Elongation of a neck of a uterus
Elongation of a neck of a uterus — pathological increase in a part of body at which its length exceeds 3,5 cm. If signs of omission are absent, the disease proceeds asymptomatically. The discomfort at sex can clinically be shown by complaints to feeling of a foreign matter in a vagina and a sexual crack, an incontience at loadings of urine and gases, the complicated urination. It is diagnosed by means of gynecologic survey, ultrasonography of pelvic bodies with a tservikometriya. Treatment only surgical. Depending on complexity and expressiveness of pathology one of operations on amputation of a neck, fixing of a uterus in physiological situation, a hysterectomy is carried out.
Elongation of a neck of a uterus
Normal the neck of a uterus has length of 3,0±0,5 cm, during pregnancy can increase to 4,0 cm. Speak about elongation of body when its sizes at not pregnant patient make more than 3,5 cm. Earlier the disease affected women of advanced age more often. Now gynecologists note its rejuvenation – EShM reveal at routine inspections at women, since 28 years, approximately at a third of patients pathology arises up to 45 years. Such dynamics is connected with increase in frequency of an undifferentiated soyedinitelnotkanny dysplasia at women of reproductive age with which lengthening of a neck is associated. Relevance of early diagnostics of frustration is connected with a possibility of successful surgical correction at initial stages for preservation of a possibility of a child-bearing.
Reasons of elongation of a neck of a uterus
The etiology of a disease is still specified. Data of morphological, immunohistochemical, clinical trials allow to claim reasonably that a key role in pathological lengthening of a uterine neck is played by the dysplasia of connecting fabric (DCF) of different degree of expressiveness revealed at 80-84% of patients. Most likely, the kollagenopatiya has hereditary character. Taking into account a poliorgannost of violations at DST allocate a number of marker states at which because of functional insolvency of connecting fabric the probability of detection of an elongirovanny neck of a uterus increases.
Diagnostic of significant criteria refer asthenic build, flat-footedness, juvenile osteochondrosis, scoliosis to number, , articulate hyper mobility, a miopiya, tendency to bystry formation of bruises, the increased dryness of integuments, tendency to emergence of striya, existence of varicose veins, hemorrhoids, vegetososudisty dystonia, bystry or rapid childbirth in the anamnesis. Relatives of patients with EShM of the first line often suffer from a prolapse of internal genitals. Heavier markers testifying to functional insufficiency of connecting fabric are ventral hernias, , , habitual dislocations of joints, a prolapse of the mitralny valve. Experts in the sphere of obstetrics and gynecology revealed a number of the assuming factors provoking elongation at women with a soyedinitelnotkanny dysplasia:
- Obstetric pathology. The weakening of muscles of a pelvic bottom arising after pathological childbirth with ruptures of a crotch and vagina exponentiates more bystry omission of the extended neck. Patrimonial traumatism often serves as an additional marker of pathology of the connecting fabric incapable to cope with considerable loadings at the birth of a large fruit or several children at polycarpous pregnancy.
- Considerable physical activities. During the occupations hard physical work and sports trainings which are connected with a raising of weights intra belly pressure increases. This factor promotes not so much increase in length of a uterine neck, how many more bystry clinical debut of a disease with omission and loss of body. The situation is aggravated in the presence of the kollagenopatiya characteristic of elongation.
- Hormonal violations. At disgormonalny states the physiological ratio between various types of the soyedinitelnotkanny fibers forming a neck of a uterus and the copular device which supports reproductive organs is broken. The probability of development of frustration increases at approach of a climax, existence of an ooforit, adneksit, cysts of ovaries, other diseases with violation of secretion of female sex hormones.
Violation of formation of collagen and processes of a shaping in basic connecting fabric against the background of which there is its morfofunktsionalny insolvency is the cornerstone of elongation of a neck of a uterus. Kollagenopatiya at EShM is shown by change of a ratio of collagen I, III, IV of types, increase in fraction with thinner fibers, the frustration of topography of distribution of connecting fabric strengthened by deposition in fibroblasta and an extracellular matriks. Kollagenopatiya strikes not only to Strom of body, but also vessels, muscular tissue.
The intramuscular kollagenization of argirofilny structures is followed by the accruing atrophy of muscles of a uterine neck. The body gradually stretches (is extended). Its elasticity decreases, the lower department hypertrophies, top — becomes thinner. As a result of the progressing sclerosis and disorganization of fibers trophic, basic, form-building functions of connecting fabric are broken, its resistance to loadings decreases. In total these processes cause inferiority of a neck of a uterus, and risk factors aggravate a situation.
Taking into account increase in the sizes of a neck distinguish three extents of elongation. At 1 degree the body is extended to 5 cm, at 2 — to 6-8 cm, at 3 — length exceeds 8 cm. Important criterion of systematization of clinical forms of elongation is violation of anatomic topography of a uterine neck with shift in relation to an entrance of a vagina and involvement in process of other reproductive organs. Such approach is justified by distinction in methods of treatment of separate forms of a disease. There are three types of elongation:
- The isolated omission of a neck. The body is increased in sizes and lowered in comparison with physiological situation. Vagina walls are not involved in process of omission. The isolated option of pathology is observed no more than in 1,7-3,5% of cases.
