Vaginal wall prolapse

　　1. Etiology of anterior vaginal wall prolapse:The vesicouterine ligaments on both sides of the cervix play an important role in maintaining the position of the bladder. If the fascia and ligaments mentioned above are excessively stretched or torn during delivery, and if the postpartum period involves physical labor too early, it leads to the inability of the vaginal support tissue to return to normal. The upper two-thirds of the anterior vaginal wall connected with the bladder can prolapse downward, forming a vesicovaginal prolapse. The prolapsed bladder, along with the anterior vaginal wall, remains within the vagina, referred to as grade I prolapse; the prolapsed area is exposed outside the vaginal orifice, referred to as grade II prolapse; and the anterior vaginal wall is completely prolapsed outside the vaginal orifice, referred to as grade III prolapse.

　　2. Etiology of posterior vaginal wall prolapse:In women who undergo vaginal delivery, when the second stage of labor prolongs, the fascia between the rectum and vagina and the fibrous muscles of the pubococcygeus are compressed for a long time, leading to excessive stretching or tearing. This results in the anterior rectal wall protruding like a blind pouch towards the posterior vaginal wall, forming a posterior vaginal wall prolapse associated with rectal prolapse. Posterior vaginal wall prolapse is less common than anterior vaginal wall prolapse. Chronic constipation, straining downward during defecation, and aging with weakness can exacerbate the degree of prolapse.

　　Feelings of defeat, fatigue, lower abdominal prolapse, weakness of the limbs, shortness of breath, and reluctance to speak.

　　1. Urinary incontinence:It is due to the injury of the bladder sphincter or neurologic dysfunction, resulting in the loss of urinary self-control and the involuntary leakage of urine.

　　2. Urinary tract infection:Urinary tract infection refers to the growth and reproduction of pathogens in the urinary tract, and the invasion of the mucosa or tissue of the urinary tract, causing inflammation. It is the most common type of bacterial infection. Urinary tract infection is divided into upper urinary tract infection and lower urinary tract infection. Upper urinary tract infection refers to pyelonephritis, and lower urinary tract infection includes urethritis and cystitis. Pyelonephritis is further divided into acute pyelonephritis and chronic pyelonephritis, which are more common in women.

　　First, anterior vaginal wall prolapse

　　1. Clinical symptoms:Mild cases have no obvious symptoms. Severe cases may feel a sense of坠垂, lumbago, and a mass prolapsing from the vagina, which is actually the prolapsed anterior vaginal wall. After long standing, intense activity, or increased abdominal pressure, the mass increases, and the sense of坠垂 becomes more obvious. If there is only a vaginal anterior wall combined with cystocele, the posterior angle of the urethra and bladder becomes acute, often leading to difficulty in urination and urinary retention, and even secondary urinary tract infection. If the anterior vaginal wall is completely prolapsed, the posterior angle of the urethra and bladder disappears, and urine may leak during coughing, straining, or holding breath, which is called stress urinary incontinence.

　　2. Diagnosis:Patients have the above obvious symptoms. During vaginal examination, the vaginal orifice is relaxed, often accompanied by old lacerations of the perineum. The anterior vaginal wall is hemispherical and prominent, soft to the touch, and the mucosa becomes thin and transparent, with the ridges disappearing. When the patient strains and holds their breath, the prolapsed anterior vaginal wall is clearly visible.

　　Second, vaginal posterior wall prolapse

　　1. Clinical symptoms:Mild cases usually have no discomfort. Severe cases may feel a sense of坠垂, back pain, and difficulty defecating, and sometimes need to push the prolapsed posterior vaginal wall with fingers to pass stool.

　　2. Diagnosis:During the examination, the posterior vaginal wall appears as a hemispherical mass prolapse, and during digital rectal examination, the tip of the finger can enter the blind pouch protruding into the vagina.

　　Self-treatment precautions

　　For surgical treatment, pay attention to lying in bed and resting; it is advisable to elevate the hip or feet by two bricks in height when sleeping.

　　After childbirth, do not get out of bed too early for activities, especially do not participate in heavy physical labor too early, and increase nutrition for self-healing.

　　Avoid long-term standing or squatting with holding breath, etc., which increase abdominal pressure.

　　Maintain smooth defecation and urination.

　　Timely treatment of chronic bronchitis, diarrhea, and other diseases that increase abdominal pressure.

　　The postpartum period should not exceed two years to prevent the atrophy of the uterus and its supporting tissues.

　　Engage in physical exercise appropriately to improve physical fitness.

