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a downward displacement of the uterus along the axis of the pelvis. If the uterus emerges outside the vulval cleft, metroptosis is called prolapse of the uterus.
Metroptosis most often occurs in multiparous women because of poor muscle tone in the anterior abdominal wall and in the pelvic fundus. Other significant factors are lacerations of the perineum during birth, heavy physical work in the postpartum period, and improper position of the uterus owing to backward version and the consequent weakening of the ligaments that hold the uterus in its normal position.
Metroptosis is often accompanied by collapse of the vaginal walls, which can also force the walls of the bladder and rectum to collapse. It results in blood stasis within the lesser pelvis. The uterus becomes enlarged and edematous, pain and a bearing-down sensation in the lower abdomen are experienced, and leucorrhea arises. The functioning of the urinary bladder is disrupted. This is manifested by such symptoms as frequent urination; involuntary leakage of urine while coughing, laughing, or rapid walking; or retention of urine.
Because of the progressive character of the disease, general restorative treatment to increase tissue tone is initiated at the earliest indications of metroptosis. The treatment makes use of a balanced diet, hydrotherapy, and special exercises. It is important that the patient work under conditions where heavy physical strain can be avoided. Orthopedic devices, for example, vaginal pessaries, are rarely used. Surgery is indicated in severe cases. Preventive measures include reduction of trauma and restoration of those muscles of the pelvic fundus that have been injured in the birth process. Exercise, observance of laws that protect working women, and the mechanization of physical labor are other helpful preventive measures.
REFERENCEZhmakin, K. N. “Anomalii polozheniia zhenskikh polovykh organov.” In Mnogotomnoe rukovodstvo po akusherstvu i ginekologii, vol. 4, books 1–2. Moscow, 1963.
A. P. KIRIUSHENKOV