Vaginal prolapse

Classification according to ICD-10
N81	Genital prolapse in women
N81.0	Urethrocele in women
N81.1	Cystocele
N81.2	Partial prolapse of the uterus and vagina
N81.3	Total prolapse of the uterus and vagina
N81.4	Uterovaginal prolapse, unspecified
N81.5	Vaginal enterocele
N81.6	Rectocele
N81.8	Other genital prolapse in women
ICD-10 online (WHO version 2019)

The vaginal prolapse (lat. Prolapsus vaginae , vaginal prolapse ) is a pathological protrusion of the vagina outwards. A reduction of the vagina without passing through the vaginal opening is used as a vaginal reduction ( vaginal prolapse , Vaginalsenkung ), respectively.

causes

In women, one or more births have usually preceded, which led to damage to the holding apparatus of the vagina and nerve damage with subsequent atrophy of the pelvic floor muscles . A vaginal prolapse occurs very rarely in women who have not given birth before. In this case, a congenital pelvic floor weakness is the trigger. Pelvic floor weakness can also occur in the postmenopause . Another trigger can be a greatly increased pressure in the abdominal cavity , for example in the case of obesity or chronic cough .

In ruminants , a vaginal prolapse occurs as a multifactorial event. Here, too, a slackening of the connective tissue bed of the vagina ( retroperitoneal part of the pelvic cavity ) is the main trigger in previous births. Also, ovarian cysts may be involved in the etiology. A vaginal prolapse usually occurs shortly before the end of pregnancy or shortly after giving birth in the puerperium .

In bitches , a vaginal prolapse is usually caused by the influence of estrogen during heat ( heat prolapse ), which leads to edematization of the vaginal mucosa and the retroperitoneal connective tissue. Most of the time, the problem worsens with each additional heat.

to form

In gynecology , the clinical picture depends on the extent of the incident. A sagging of the vagina without going through the vaginal opening is called a descensus vaginae . If the lower third of the vagina is affected, the urethra ( urethrocele ) is usually involved , and if the lower two thirds are affected, the urinary bladder ( cystocele ) as well. If the posterior vaginal wall sinks , the rectum may also be affected ( rectocele ). If the upper part of the vagina is affected, the Douglas space can also be involved ( Douglas cele or, if loops of intestine are involved, enterocele ). The complete eversion of the vagina can be accompanied by the simultaneous eversion of the uterus .

In buiatrics, a distinction is made between slight forms with partial invagination of the vagina into its lumen ( inversio vaginae ), a partial prolapse outwards ( prolapsus vaginae incompletus sive partialis ) and the complete vagina prolapse ( prolapsus vaginae completus sive totalis ). If the cervix is also present, it is called a prolapsus vaginae et cervicis . In cows, the vaginal prolapse can only occur temporarily, especially when lying down ( prolapsus vaginae intermittens sive habitualis )

Clinical picture

Vaginal prolapse in a cow

Affected women feel a feeling of pressure downwards. The gynecological examination reveals a bulging of the vaginal lining through the vulva . With simultaneous cystocele, urinary incontinence can occur , with larger cystoceles also urinary retention . Faecal problems can occur with rectoceles. Pain is rare, mostly as back pain, which increases during the day.

In animals, a vaginal prolapse can be clearly identified by looking at the vulva externally.

treatment

In women, conservative treatment with ring or sieve pessaries can be used. Furthermore, individual pelvic floor training can improve symptoms and improve quality of life. An anterior or posterior vaginoplasty ( colporrhaphy ) can be performed surgically . If the cervix is elongated and the body of the uterus is well secured, the anterior vaginal plasty can be combined with an amputation of the cervix with gathering of the parametria ( Manchester-Fothergill operation , named after the English surgeon and gynecologist William Edward Fothergill ). If the uterus has prolapsed at the same time, vaginal hysterectomy is the method of choice.

In cattle and sheep, the prolapsed tissue is cleaned and rinsed with an antiseptic solution. This is followed by reduction, which is usually achieved with the aid of a vaginal tube. An incident bandage or a sheep rescuer can be attached if the patient is presented early and is not very extensive . In pronounced cases, a partial surgical closure of the vulva is carried out. This must be removed immediately when the birth begins, so that close monitoring of the birth is necessary.

In bitches an attempt can be made to reduce the incident. An ovariohysterectomy is then recommended to eliminate the influence of estrogen and prevent recurrence. If the prolapsed tissue has already changed significantly, a partial resection of the vagina can be performed.

Individual evidence

↑ ^a ^b ^c ^d Janice Rymer: In focus gynecology . Elsevier, Urban & Fischer Verlag 2007, ISBN 978-3-437-42914-9 , pp. 104-106.
↑ ^a ^b ^c ^d Eberhard Grunert: Fertility disorders in female cattle . Georg Thieme Verlag, 3rd edition 1999, ISBN 978-3-8263-3150-3 , pp. 217-232.
↑ ^a ^b Heinrich Behrens et al .: Textbook of Sheep Diseases . Georg Thieme Verlag, 4th edition 2001, ISBN 978-3-8263-3186-2 , pp. 73-77.
↑ ^a ^b Nobody / Suter: Internship at the dog clinic . Paul Parey 2004, ISBN 3-8304-4159-2 , pp. 879-860.
^ Serban-Dan Costa : The gynecology . Springer, 2nd edition 2006, ISBN 978-3-540-25664-9 , p. 212.
↑ Suzanne Hagen, Diane Stark, Cathryn Glazener, Sylvia Dickson, Sarah Barry, Andrew Elders, Helena Frawley, Mary P Galea, Janet Logan, Alison McDonald, Gladys McPherson, Kate H Moore, John Norrie, Andrew Walker, Don Wilson: Individualized pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomized controlled trial. In: The Lancet. 2013, S., doi : 10.1016 / S0140-6736 (13) 61977-7 .
↑ Barbara I. Tshisuaka: Fothergill, William Edward. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 417.

[Rymer-1] Janice Rymer: In focus gynecology . Elsevier, Urban & Fischer Verlag 2007, ISBN 978-3-437-42914-9 , pp. 104-106.

[Grunert-2] Eberhard Grunert: Fertility disorders in female cattle . Georg Thieme Verlag, 3rd edition 1999, ISBN 978-3-8263-3150-3 , pp. 217-232.

[Behrens-3] Heinrich Behrens et al .: Textbook of Sheep Diseases . Georg Thieme Verlag, 4th edition 2001, ISBN 978-3-8263-3186-2 , pp. 73-77.

[Niemand-4] Nobody / Suter: Internship at the dog clinic . Paul Parey 2004, ISBN 3-8304-4159-2 , pp. 879-860.

[5] Serban-Dan Costa : The gynecology . Springer, 2nd edition 2006, ISBN 978-3-540-25664-9 , p. 212.

[DOI10.1016/S0140-6736(13)61977-7-6] Suzanne Hagen, Diane Stark, Cathryn Glazener, Sylvia Dickson, Sarah Barry, Andrew Elders, Helena Frawley, Mary P Galea, Janet Logan, Alison McDonald, Gladys McPherson, Kate H Moore, John Norrie, Andrew Walker, Don Wilson: Individualized pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomized controlled trial. In: The Lancet. 2013, S., doi : 10.1016 / S0140-6736 (13) 61977-7 .

[7] Barbara I. Tshisuaka: Fothergill, William Edward. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 417.