RETROVERSION OF UTERUS

RETROVERSION: - Retroversion (RV) is the term used when the long axes of the corpus and cervix are in line, and the whole organ turns backwards in relation to the long axis of the birth canal. Retroflexion signifies a bending backwards of the corpus on the cervix at the level of internal OS. The two conditions are usually present together and are loosely called retroversion or retro displacement.

Degrees Conventionally, three degrees are described.

First degree — The fundus is vertical and pointing towards the sacral promontory.

Second degree — The fundus lies in the sacral hollow but not below the internal OS.

Third degree — The fundus lies below the level of the internal OS.

CAUSES: -

DEVELOPMENTAL: - Retro displacement is quite common in fetuses and young children. Due to developmental defect, there is lack of tone of the uterine muscles. The infantile position is retained. This is often associated with short vagina with shallow anterior vaginal fornix.

ACQUIRED: -

Puerperal: The stretched ligaments caused by childbirth fail to keep the uterus in its normal position.

A subinvoluted bulky uterus aggravates the condition.

PROLAPSE: Retroversion is usually implicated in the pathophysiology of prolapse which is mechanically

caused by traction following cystocele.

TUMOR: Fibroid, either in the anterior or posterior wall produces heaviness of the uterus and hence, it falls behind.

PELVIC ADHESIONS: Adhesions, either inflammatory, operative, or due to pelvic endometriosis, pull the uterus posteriorly.

CLINICAL PRESENTATION: The condition is classified either as mobile and fixed or uncomplicated and complicated by pelvic diseases.

MOBILE RETROVERTED UTERUS: -

SYMPTOMS: - Mobile extroverted uterus is quite common and almost always remains asymptomatic. However, the following symptoms may be attributed to it.

Chronic premenstrual pelvic pain — It is due to varicosities in broad ligament produced by the kinks. The manifestations are those of ‘pelvic congestion syndrome.

• Backache
• Dyspareunia — Deep dyspareunia may be due to direct thrust by the penis against the retroflexed uterus or the prolapsed ovaries lying in the pouch of Douglas. Similar pain, if reproduced by pressing with examining fingers, may confirm its reality.
• Infertility — In third degree retroversion, the external os is away from the seminal pool at the posterior fornix during coitus or it may be occluded by the anterior vaginal wall. Associated underdevelopment of the uterus may also be a contributing factor.

The physician should however, think twice before declaring to the patient the fact that the particular symptomatology is related to the backward position of the womb. This applies especially to backache, chronic pelvic pain, or dyspareunia. In such cases, a Hodge-Smith pessary may be placed inside for about 3 months after correcting the uterine position to ante version. If the symptoms are in abeyance during this period and recur back after its removal, it may be concluded that the symptoms are due to retroverted uterus. This is known as ‘pessary test’.

SIGNS: - Bimanual examination reveals —

(a) The cervix is directed upwards and forwards.

(b) The body of the uterus is felt through the posterior fornix. It is found continuous with the cervix and it moves when the cervix is pressed up. The size of the uterus is difficult to assess at times.

Speculum examination reveals — the cervix comes in view much easily and the external os points forwards. Rectal examination is of help to confirm the diagnosis.

HOMOEOPATHIC MANAGEMENT OF RETROVERTED UTERUS: -

The medicines which are made from natural substances help in providing strength to the loose and weak muscular and ligament structure of the pelvis. As the muscles and ligaments regain strength they tighten, pull back and hold the uterus at its proper place.

SEPIA: - Used when there is constant bearing down sensation in the pelvic region that is feeling the sensation as if uterus is dragging in the downward direction and is about to come out. Crossing the lower limbs may prove slightly helpful to decrease the bearing down sensation.

LILIUM TIGRINUM: - Used in women who have constant urge to pass urine or stool. This is most of the times accompanied by a distended feeling in the pelvis. Supporting the vulva or taking rest brings about a slight relief in the dragging sensation.

MUREX: - Where the uterus is bulky, enlarged and is pushed out of the pelvis. Women experience a bearing down feeling in the pelvis and need to tightly cross legs to prevent the bearing down sensation. Also proves useful in decreasing the pain during periods due to a displaced uterus.

LAPPA ARCTICUMA: - Can be used in all those cases where the muscles, ligaments and tissues in pelvis lack tonicity and are relaxed to a greater extent resulting in displaced or prolapsed womb. Is of great help in providing the tonicity in pelvic tissue.

FRAXINUS AMERICANA: - Fraxinus Americana can be used in cases where the uterus is enlarged. Bearing down pains in the pelvis may be present.