　　Increase nutrition and eat more foods that have a nourishing and kidney-tonifying effect, such as chicken, yam, mung beans, lotus seeds, Coix seed, loach, sea asparagus, chive, and jujube, etc.

　　Abstain from sexual activity.

　　1. Vaginal speculum examination:Vaginal speculum examination is the use of a vaginal speculum to examine the vagina, used to observe whether there are any abnormalities in the vagina.

　　2. Vaginal palpation:Vaginal palpation is a method of physical examination using the doctor's fingers or tactile sensation. By touching, feeling, pressing, and pressing the examined local area, the condition inside the vagina can be understood.

　　3. Gynecological examination:Gynecological examination is a more comprehensive examination of women, which can prevent and diagnose diseases in a timely manner. Gynecological routine examination is a routine gynecological examination of women, which is divided into gynecological specialist physical examination and related auxiliary examinations. It is the first choice before the treatment of diseases, the purpose of which is to effectively diagnose and examine the specific condition of the patient and formulate a treatment plan according to the actual situation.

　　4. Gynecological routine examination of the vulva:Gynecological routine examination of the vulva is a preliminary routine examination of the vulva, used to provide a basis for further diagnosis, and can also prevent and treat vaginal diseases in a timely manner.

　　Using 250 grams of pork intestines, 100 grams of black sesame seeds, and 9 grams of Cimicifuga, first wash the pork intestines, wrap Cimicifuga in gauze and put it with black sesame seeds into the intestines, put it in a pot, add water to cook until熟, remove Cimicifuga, add spices, eat in two servings, and drink the soup twice or three times a week.

　　Using 1000 grams of lychee and 1000 milliliters of yellow wine, soak together for 7 days, drink 30 milliliters each time in the morning and evening.

　　Using 5 to 10 heads of turtle (water turtle) heads, wash and chop them, dry them in a pot, grind them into powder, take 3 grams before going to bed every night, and take it with rice wine or yellow wine.

　　Using 1 egg and 30 grams of Polygonum multiflorum, decoct with water, then extract the concentrated juice of Polygonum multiflorum and add it to the egg to cook until熟, eat the egg and drink the soup twice a day.

　　Using 60 grams of black plum, decoct it with water and steam it hot before washing, twice a day.

　　Using 9 grams each of Chuanwu and Chinese toadstool, decoct the water and add 60 grams of vinegar for fumigation and washing.

　　Using 30 grams each of lonicera japonica, scutellaria baicalensis, and taraxacum mongolicum, 15 grams each of cimicifuga, Sophora flavescens, and Phellodendron amurense, 10 grams of calamine, and 6 grams of coptis, decoct and fumigate for use in cases of vaginal prolapse with infection and yellow discharge.

　　Using 6 grams of chicken stomach, 9 grams of red ochre, 6 grams of Chinese toadstool, 0.6 grams of borneol, grind into fine powder, store in a bottle and seal for later use. First, decoct Chinese toadstool with water for fumigation and washing, dry the vulva, apply the powder, and then insert the prolapsed uterus into the vagina, hold it with a menstrual belt, and apply it twice a day.

　　Menopause is a period of transition from maturity to senility in women's physiological functions, and it is also the transition period from the mature reproductive period to old age. During this period, the ovarian function gradually declines until it finally disappears. Therefore, women during menopause and old age are prone to vaginal prolapse due to the decline in ovarian function and the low level of estrogen, which makes the pelvic floor tissues and the suspensory apparatus of the uterus become weak and lose tension. On the other hand, as women age, their physical constitution also gradually weakens, and the tension of the whole body also tends to decline. Therefore, it is extremely important to do a good job in the health care of women during menopause and old age to prevent vaginal prolapse.

　　1. Women in the perimenopausal and elderly periods should pay special attention to the combination of work and rest, avoid overfatigue, and pay more attention to maintaining a pleasant mood and reducing mental burden, eliminating tension, anxiety, and fear.

　　2. Reduce work appropriately and avoid participating in heavy physical labor.

　　3. Pay attention to nutrition, do appropriate physical exercise, persist in kegel exercises, in order to prevent excessive relaxation or premature aging of tissues.

　　4. Actively prevent and treat senile chronic bronchitis and habitual constipation, regularly conduct general and gynecological examinations, and detect and treat common diseases in perimenopausal and elderly women as soon as possible.

　　5. Receive estrogen replacement therapy as soon as possible. When excluding systemic diseases such as gynecological tumors, cardiovascular diseases, breast cancer, hyperlipidemia, and liver and gallbladder diseases, estrogen replacement therapy should be received in a timely manner. It not only can prevent osteoporosis, alleviate and relieve menopausal symptoms, but also improve the physiological basis of vaginal prolapse and vaginal wall prolapse in perimenopausal and elderly women due to the decline or even disappearance of ovarian function.

