The symptoms characterising retroversion of the womb consist in pains in the small of the back, discharge, increased menstruation, frequent desire to urinate, and constipation. Instead of these local disturbances, nervous reflex irritations (headache, pain in the stomach, etc.) may be present. These dis turbances should disappear as if by magic after the womb has been placed in its correct position. If they do not, the inference is that they were not due to the displacement.
The treatment of retroversion consists in placing the womb in its correct position, and keeping it there by means of a pessary. This treatment strengthens the ligaments of the womb ; and recent cases, especially those treated soon after a delivery, may be so completely cured that the pessary can be dispensed with in about three months. Every woman should undergo a medical examination after childbirth, in order to determine whether the womb is in the correct position or whether it has been displaced. In old cases it may be necessary to wear a pessary constantly. To avoid this, and in cases where the pessary proves inefficient, the affection may be cured, without danger, by an operation, whereby the fundus of the womb is sutured to the anterior wall of the abdomen or to the anterior wall of the vagina. This causes an artificial adhesion which keeps the fundus of the uterus downward.
After delivery the vagina may be greatly relaxed ; and when this is the case it may happen, if the patient gets up too soon and attends to her work, that the womb suddenly or gradually falls downward, dragging the vagina with it. This is called prolapse of the womb. In such a case the uterus is situated in front of the genitals, in a pouch whose size may vary between that of a fist and that of a child's head. In this pouch may be recognised the vaginal part of the uterus (Fig. 444, a a), the anterior wall of the vagina (a–e), and the posterior wall of the vagina (a, d). The remaining part of the womb, and a portion of the bladder (I) may be felt also. This extremely annoying— in fact, dangerous—condition, affects principally hard-working women of the lower classes, who often get up and begin work too early after childbirth. The pessary treatment of such cases being attended by many disadvantages, operative inter ference is often necessary. Medical
supervision, and the observance of the rules of hygiene during pregnancy and labour, render it possible to prevent these troublesome displace ments, or to correct those that have already arisen, without resorting to operative means.
Haemorrhage from the Womb.— Bleeding from the womb may occur at any age. After the onset of menstruation, it is a physiological event at regular intervals of 28 days (see MENSTRUATION). E.ernorrliages other than those due to menstruation are not infrequent, even in young children, and require careful attention. Irregular menstrual haemorrhage itself often needs careful hygienic management. Excessive menstruation may be due to a number of causes. A pronounced proliferation of the mucous membrane of the uterus, necessitating removal by scraping, is one of the most persistent causes. The slight operation of scraping the uterus is performed under anzesthesia ; and it often transforms anxmic, listless individuals into healthy and active women. Hemorrhage in young married women is often due to late or tardy involution of the uterus after the birth of a child, or it may follow uterine displacements. It may result also from miscarriage, in which remains of the foetal structures have not been passed. \yhen occurring in older women, is usually the sign of the presence of a tumour. The possibility of a cancerous affection of the uterus should be carefully consideted, especially when occurs after menstruation had ceased for some length of time (see Cancer of the Womb). In general, hemorrhage from the uterus occurs, not only in all affections of that organ, but also as a result of diseases of the tubes and ovaries. It may result also from disturbances of the circulation, due to disorders of the heart or of the lungs.
Uterine hxmorrhage is always a sign of some disease. This is particu larly true when it occurs during the change of life (see MENOPAUSE). The patient should always submit to an immediate examination by a physician, and not wait until the bleeding has ceased. In many cases of cancer of the womb, the haemorrhage does not stop of its own volition, and thus valuable time is lost.