A system of practical medicine. By American authors. Vol. 4

by Unknown

The SYMPTOMS are a frequent desire to urinate, with tenesmus and scalding; there is also a sense of heat and pain in the bladder. There is usually more or less ropy mucus discharged with the urine. If a uterine sound or catheter is passed into the bladder with its point downward, and can be felt protruding into the pouch, there remains no doubt as to the case being one of cystocele vaginalis.

Rectocele Vaginalis, or Recto-Vaginal Hernia.

This consists in a protrusion inward of the posterior vaginal wall and a pouch of the rectum, which is carried with it. The tendency to rectocele is seen in the natural bulging of the rectum caused by its expansion just above the sphincter ani. This is more readily perceptible in cases where the perineum has been torn. If from perineal laceration or any cause the posterior wall of the vagina fails to give adequate support to the anterior wall of the rectum, the bulging just mentioned increases, forming a pouch which becomes filled with fecal matter. The bowel becomes more distended with feces, which usually accumulate and harden, and, acting as an irritant, produce tenesmus with mucous discharges. The venous circulation being interfered with, hemorrhoids are common, adding to the patient's suffering.

On examination a tumor is found, sometimes as large as a man's fist, which can be felt projecting from the posterior vaginal wall and over the perineum; sometimes it is soft and compressible, while at other times it is quite solid, depending on the absence or presence of hardened feces. To leave no room for doubt in diagnosticating a case of rectocele, the rectum should be explored with the index finger.

Enterocele Vaginalis, or Entero-Vaginal Hernia.

This consists in a portion of small intestine dilating the cul-de-sac so that the peritoneum is carried down with the intestine between the vagina and rectum as far as the perineum, sometimes forming an elastic tumor at the vulva. The chief dangers arising from this form of vaginal hernia are from its being strangulated or lacerated during childbirth.

Enterocele vaginalis is not frequently met with, but it is important for the physician to know that such a condition is possible and difficult to differentiate from some forms of vaginal tumor. A thorough and careful rectal examination is requisite for diagnosis. An enterocele has the peculiar elastic feeling of a tumor distended with air, a tympanitic resonance on percussion, and a peristaltic movement. If there remains any room for doubt, aspiration with the smallest needle will enable the physician to perfect his diagnosis, for if the needle enter the intestine it is not in any sense a dangerous procedure.

TREATMENT.—The treatment of prolapsus and hernia of the vagina is similar to that of prolapsus of the womb.

If a prolapsus of the vagina has existed but a brief period or has come on suddenly, it should be immediately reduced and proper measures taken to prevent its recurrence. To accomplish this the patient should assume the genu-pectoral position, while the physician with well-oiled fingers restores the parts to their normal position. The patient should then lie upon her back with the hips elevated; astringent vaginal injections ought to be used every four or six hours; and quiet secured or discomfort or pain relieved by opiates. Sudden displacements of the vagina not being of frequent occurrence, the physician more frequently meets with cases of long standing which have come on gradually and slowly.

Attention to the general health is an important requisite: with this in view tonics should be prescribed in many cases, the bowels regulated by means of proper diet or if necessary by medicine, and the bladder more frequently evacuated than in health. Astringent injections are fully as useful in cases of long-standing displacements of the vagina as in those of more recent occurrence; among those more generally used are solutions of tannin, sulphate of zinc, or alum (drachm iv ad pint j). Sea-bathing and injections of sea-water into the vagina are beneficial. It is sometimes more convenient to make topical applications with vaginal suppositories containing one of the astringents just mentioned.