... info på engelska (dock från en site som försöker sälja hemorrojdprodukter, men ändå.. de har en bra beskrivning av olika former av prolapser i samband med och utan förlossning.. ) Källa: http://www.hemorrhoidshemroids.com/Non-hemroid-pregnancy-prolapses.html
Differentiating between hemroids and prolapses of pregnancy and childbirth.
Our page on pregnancy hemroids fully explains what hemroids are and do during and after pregnancy,
so this page is to provide the other types of prolapses that can often accompany pregnancy and child birth
About 50% of mums will have one or more of these prolapses and many of these mums will also have pregnancy hemroids. So this page answers the question: How are prolapses different from hemroid/s prolapse?
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Prolapse During Pregnancy: What Is Going On, Anyway?
Postpartum pelvic organ prolapse can be a downright scary thing to happen right after you've had a baby. One day you're fine, the next day one, some, or all of your pelvic organs are trying to come out of your body. This can happen to the bladder, the uterus, the vagina, or the rectum. While it may be frightening, knowing what is going on can help you to make the right decision for treatment.
Pelvic organ prolapse ( POP ) can happen to just about any woman after birth. Age can make it more likely, as can obesity, but even young, otherwise healthy women have been known to develop postpartum prolapse. The reason is occurs is that the pelvic region contains two outlets to the exterior of the body that have internal spaces attached to them, and those internal spaces are under constant pressure. These outlets are the vulva and the rectum. The pelvic organs are under pressure from the weight and musculature of the rest of the abdomen, but are usually prevented from descending through the internal canals by a system of muscle and tendon. During the high strain and potential damage of labor, these muscles and tendons can get weakened, thus leading to prolapse of one or more of the organs in question.
TYPES OF PROLAPSES
If the bladder starts to fall, it puts pressure on the front, or anterior, wall of the vagina and is called a cystocele. This is the most common form of postpartum prolapse.
If, however, the rectum starts to fall and puts pressure on the back, or posterior, wall of the vagina, this is called a rectocele. It is more rare, but again, not unheard of.
If the entire anorectal canal falls, it will probably protrude through the anal sphincter, and is referred to as a ano-rectal prolapse.
If the uterus itself falls, and the cervix, which is supposed to be at the top of the vagina deep within the body, can be felt right at the entrance to the vagina, this is a uterine prolapse.
The two forms of externally protruding prolapse are the most severe problems, but any of these problems needs to be seen by your obstetrician as soon as possible. Of course, just to make life a bit more difficult, any combination of these conditions can occur simultaneously.
Why do these pregnancy / childbirth prolapses occur?
To fully understand why this can occur, it helps to understand the overall structure of the area. Women have muscles and tendons all over the pelvic area that, under normal conditions, serve to keep the organs in place. Each separate organ has its own connective tissue binding it to the pelvic bone girdle. In addition, there is a set of powerful muscles that, together, are called the pelvic floor. These muscles work together to function like the bottom of a box, to exert more upward pressure than the weight of the abdomen exerts downward pressure. While these muscles, like the lungs, are consciously controllable to a degree, we normally do not have to think about them, and we normally cannot fully relax them. This complex system of powerful muscle, ligament, and sturdy bone usually serve to keep our bits where we need them to be without us having to pay any attention whatsoever.
However, during the quite extreme process of giving birth, several different things can happen. If the muscles that support the system are stretched too far, are torn, or if the nerve that keeps them contracted is damaged, those muscles can relax too far, allowing the pelvic organs to start migrating. If that happens, the ligaments can take the load for a little while, but they were never meant to do so on their own and will eventually give way as well. If the baby's head stretches or breaks a ligament while trying to fit through that excruciatingly small opening, the ligament may no longer be able to position the organ in such a way as the muscle can support it. In effect, the ligaments keep the organs spaced apart correctly, while the muscles hold them up against the pull of gravity and the push from the abdomen. Both ligaments and muscles can be weakened from obesity, heavy lifting, or age. In addition, weak or strong ligaments can be inherited, which is why a woman with a family history of pelvic organ prolapse is slightly more likely to develop a prolapse herself.
