Retroverted uterus is a violation of the position in which the body of the organ deviates posteriorly, and the cervix anteriorly, over time an angle is formed that is open backwards (retroflexia). In most cases, the condition is asymptomatic, depending on the cause, pelvic pain, pathological white spots, dysmenorrhea may bother. The diagnosis is made during a two-handed examination, ultrasound, MRI may be required to confirm. Treatment is carried out in the presence of symptoms of the disease. Conservative methods, physical therapy, gynecological pessary are used. In case of inefficiency, surgical correction is resorted to.
ICD 10
N85.4 Incorrect position of the uterus
General information
Retroverted uterus (retroflexia-retroversion) is a rare pathology found in adolescents and women of reproductive age. The exact prevalence is unknown, the occurrence increases in groups of patients with asthenic physique, hyperplastic processes in the pelvic cavity, traumatic childbirth. In girls with congenital disorders of connective tissue development, the deviation of the uterus posteriorly is determined in 10% of cases. Pathology is often combined with hypoplasia, infantilism and other developmental abnormalities.
Causes
For the development of retroverted uterus, it is necessary to weaken the ligamentous apparatus of the pelvis and preserve the elasticity of its muscles. Sometimes the formation of pathology is influenced by increased intra-abdominal pressure. Pregnancy does not act as a provoking factor. The causes of the condition are congenital and acquired:
- Connective tissue dysplasia. In girls with a violation of the formation of the ligamentous apparatus, the genitals do not have normal fixation, therefore, as the uterus grows, it deviates posteriorly. At the same time, the pelvic muscles do not allow prolapse to develop. Retroverted uterus occurs with Shereshevsky-Turner syndrome, combined with other anomalies of the genitals.
- Asthenic physique. Adipose tissue located in the abdominal cavity and pelvis participates in maintaining the position of internal organs. With a low weight, a sharp weight loss, a state of exhaustion, an asthenic type of constitution, the uterus loses additional support and can change position. Weight gain does not lead to correction of the position of the genitals.
- Diseases of the reproductive organs. Retrodeviation is provoked by inflammatory processes in the pelvis, which are accompanied by the formation of adhesions that fix the uterus in the wrong position. The cause may also be tumor processes of benign and malignant nature. A temporary violation of the position occurs during ectopic pregnancy.
- Injuries in childbirth. With rapid childbirth, a large fetus, high parity, there is a risk of overstretching of the ligamentous apparatus, its weakening. The chances of the formation of retroverted uterus increase with endometritis, parametritis in the postpartum period. Heavy physical labor, constant carrying of a large child in the arms increase the likelihood of developing violations of the position of the uterus.
Pathogenesis
For the formation of retrodeviation, it is necessary that a woman has a weakening of the ligaments with preserved uterine tone and elasticity of the pelvic floor muscles. In girls, the formation of an anomaly of position is possible only after the uterine body exits into a wide part of the pelvic cavity, when the size of the uterus begins to exceed the size of the cervix. This condition is observed at the age of at least 10 years.
Retroverted uterus is facilitated by other congenital anomalies. A short posterior wall of the vagina, a conical and long uterine neck, an insufficient angle of inclination of the pelvis contribute to a change in the position of the organs. With an increase in intra-abdominal pressure, the intestinal loops press on the uterus. If the uterus has preserved its tone, but the ligaments are weakened, it leans back. The factor contributing to the inflection is the levator muscle, which pushes the uterine body posteriorly.
After starting the deviation process, the intestinal loops get freer access to the pelvis. The growth or maintenance of high intra-abdominal pressure completes the process of formation of the first degree of retrodeviation. If the provoking factor is not eliminated, the condition gradually progresses towards an increase in the angle of inclination.
Classification
Retroverted uterus can be congenital and acquired. Separately, a fixed type of pathology is distinguished, in which the organ is tightly soldered to neighboring tissues. The stage classification reflects the position of the uterus relative to the neck in the pelvis, but the severity of clinical symptoms has no direct connection with the magnitude of the angle of inclination. There are the following degrees of state:
- Retroclination (1 degree). The uterus is deflected back, anteflexia is preserved.
- Retroversion (2nd degree). The uterus is revealed, deflected posteriorly, there is no pronounced angle between the body and the neck.
- Retroflexia (3rd degree). The body of the uterus is deflected backward, and the neck is forward, a pronounced angle is formed between them.
Symptoms
Pathology is not always accompanied by pronounced symptoms, sometimes it becomes an accidental finding during a gynecological examination. Some women complain of frequent pain in the pelvic area, giving to the sacrum. The pain increases after a long vertical position of the body, motionless standing. Painful menstruation worries. With a pronounced deviation of the uterus, the outflow of blood may be difficult, which is accompanied by the appearance of large clots during menstruation.
