Diseases & Conditions Blog

This is a condition in which fragments of endometrium, the tissue which lines the uterus, migrate to other parts of the body and become implanted there. In effect, the displaced tissue acts very much like a miniature uterus in a place where it has no business to be.

Under the influence of ovarian hormones, the displaced tissue bleeds (or “menstruates”) like normal endometrium lining the cavity of the uterus. This causes chemical irritation. Nature’s attempt to wall off these pockets of menstruating tissue results in formation of cysts filled with blood. The cysts may rupture and release tissue which forms additional implants.

These cysts are commonly in the ovaries, tubes, uterus, or the peritoneum lining the pelvic cavity. Endometrial implants in the ovary commonly cause so-called “chocolate cysts,” filled with chocolatecolored material.The cysts continue to grow under continued stimulation by the ovaries.

Signs and Symptoms Of Endometeriosis

Endometriosis symptoms arepainful periods, profuse and prolonged periods, or pelvic adhesions that result in various symptoms, depending on the location of tissues that become adherent. Endometriosis is frequently a factor in complaints of inability to become pregnant.

Endometriosis is fairly common in young women. Diagnosis may be difficult since there are rarely any external signs, although sometimes a vaginal examination may disclose local lesions. A number of other pelvic conditions which may produce somewhat similar symptoms must be distinguished. Positive diagnosis may require surgical exploration.

Endometeriosis Treatment

Treatment of endometriosis is not necessarily surgical. There is a great range in severity of symptoms. Small areas of endometriosis may cause few if any symptoms. Frequently explanation of the situation will encourage some patients to endure some premenstrual and pelvic discomfort if it is not severe.

Uterine Displacements

These conditions are often referred to as a “tipped uterus.” Such conditions are very common in women and rarely cause any serious symptoms. The great majority of women who have a uterus somewhat out of theoretically “ideal” position do not report any symptoms. A normal uterus is directed forward. Occasionally a large boggy uterus that is tipped backward (retroverted) may cause some feeling of heaviness in the pelvis, sometimes backache, and make pregnancy less likely but by no means impossible. A physician can usually replace a uterus and insert a supporting device (pessary) which holds it in satisfactory position, to see if symptoms complained of will be relieved.

Vaginal Relaxations

These occur commonly as women become older and their tissues become less firm and muscular. Although childbirth injuries may be important contributing factors, relaxation of adequate support of pelvic structures may occur in women who have not borne children, presumably due to inheritance of deficient supporting tissues. With weakened muscular tone and with stresses such as lifting and gravity, the uterus may “drop” into the lower part of the vaginal canal. This is usually associated with some variety of uterine displacement previously mentioned. Occasionally the uterus may actually protrude through the vaginal opening. This condition is known as prolapse of the uterus.

If supporting structures of the bladder become weakened, the base of the bladder may sag into the vaginal canal and bulge through the vaginal opening. This is known as a cystocele. It is a partial hernia. As the condition progresses there may be frequency of urination and involuntary passage of a small amount of urine when the patient is in an upright position. There is increased risk of bladder infection (cystitis) which may spread to the upper urinary tract.

In similar fashion, if supporting tissues of the lower bowel and rectum become weakened, this organ bulges (herniates) through the rear wall of the vagina. This is called a rectocele. It may cause pain and difficulties in defecation, although a mild herniation may not be particularly troublesome .

Cystoceles and rectoceles can be corrected surgically. Some women refuse surgical repair. Occasionally, the general physical condition of the patient may preclude the stresses of surgery, but this is quite rare today, for with modern surgery and local types of anesthesia, elderly women tolerate reconstructive vaginal surgery very well.

There are nonsurgical methods of support which may be used successfully, although permanent repair by surgery is usually preferable. Devices used to support the uterus and/or the vaginal walls are called pessaries. These are usually made of rubber or plastic material in a variety of shapes suited to individual need. Pessaries require careful fitting and removal at frequent intervals. Some women find it helpful, in giving some support to sagging uterus or vaginal structures, to insert into the vagina every morning a large cotton tampon with string attachment, which is removed and discarded at night.

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