The influence of these bandages ou the position of the uterus depends on two factors: The increase in the intra-abdominal pressure, and the limiting of the movability of the pelvic organs. Rectification of an ab normal position of the uterus by means of an abdominal bandage is not possible, still, frequently it has a good effect in modifying the symptoms which are caused by the pathological position of the organ. In case of prolapse of the uterus the abdominal bandage does not lessen but rather increases the symptoms, since the intra-abdominal pressure is increased and the uterus is pressed down further, unless a vaginal pessary prevents. In case of the versions, however, the bandage is of assistance, since it fixes the uterus, the pressure acting on one or another of the surfaces.
Many abdominal bandages have been devised by physicians and in strument makers, and their very multiplicity proves that a thoroughly good one under all circumstances has not been found as yet. The reason of this is apparent when we remember that the abdomen is constantly changing its dimensions, that the curvature of its anterior surface renders difficult the uniform application of a bandage, and that fixed points are lacking on which the bandage may take purchase. Therefore it is why many abdominal supporters slip up or down, and many are so tight that they cannot slip, but cause such great pressure that they cannot be worn for long.
There are many women who are able themselves to make a good sup porter. They may be directed to take a quadrilateral piece of elastic material, such as flannel, to place it around the abdomen and to cut it at the sides. In case elastic material is not used, then it should be cut diagonally, not parallel, to the fibres, for thus the extensibility of the material is heightened. The lower edge of this supporter should be cut so as to fit directly over the crests of the ilium, and then a sufficient number of folds are taken and temporarily pinned as to cause the sup porter to lie smoothly; these folds are next cut out and the edges sewed together. Behind, the edges of the supporter are laced together, and it is thus kept in place.
Every supporter which is intended to surround the entire abdomen and to subject it to equable pressure, consists either entirely of elastic material, or else elastic portions are inserted into it. All inelastic sup porters which have one or more laced portions (one in the centre, in front, and one each side), readily crease and slip.
Elastic supporters ordinarily contain elastic fibres, and either form a closed girdle (Fig. 128) or they are open and must be laced or strapped together, particularly at the sides: They maintain an equable pressure on the abdominal contents, and do not slip very readily, provided the ab dominal curvature is large enough. These supporters should be applied over the undergarment, for otherwise the elastic fibres, which are in them, press into the skin of the abdomen and back, and cause pain pro portionate to the tightness of the supporter and the distension of the abdomen.
Supporters which exert more pressure, and which are used for strengthening the abdomen in the presence of fibroids, cysts, etc., consist only in part of elastic material. An elastic piece is ordinarily inserted in front, at the sides (Fig. 129), or behind, as in the Leiter abdominal sup porter (Fig. 130). Frequently strips of whalebone are inserted into the anterior portion of the supporter, which enhance its rigidity and ensure its remaining in place; often, however, these strips exert an unpleasant pressure. Ordinarily there are straps at the lower border of the sup. porter, which are either drawn from the sides and fastened in the middle, or else are buckled at the sides. The lower border of the supporter should hence be made as narrow as possible to prevent its rising up. Aside from the fact that creases may still form, the slipping up of the bandage is not thus certainly prevented. The only method which cer tainly answers is the insertion of thigh straps. At the outset the majority of patients complain of these straps, and a number of days must elapse before they become accustomed to them. These bands should be con structed of strong unyielding material, which is lined with silk to lessen the friction on the thighs. It is preferable to cover the straps with rubber, or else to make the straps of slender rubber tubing. These straps extend either side, from the anterior portion of the supporter under the thighs, a trifle beyond the centre where they are fastened. Care should be taken not to have the point of fastening too far backwards, else the straps readily slip into the groove between the nates.
As a further means of preventing the upward slipping of the sup porter, and at the same time to exert greater pressure above the symphy sis, a cushion or an air bladder has been inserted into the bandage, as in Bourjeaurd's.