CHRONIC INVERSION OF THE UTERUS

Definition: Inversion is a condition where the uterus becomes turned inside out the fundus prolapsing through the cervix.

CAUSES

• Incomplete obstetric inversion unnoticed or left uncared following failure to reduce for a variable period of 4 weeks or more.
• Submucous myomatous polyp arising from the fundus → traction effect.
• Sarcomatous changes of fundal fibroma → infiltration of malignancy into the myometrium
• softening of the wall. - Senile inversion following high amputation of the cervix. It is probably due to cervical atony and incompetence.

TYPES: Two types are described in chronic inversion.

INCOMPLETE — The fundus protrudes through the cervix and lying inside the vagina.

COMPLETE — Whole of the uterus including the cervix are inverted. The vagina may also be involved in the process.

 SYMPTOMS: -

• Sensation of something coming down per vaginum.
• Irregular vaginal bleeding.
• Offensive vaginal discharge.

SIGNS: INSPECTION

The protruding mass has got the following features:

(i) Globular

(ii) No opening in the leading part

(iii) Shaggy look

(iv) Tumor may be present at the bottom.

PER VAGINUM:

(a) The cervical rim is felt high up in incomplete variety but not felt in complete one.

(b) Cup-shaped depression at the fundus is felt or the uterus is not felt in position.

RECTAL EXAMINATION: Recto abdominal examination is more informative to note the fundal depression or displacement of the uterus.

SOUND TEST: Demonstration of shortness or absence of uterine cavity using a uterine sound is reasonably confirmative.

EUA: At times, it is needed to confirm the diagnosis.

The diagnostic difficulty is much when inversion is secondary to a fibroid polyp or sarcoma and the inversion is incomplete, filling the vagina. A portion is to be removed from the tumor mass for histological examination to differentiate between a simple fibroid or sarcoma.

DIFFERENTIAL DIAGNOSIS: -

1. Fibroid polyp,
2. Uterine prolapse,
3. Prolapsed hypertrophied ulcerated cervix,
4. Fungating cervical malignancy.

In fibroid polyp — The uterus is in normal position and the uterine sound can be passed into the uterine cavity. In difficulty, examination under anesthesia may be required.

HOMOEOPATHIC MANAGEMENT OF UTERINE TROUBLES: -

Thlaspi bursa: - One of the top homeopathic medicine for Uterine troubles with heavy menstruation. It is given in cases where the periods are prolonged, frequent, and very discomforting.

Calcarea carb: -  Another excellent remedy for heavy, frequent periods, sometimes accompanied by vertigo. The troubles usually increase during a tiring and straining day.

Calcarea flour: - Cal carb is one of the best Homoeopathic medicine for uterine troubles. It restores the elasticity of smooth muscles in the uterus.

Belladonna: - If the pain causes a cramping sensation in the whole Abdominal region.

Sepia: - Reduces the bearing down sensation and protects against recurrent vaginal and urinary tract infections.