Prolapse Symptoms
The symptoms of the various sorts of prolapse vary wildly.
If the bladder prolapses, it will not fit through the tiny urethra that is the bladder's pathway to the outside world. It will fall against the front wall of the vagina, and may block the urethra from opening, and thus counts as a cystocele. You would feel this as strange pressure in the front half of your body, and you may be able to feel the bulk and curve of the bladder through the vagina wall.
A rectocele, as opposed to full rectal prolapse, happens when the rectum falls against the posterior wall of the vagina, and can generally be felt as strange pressure in the back half of the body. If this happens, you may have to push against the back wall of the vagina with a finger in order to have a bowel movement. In a rectocele, either the entire rectum may have fallen, but the anal canal is still strong, or a small space may have opened between the rectal wall and the vagina that allows a small loop of rectum to migrate into that area.
Needless to say, all of these can be a bit uncomfortable. However, it starts getting really frightening when your see bits of you coming out of you, which is what happens with vaginal, rectal or uterine prolapse.
In vaginal prolapse, you'll just see or feel bits of vaginal wall protruding out of the birth canal, inuterine prolapse you'll see the actual cervix, which should look and feel like a small, hard lump, coming out, and in anorectal prolapse you'll feel a large lump of tissue protruding from your anus during and after bowel movements that doesn't stay pushed back in.
If you have a lump of tissue that protrudes from the anus that can be pushed back in, it's probably a prolapsed hemroid instead of a full on anorectal prolapse. However, the suggestion for any of these conditions is the same, get yourself to a doctor as soon as possible.
Prolapse Treatment Objectives
Keep in mind that upon examination, your doctor may recommend one of several different things, based both on your condition and what your life-plans are.
If the prolapse is not too severe, you may have to do Kegel exercises, which is where you contract and release your pelvic muscles consciously, in order to retrain your pelvic floor to do its job. If your doctor feels that your prolapse is very mild in nature, this is going to be the most likely prescribed course.
If your prolapse is more problematic, your doctor may advise you to do Kegels but to not have any more children without consulting a doctor first. If your prolapse is in this middling state of severity, you may have to comply with severe restrictions during subsequent pregnancies, even up to continual bed rest and use of a pessary, which is a device that is inserted into the vaginal or anal canal to support and retain all of the organs in their proper places.
If you have a severe bladder or rectal prolapse, or in the case of some uterine prolapses, a surgical procedure known as a ligament fixation is available.
For pelvic ligament fixation, the surgeon can go in through either the vagina or through the abdominal wall to perform the surgery. If you want to have more children, have the doctor go in through the abdominal wall to fix the ligaments. If the surgeon goes through the vagina, this can weaken the vaginal wall to the point that natural birth is thereafter impossible.
For uterine prolapses, the most extreme form of surgery is a full hysterectomy, which of course brings full sterility with it.
Sufficiently severe bladder and rectal prolapses also have surgeries that remove the prolapsed organ, but any of these surgeries should be approached with utmost caution and as a last resort, as all of them carry lifestyle change implications of the highest order. With removal of either the bladder or the rectum, you will have to keep a bag hooked into either the kidney or the intestinal system and empty it on a regular basis, which can lead to serious issues.
While the removal of the uterus does not carry such openly severe day to day consequences, it has its own documented range of side effects, such as psychological loss, surgically-induced menopause, damage to other organs, and a remote possibility of infection.
If, however, the prolapse is severe enough to be life-threatening, one of these major surgeries may be in order. Keep in mind, however, that while a doctor may be reluctant to remove the rectum or bladder, the removal of the uterus is much more acceptable and common in the modern medical community. If a hysterectomy is recommended, it may be worth your time to seek a second opinion.
So, while pelvic organ prolapse can be a strange and frightening condition, it does not have to be a life-altering one. If you believe you are suffering from postpartum prolapse, read up on the various conditions as much as possible, find out all of your locally available alternatives, and always remember to make the best decision for you.