　　Two, women go through many special physiological periods in their lives, which are also the periods when they are prone to diseases. Good health care during these periods can avoid or alleviate the pathological basis of vaginal prolapse, which is the key to preventing vaginal prolapse in perimenopausal and elderly women.

　　1. Strengthen labor protection for women: Overload and posture-related effort are one of the important causes of vaginal prolapse. Strengthening labor protection for women is a reliable guarantee for preventing and reducing vaginal prolapse.

　　2. Do a good job in adolescent health care: Girls between the ages of 12 to 18 are called adolescents. Due to the incomplete development of ovaries and female reproductive organs during adolescence, they are prone to various diseases affected by external and internal environments, thus affecting the normal development and reproductive function of girls. Girls with poor development often have weak muscles, poor ligament tension, and are often accompanied by abdominal wall relaxation and weakness, known as asthenic physique. Such people usually have prolapse of visceral organs (such as kidney prolapse, gastric prolapse, etc.). If the intra-abdominal pressure increases due to certain reasons, it is easy to cause vaginal prolapse. Therefore, doing a good job in adolescent health care is of great significance in ensuring women's physical health, normal development, and preventing the occurrence of vaginal prolapse.

　　3. Pay attention to menstrual health care: Although menstruation is a physiological phenomenon in women of childbearing age, women's cerebral cortex excitability decreases during menstruation, and pelvic congestion occurs due to endocrine influence, which leads to a decrease in the overall and local resistance. If menstrual health care is not paid attention to, it is easy to cause various acute and chronic diseases in women, affecting their physical health. Especially during menstruation, cold stimulation (mainly cold water) is easy to cause ovarian dysfunction and menstrual disorders, even amenorrhea. It is believed that there is a significant relationship between ovarian function and the tension of pelvic supporting tissues. During amenorrhea, due to the decline in ovarian function, the secretion of estrogen is reduced, causing the tension of pelvic supporting tissues to decrease, which is easy to lead to vaginal prolapse. Therefore, strengthening menstrual health care is of great significance in preventing the occurrence of vaginal prolapse.

　　4. Take good care of prenatal health: Taking good care of women's prenatal health, timely detecting and correcting abnormal fetal position to prevent difficult labor due to fetal position, is also one of the important measures to prevent vaginal prolapse.

　　5. Properly handle the stages of labor: Labor injury is an important cause of vaginal prolapse. The longer the labor process, the higher the incidence of vaginal prolapse, which is related to the greater opportunity for damage to the suspension devices and soft tissues that support the uterus. The injuries caused during the first delivery are more critical. Among patients with vaginal prolapse, those who develop the disease after the first delivery account for about 30%. Therefore, properly handling the stages of labor and preventing injuries is the most important link in preventing vaginal prolapse.

　　6. Take good care of puerperal period health: It usually takes 6 to 8 weeks for women to recover to a non-pregnant state after the placenta is delivered. This recovery period is called the puerperal period. During this period, there are significant anatomical and physiological changes in women. If not paid attention to, vaginal prolapse is most likely to occur. According to reports, the incidence of vaginal prolapse during the puerperal period is significantly higher than that in other periods. The highest incidence of vaginal prolapse among those who return to work within 1 month is over 85% of all cases. This is because the physiological and pathological changes of the uterus and its supporting structures caused by pregnancy and childbirth have not been fully recovered before they participate in labor (including heavy household chores), which is easy to cause vaginal prolapse. Therefore, taking good care of puerperal period health is of great significance in preventing vaginal prolapse.

　　7. Take good care of lactation period health: Ovarian function decreases during lactation. Especially for long-term lactation after childbirth, the uterus can atrophy due to the long-term low ovarian function, the supporting structures and suspension devices of the uterus become loose and weak, the tension and elasticity of the pelvic floor muscles decrease. In this case, any external factors such as increased abdominal pressure or posture-related force can trigger vaginal prolapse. Vaginal prolapse in lactation within 1 year accounts for less than 9% of patients, while those with lactation for more than 1 year account for more than 90%. This indicates that the incidence of vaginal prolapse is significantly higher in those with lactation for more than 1 year. Another finding is that women's uterus position drops significantly after bearing abdominal pressure during lactation compared to non-lactation period. Therefore, taking good care of women's lactation period health is an important measure to prevent vaginal prolapse.