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Cystocele, urethrocele and rectocele
Last reviewed: 23.04.2024
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Cystocele, urethrocele and rectocele - protrusion of the bladder, urethra and rectum respectively into the vaginal canal. Symptoms of this pathology include urinary incontinence and a feeling of pressure. The diagnosis is based on clinical data. Treatment includes the introduction of uterine rings in the vagina, therapeutic gymnastics for strengthening the muscles of the pelvic floor and surgical treatment.
Cystocele, urethrocele and rectocele are most commonly found together. Hernia bladder (cystocele) and urethrocele usually develop when there is an incompetence of the lonnochechnoy bubble fascia. There are several degrees of cystocele depending on the level of pustulation: up to the upper part of the vagina (I degree), before entering the vagina (II degree), outside the genital gaps (grade III). Rectocele is the result of a rupture of the muscles that lift the anus, and is classified like a bladder hernia.
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Symptoms of cystocele, urethrocele and rectocele
Common signs are the lowering of the walls of the vagina and pelvic organs, a feeling of pressure, tension. Organs can protrude into the vagina or to the vagina, especially when strained or coughing. Cystocele and urethrocele are often accompanied by stress urinary incontinence. Rectocele is the cause of constipation and incomplete bowel movement. Patients need to press the back of the vagina for defecation.
Diagnosis of cystocele, urethrocele and rectocele
The diagnosis is confirmed on examination. Cystocele or urethrocele is diagnosed by inserting a mirror into the back of the vagina at the position of the lithotomy. The patient's tension at the request makes hernia bladder or urethrocele clearly visible and tangible as soft, repaired tumors that protrude the vaginal wall. Inflamed paraurethral glands are palpated anteriorly and laterally from the urethra, they are painful on palpation, pus is secreted from them. The enlarged Bartholin glands can be palpated, because they are located in the middle and lower third of the labia majora, when infected these glands are soft. Rectocele is also determined when the anterior vaginal wall is raised by a mirror when the patient is in the position of lithotomy, under the strain of the patient, which makes the rectocele visible and tangible during rectovaginal examination.
Treatment of cystocele, urethrocele and rectocele
Initially, treatment can consist of the introduction of pessaries and gymnastics Kegel. Pessary (uterine ring) is a prosthesis that is inserted into the vagina to support the lowered organs. Uterine rubber rings have different shapes and sizes; if they are improperly selected, they can cause the formation of ulcers on the walls of the vagina and strengthen the discharge. Kegel's exercises are aimed at isometric contractions of the lumbococcal muscle. Its reduction is difficult (about 50% of patients can not do this), but it is necessary. The method of Valsalva is harmful, and the reduction of the buttocks or thighs is not beneficial. The contraction of the muscle is best started by asking the patient to simulate an attempt to retain urine. It is recommended to perform such exercises for 810 reductions 3 times a day. It is recommended that the initial duration of the exercise is 12 s with an increase of up to 10 s at every opportunity. Exercises can be facilitated with the help of weighted vaginal cones that help patients focus on cutting the required muscle. You can use a feedback biofeedback system or an electrical stimulation that causes the muscle to contract.
If the symptoms of the disease are very serious and not eliminated by conservative treatment, then a surgical correction (anterior and posterior colporphy) is prescribed. If necessary, surgical shortening and suturing of the perineum (perineoraphy) is performed. Colporaphy is usually delayed for the period when the woman performs reproductive function, because the subsequent vaginal delivery can again lead to rupture. Simultaneously with colpaphia, surgical correction of urinary incontinence can be performed. After surgical treatment, patients should avoid lifting weights for 2 months. After surgical correction of the cystocele or urethrocele, the urethral catheter is used for 24 hours after the operation and, rarely, for several days.