SUBINVOLUTION OF THE UTERUS; SUPERINVOLUTION OF THE UTERUS.
SUBINVOLUTION OF THE UTERUS.
Subinvolution of the uterus is a condition that results from imperfect
involution of the uterus after labor, abortion, or miscarriage. The
muscular and fibrous structures of the uterus, which had become
hypertrophied under the influence of pregnancy, fail to undergo
properly the retrograde changes of fatty degeneration and absorption
which normally occur after the expulsion of the product of conception,
and which are essential for the restoration of the uterus to its normal
size. The elements of the endometrium and the vascular system of the
uterus also remain hypertrophied; consequently the uterus is larger,
heavier, more congested than normal.
Similar arrest of involution may occur coincidently in the ligaments of
the uterus, which are left larger, longer, and more relaxed than in the
normal condition.
The pathological changes that occur in the subinvoluted uterus are
similar to those found in chronic endometritis and metritis, which have
already been described. In fact, chronic endometritis and metritis
accompany subinvolution from the beginning.
There are many causes of subinvolution of the uterus. Too early rising
from bed is a most frequent cause. This is especially true after
abortion or miscarriage; for many women treat such occurrences as of
but little moment, and refuse to stay in bed for more than a few days.
Imperfect evacuation of the uterus after abortion or miscarriage is
a common cause. Laceration of the cervix, retrodisplacement of the
uterus, and laceration of the perineum are all causes of subinvolution
of the uterus.
The symptoms of subinvolution are the same as those already described
under Chronic Metritis--backache, headache, bearing-down pain in the
pelvis, general physical debility, leucorrhea, and menorrhagia.
The =treatment= of subinvolution should be directed toward the relief
of the primary cause of the condition. Laceration of the perineum
or of the cervix, retroversion, or endometritis caused by retention
of placental tissue after miscarriage, should receive appropriate
treatment.
Subinvolution may often be cured by the douches, iodine applications,
and depletion of the cervix spoken of under the treatment of laceration
of the cervix, provided the primary cause is removed or corrected.
In any case the cure is always hastened by thorough curetting of the
uterus. This operation should always be performed when the woman is
etherized for the relief of any other condition, as a laceration of the
cervix or of the perineum.
The cure of subinvolution depends a great deal upon the time that
has elapsed from the inception of the condition to the institution
of treatment. The secondary changes in the endometrium and body of
the uterus resulting from chronic congestion and inflammation in
time becomes so established that the disease will not yield to any
treatment, even though the primary cause of the trouble may be cured.
In obstinate chronic cases of subinvolution of the uterus amputation
of the cervix sometimes has a most marked effect, and this operation
should always be resorted to whenever the disease has resisted the
milder treatment already prescribed. Amputation of the cervix is
sometimes followed by a transformation of all the tissues of the uterus
similar to that occurring in normal involution after labor, and a
striking diminution in the size of the uterine body takes place. The
amputation of the cervix should always be accompanied by a thorough
curetting. Sometimes the change in the body of the uterus is so marked
after amputation of the cervix, or even after trachelorrhaphy, that a
condition of superinvolution, or uterine atrophy, results.
SUPERINVOLUTION OF THE UTERUS.
Superinvolution of the uterus is a disease the reverse of
subinvolution. In this condition the uterus, after childbirth or
abortion, not only undergoes the normal involution, but continues to
atrophy until the length of the uterine cavity may measure but one and
a half inches. The atrophy involves the neck as well as the body of the
organ, the Fallopian tubes, and sometimes the ovaries.
Superinvolution of the uterus is a rare condition. The cause is
difficult to determine. It has been attributed to great loss of blood
at confinement, to prolonged lactation, and to pelvic peritonitis
occurring during the puerperium.
Amenorrhea is the most marked symptom of superinvolution. Nervous
disturbances and hysterical symptoms may also be present.
The diagnosis is easily made from the history of the case and by
means of bimanual examination and the use of the sound. Congenital
malformation may be excluded from the fact that a pregnancy has
occurred, and senile atrophy from a consideration of the age and
history of the woman. The treatment should be directed to restoring and
maintaining the general health of the woman.
Iron and the remedies useful in other forms of amenorrhea may be of
advantage.