The preservation of the remnants of secretions in the uterine cavity leads to their decay, the appearance of an unpleasant odor. Secondary infection may join, acute endometritis occurs with a tendency to transition to a chronic form. This condition is characterized by symptoms of inflammation, increased abdominal pain, and the release of purulent whites. Sometimes metrorrhagia occurs.
There are no difficulties with conception, with pronounced forms of retroverted uterus, miscarriages may develop in the early stages. More often they are associated with concomitant diseases, chronic inflammation. In other cases, the uterus gradually increases in size and after 16 weeks assumes a normal position that does not affect the course of pregnancy and the process of childbirth.
Complications
Anomalies in the position of the genitals rarely lead to complications. In case of violation of the formation of connective tissue, retroverted uterus may be accompanied by prolapse of the genitals. In this case, due to the displacement of the position of the bladder, urethra, dysuric disorders appear, urges become more frequent, incontinence worries. When squeezing the rectum, constipation may occur.
A pronounced deviation of the uterus back causes its infringement, a critical violation of blood flow. This is facilitated by the large depth of the Douglas space, a narrow pelvis and perimetric adhesions. Lack of blood flow, venous stagnation lead to the development of edema, tissue hypoxia, acute pain syndrome. In a neglected case, necrosis is possible if you do not consult a doctor in time.
Diagnostics
To examine and find the causes of retroverted uterus, a woman should contact an obstetrician-gynecologist. If you suspect a malignant tumor, you may need to consult an oncologist. Diagnosis is usually non-invasive, with severe pathology, invasive examination methods are resorted to. The following methods are used:
- Gynecological examination. During a bimanual examination, the doctor can determine the deviation of the uterine body posteriorly, the abnormal location of the cervix. There is a dense consistency of the organ, its mobility or solidity with surrounding tissues, soreness during palpation.
- Ultrasound of the genitals. With the help of ultrasound, you can study the structure of tissues. Sometimes myomatous nodes, bulky formations of presumably malignant origin, adhesions in the pelvic region, inflammatory tissue changes are detected.
- MRI of the pelvis. It is necessary with a pronounced degree or fixed retroverted uterus. It allows you to determine the number and location of myomatous nodes, confirm the fixation of the uterine body due to a pronounced adhesive process, and detect other neoplasms.
- Diagnostic laparoscopy. For examination, hospitalization in the department of gynecology is necessary. The method is used in severe cases to clarify the severity of the adhesive process, can be used simultaneously for treatment and differential diagnosis with ectopic pregnancy.
Treatment
In the absence of symptoms, treatment is not indicated, in other cases, conservative therapy is carried out. Symptomatic means are used, the causes that caused the anomalies of the position are eliminated. Hospitalization is not required for most patients, the course of therapy is monitored by the doctor of the women’s consultation. The following approaches are used:
- Physical therapy. A consultation of a physical therapy doctor is appointed, who selects exercises aimed at strengthening the ligamentous apparatus and changing the position of the uterus body. In the advanced stage, physical therapy is ineffective.
- Gynecological pessary. Silicone products are installed, which are selected individually, temporarily (during wearing) change the position of the organ. They can contribute to an even greater weakening of the ligamentous apparatus, the attachment of pelvic organ prolapse, the development of inflammation and bedsores.
- Anti-inflammatory therapy. It is recommended if retrodeviation is combined with endometritis. Broad-spectrum antibiotics, nonsteroidal anti-inflammatory drugs, enzymes for dissolving adhesions are used. With a pronounced and old adhesive process, drug lysis does not bring the desired result.
- Physical therapy. It can be used with a fixed form of retroverted uterus. Effective mud treatment, ionophoresis, diathermic treatment. After physiotherapy, gynecological massage can be performed.
- Reposition of the uterus. It is rarely carried out due to low efficiency. Restoring the position does not eliminate the cause of the anomaly, so the uterus may soon take its former position. The procedure is performed with an emptied bladder and rectum. The technique is used according to Schulze, Ott or with the help of bullet forceps according to Kustner.
- Surgical treatment. It is necessary with a large number of adhesions, bulky formations in the pelvic organs. Connective tissue jumpers are dissected, neoplasms are removed. To fix the uterus and eliminate retrodeviation, Pestalozzi or Kakushkin surgery is performed.
Prognosis and prevention
With timely access to a gynecologist and compliance with the recommendations, the prognosis is favorable, retroverted uterus rarely causes pregnancy complications and does not violate reproductive function. With pronounced degrees of deviation, full-fledged treatment is required. The anomaly can be eliminated independently after pregnancy and successful uncomplicated childbirth.
Prevention requires proper nutrition in adolescence, the rejection of strict diets. To prevent inflammation in the uterus, you need to avoid casual sexual intercourse, use barrier contraceptives. After operations on the organs of the abdomen or pelvis, cesarean section, preventive anti-adhesive treatment is prescribed. Rational and careful management of childbirth is required.