Research and main write by Loni L. Ice, editing by D. S. Urquhart.
TREATMENT FOR THE NON HEMROID PROLAPSES YOU MAY EXPERIENCE POST PREGNANCY / CHILDBIRTH:
As one of our gynecologists said, half their doctoring time is spent delivering babies, the other half fixing up the damage the birthing causes - getting a baby out of such a small opening is bound to have damaging risks associated with it.
So, you got through the pregnancy hemroid phase OK, but now you have a prolapse of a different kind.
If you have one of these simpler prolapses, then treatment via cut and slice surgery is relatively easy, though the after effects can be pain for some weeks.
Anal Wall Prolapse
The first is an anal wall prolapse, where the wall of the anus bends in toward the vagina. When this happens bowel movements may become difficult, emptying the bowel almost impossible with just little bits of poo coming out, leakage may occur as well, that is, you wipe your self clean, but then find poo on your underpants later - essentially the bowel is kinked off.
Bladder Prolapse
The second type of prolapse is of the bladder, the bladder falls down inside and this can have the symptoms of being unable to empty the bladder fully, lots of little frequent wee's rather than a big one, sometimes lots of urinary tract infections - frequent waking up during the night to go to the toilet - the urinary tract is kinked off.
Uterus Prolapse
The third type of post pregnancy prolapse is of the uterus.
Prolapse Treatment - the cut and stitch for the simpler prolapses.
As for treatment, our specialist tells me the anal wall prolapse, vaginal wall prolapse and the bladder prolapse are readily fixable by surgery and that the prolapse surgery is quite safe. The prolapse surgery is also optional, as your life is not normally jeopardized by the simpler prolapses, though the quality of your life may be.
Prior to having the surgery, you will likely be required to have an enema to empty the bowel out, as well as a shower with antibacterial wash. The nurses may also shave you down below.
The prolapse surgery can be done one of two ways - under a general anesthetic which knocks you out, or by a spinal anesthesia which knocks out the bottom half of your body but leaves you awake. The spinal anesthesia may be more suitable if your respiratory system is compromised by asthma and so on, or if you are likely to be violently ill from a general anesthetic. If you are likely to vomit, you may compromise the surgery that was performed on you, as vomiting puts too much strain on the stitches. If you need a spinal anesthesia, but don't want to be alert to what's happening down below, you may be able to request a strong sedative be administered just prior the cutting and stitching, to block the experience out.
The surgery revolves around restoring your condition prior to the prolapse. This means that muscles that were stretched out may be sewn together more to rebuild walls. Prolapsed bits repositioned and sewn into place. You may find that your vagina may have been cut and re sewn in places.
Prolapse Treatment - The recovery phase for the simpler prolapse surgeries
The gynecologist also provided the following post pregnancy prolapse surgery recovery information: For the first week following surgery you do nothing but rest, the second to third week you are doing very little - lifting and carrying is out of the question along with standing for any length of time. By the fourth week you are 60% healed , but still should avoid lifting or carrying things or prolonged standing. By the end of the sixth week you are about 90% recovered and normal sex can be resumed. Full recovery from post pregnancy prolapse operations takes about three months.
The recovery phase after prolapse surgery, at least for the first two or three weeks is very uncomfortable and may be a lot painful.
One also needs to be alert to any smelly or discolored discharge, which may indicate an infection requiring antibiotics.
Bladder retraining may be needed, as it may not be accustomed to emptying properly - your nurse will discuss this with you if needed and show you how to use the catheter and mirrors to help you relearn, if the basic techniques they teach you don't work.
Be aware, that until your passing poo again, that the bowel may be blocking off the wee partly. Your bladder may empty properly once you pass the poo. Poo may not be forth coming for up to 5 days.
Prolapse and active / natural births
Active or natural pregnancy and birthing is no guarantee the damage wont be done, though it may lessen the risk. My wife had two prolapses and we were both avid active birthers.
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