- Elongation of a neck and omission of a vagina. The most common form of EMSh revealed at a half of patients. Because of weakness of muscles of a crotch and the supporting copular device of a uterus omission of a neck and walls of a vagina is noted.
- Lengthening of a neck and loss of a uterus. At such prolapse of reproductive organs the extended neck is outside a vagina. Loss of a uterus can be both partial, and full. This form pathology occurs at 45,5-47,3% of patients.
Symptoms of elongation of a neck of a uterus
At the I degree of a disease the symptomatology usually is absent. In process of increase in length and change of position of a neck of a uterus there are complaints to feeling of third-party inclusion in a vagina or areas of a crotch, discomfort and difficulty at sexual contacts. The urine incontience at physical loadings, sneezing, cough is characteristic of elongation of the II degree with omission of a vagina and loss of a uterus. In far come cases dribble of urine is observed even at rest. To 25-26% of patients experience difficulties at an urination with the III extent of elongation. The incontience of gases arises at 14-15% of patients.
Elongation is one of causes of infringement of reproductive function at women of childbearing age. At such patients cervical infertility is more often observed, the wrong attachment of a placenta, a neck rigidnost at the time of delivery, difficulties are noted when passing the child on patrimonial ways, patrimonial traumatism. Development of a disease in the period of a climax and a postmenopause is complicated by formation the tsistotsel and the rektotsel with considerable malfunction of pelvic bodies. At continuous finding of a neck outside a vagina the risk of its traumatic damage, accession of infectious process increases (a colpitis, an ekzotservitsit, an endotservitsit, an endometritis).
Identification of elongation of a neck of a uterus — rather simple diagnostic task. For its decision to patients with a complex of typical complaints appoint the fizikalny and tool inspection allowing to confirm authentically lengthening of body and to determine its possible shift. The most informative for diagnosis are:
- Survey on a chair. At a bimanualny palpation separately of the increased body without its omission deepening of the arches of a vagina is noted. The neck of a uterus is mobile, the tugoelastichna, is painless. At omission it is located in the lower departments of a vagina, a threshold or outside a sexual crack.
- Transvaginal ultrasonography with a tservikometriya. The method allows to obtain exact data on the sizes, structure and position of a neck, to estimate mobility of walls of a vagina, to measure an uretro-vezikalny corner, to reveal deformation of a rectum. The diagnostic value of a technique increases when conducting test of Valsalva.
As the additional researches directed to assessment of a condition of a neck, identification of signs of infectious and inflammatory or neoplastic processes the kolposkopiya, dab microscopy from a vagina, bacterial crops with antibiotikogrammy, PTsR-diagnostics, RIF, IFA, a biopsy of doubtful sites with the histologic analysis of the received materials can be recommended. Differential diagnostics is carried out with omission or loss of internal female genitals without elongation of a neck, a uterus neck hypertrophy, cicatricial deformation, cancer of a vagina or neck. According to indications the patient is advised by the oncologist, the urologist, the proctologist, the infectiologist.
Treatment of elongation of a neck of a uterus
Conservative methods of correction of a disease do not exist. At the choice like surgical intervention consider degree and a form of elongation, existence of the accompanying changes in uterus neck tissues, surrounding bodies, age and reproductive plans of the woman. Taking into account expressiveness of pathology at the extended uterine neck the following types of operations are recommended:
- When lengthening without omission operations of the choice are wedge-shaped amputation or a partial resection of body for sidewalls with strengthening of the copular device supporting a neck. The additional indication to such interventions existence of cicatricial deformation, an erosion, ulcer defect mucous in an external pharynx is considered. Advantage of operations is fertility preservation.
- At elongation with omission or loss high amputation of a neck of a uterus or the Manchester operation with strengthening of muscles of a pelvic bottom is recommended. Interventions effectively eliminate the urine incontience characteristic of this form of a disease. Because of essential shortening of length of body and increase of risk of premature interruption of future pregnancy are not carried out to the patients planning the birth of children.
- At elongation of a neck and omission of a uterus the wide range of operations — from amputation of a neck in a combination with the techniques fixing a uterus in the correct situation (a kolpoperineolevatoroplastiky, ventrosuspenziy, ventrofiksatsiy, sakrovaginopeksiy, median kolporafiya) to a uterus extirpation without appendages is offered. A lack of such interventions is the impossibility of incubation of the child.
Forecast and prevention
Correctly carried out surgical correction of elongation allows to get rid of discomfortable feelings, an incontience of gases and urine, it is essential to improve quality of life of the patient, to prevent omission of other pelvic bodies. Some of surgeries break reproductive function. Prevention of a disease assumes refusal of heavy physical activities, performance of special exercises on strengthening of pelvic muscles at the identification of markers of a soyedinitelnotkanny dysplasia and factors increasing risk of development of frustration. An important role in the prevention of pathological elongation is played by careful conducting childbirth, a careful ushivaniye of ruptures of a neck, vagina and crotch.