient lies down and replaces the uterus with her finger; in other cases micturition may be annoyingly frequent. Constipation is often complained of, and, if the woman be careless, a large accumulation of feces may take place in the rectum.
By a vaginal examination the os uteri is found low down, and if the cervix is of the natural length, we know that it is prolapsis.
If a round tumor is seen projecting beyond the vulva, and if at the lowest part of it there is what seems to be the mouth of the uterine cavity, it may be advisable to introduce a sound or catheter, to make sure that the opening is not a mere cleft in a uterine polypus. (Of course, you would not use a sound if you suspected pregnancy.) If there are ulcers, cracks, etc., they may be detected, the ulcers looking as if portions of the mucous lining had been punched out.
In pregnancy, displacements may occur either slowly or suddenly, though the woman may have had nothing of the kind previously, or they may be the continuation of a previous prolapse. The progressive development of the uterus generally removes the prolapsis about the fourth or fifth month, but if the pelvis is very large, it may possibly continue.
As in other cases of prolapsis, the pregnant woman may suffer very much from it. She may suffer from a feeling of weight at the anus; painful tractions in the groins, lumber regions and umbilicus; a fetid discharge may come on; there may be complete retention of urine, very obstinate constipation, etc.; and the pressure on the uterus may cause abortion.
For complete retention of the urine the catheter may be used, or the womb may be pressed up by one or two fingers introduced into the vagina; or the woman may be able to urinate if she lies down and elevates her hips considerably.
THE OPERATION OF INTRODUCING THE CATHETER may be performed by the educated nurse. The patient being placed upon her back and the labia separated, the point of the forefinger of the left hand should be placed just within the orifice of the vagina so as to press slightly the upper edge; the catheter should then be passed along the inner surface of the finger until it is arrested by the anterior part of the vagina; when there, a very slight movement so as to elevate the point of the instrument a little, enables the operator in the majority of cases to enter the catheter into the canal. The operation is more difficult when the parts are swollen or distended, as happens occasionally from disease, during pregnancy or labor, or after delivery. If we cannot detect the orifice by the touch, we may use a light, and the patient may be placed on her side. We may adopt another way to proceed. The point of the forefinger finds the clitoris, and passes from above downwards to the middle of the vestibule; the first inequality met with is the orifice of the urethra, into which the instrument can then be passed. It will easily slide in if the instrument is not passed either to the right or the left of the median line.
When a woman who has previously suffered from prolapsis becomes pregnant, it is sometimes necessary for her to keep the horizontal position during the first three or four months of pregnancy, and after her confinement she should keep her bed a considerable time—perhaps for two months.
For the treatment of prolapsis in non-pregnant women, the general principles are to be applied: To afford artificial support to the superincumbent abdominal viscera; give tone to the broad and round ligaments of the uterus, to the vaginal walls and the perineum; and to remove any complications that induce the falling, such as uterine congestion, hypertrophy, cough, constipation, etc.
The uterus may usually be easily pushed back to its place when the patient is lying down, or, what is better, her head much lower than her pelvis. (Fig. [13]). The knee-chest position is the best one.