Subinvolutio uteri puerperalis is a postpartum involution disorder in which the mother’s uterus does not involute sufficiently. The most common causes of the phenomenon are multiple pregnancies and insufficient exercise during the postpartum period. Treatment consists of movement sessions and medical support, although curettage may be necessary under certain conditions.
What is puerperal subinvolution?
With the birth of a child, the female body goes through a significant effort, which anatomically manifests itself in various changes. During the confinement period, the new mother’s body recovers from the exertions of childbirth and returns to its original state. For crps in English, please visit gradphysics.com.
This is true on both an emotional and a biological level. The hormonal balance is restored and changes recede. In this period of time, regression disorders can occur. One of them is subinvolutio uteri puerperalis. The uterus of those affected does not recede sufficiently. At the same time, bloody weekly flow begins to increase.
The postpartum period lasts up to eight weeks after the birth of the child. If the uterus does not regress sufficiently in this period of time, the diagnosis of subinvolutio uteri puerperalis is obvious. The new mother can support the regression of her body through various activities. In the absence of such self-regression efforts, regression disorders are favored.
Various causes of regression disorders are particularly common. Women with an overstretched uterus after multiple pregnancies are particularly susceptible to disorders such as subinvolutio uteri puerperalis. The same applies to women with loose connective tissue, such as those who give birth frequently.
Other causes of subinvolutio uteri puerperalis can be remnants of the placenta that have remained in the uterine cavity and make regression difficult. In addition, the phenomenon can be favored by uterine myomas or congenital uterine malformations as well as those acquired through previous pregnancies or operations.
In addition, endometritis and a lack of hormonal stimulation when weaning are common causes of the regression disorder. Cases have also been documented in which the lack of movement in the new mother has caused subinvolutio uteri puerperalis.
Symptoms, Ailments & Signs
Patients with subinvolutio uteri puerperalis notice the regression disorder, especially with bloody weekly discharge. In addition, the lack of regression can be felt in individual cases by palpation in the area of the postpartum uterus.
The fundus uteri protrudes more or less, or at least does not develop backwards in the confinement days. In addition, the uterus feels unusually soft. Not every woman notices the regression disorder on palpation. The bloody and increased weekly flow is therefore understood as a key symptom for self-diagnosis.
Patients with the regression disorder can suffer from other symptoms that only develop from the phenomenon of subinvolutio uteri puerperalis. Ascending infections are particularly common as a secondary disease, for example. The main symptom of these infections is puerperal fever, which simulates an inflammatory change in the genital tract and is caused by bacteria that have penetrated the birth wound.
Diagnosis & course of disease
To make a diagnosis of subinvolutio uteri puerperalis, the doctor performs a clinical examination including palpation of the uterus. An essential criterion for the diagnosis is a highly palpable uterus, which is clearly raised given the day of confinement. Ultrasound examinations of the uterus are used to confirm the diagnosis.
The causes of the regression disorder must be elucidated in the differential diagnosis. In the case of an ultrasound examination, causes such as residues of the placenta, for example, can be easily identified. The prognosis for patients with subinvolutio uteri puerperalis depends primarily on the primary cause of the phenomenon. Women with particularly weak connective tissue, for example, will also be susceptible to the regression disorder in subsequent pregnancies.
With this disease, those affected primarily suffer from an excessively bloody weekly discharge. This discharge also occurs over a longer period of time and is often associated with pain. A clear regression can also be felt in the area of the uterus, which can lead to slight panic in many of those affected.
Infections can also occur due to illness. Most of those affected also suffer from a high fever and at the same time from tiredness and exhaustion. The quality of life of those affected is significantly reduced and limited by the disease. If the infections are not treated, in the worst case it can lead to blood poisoning and thus the death of the patient.
However, this can be avoided relatively easily. The treatment of this disease takes place without complications. With the help of various therapies and sufficient exercise, the symptoms can be reduced.
As a rule, the course of the disease is positive. In some cases, those affected are dependent on taking medication. As a rule, the life expectancy of the patient is not negatively influenced by the subinvolutio uteri puerperalis.
When should you go to the doctor?
In the case of subinvolutio uteri puerperalis, the patient is dependent on medical treatment in any case in order to prevent further complications or symptoms. A visit to a doctor is unavoidable, since healing cannot occur on its own. The earlier the doctor is contacted, the better the further course is in most cases.
As a rule, a doctor should be contacted in the case of subinvolutio uteri puerperalis if the person concerned notices a bloody discharge. This discharge can emerge in various parts of the body and significantly reduce the quality of life of those affected. Furthermore, high fever can indicate the subinvolutio uteri puerperalis. If a high fever occurs after a serious operation, a doctor should also be contacted. In most cases, those affected also suffer from various infections or inflammations.
In the case of subinvolutio uteri puerperalis, a general practitioner can be contacted in the first place, and the treatment is usually carried out with the help of medication. Whether the disease will reduce the life expectancy of those affected cannot be universally predicted.
Treatment & Therapy
Postpartum patients with postpartum disorders are asked by the doctor to support their own body in the process of regression. This support can mean targeted and regular exercise, for example. The regression of the uterus can often be set in motion in a natural way by such increased physical activity.
If a lack of exercise was the cause of the regression disorder, the movement units are causal therapy measures that tackle the problem at its source. In addition to the self-efforts, a conservative drug therapy of the regression disorder can be carried out.
Contraction agents such as ergotamine or oxytocin accelerate the involution of the uterus and can be used as supportive treatment steps. If remnants of the placenta are found to be the cause of the regression disorder during the ultrasound examination, exercise units and supportive medication are usually not sufficient for regression.
In most cases, the doctor will advise an invasive procedure in this situation. In this case, curettage of the cavum uteri may be indicated. If uterine fibroids prevent the uterus from regressing, an invasive or at least minimally invasive procedure to remove the fibroids is also indicated in this context.
In the context of regression disorders such as subinvolutio uteri puerperalis, prevention is almost more important than aftercare. Women can, for example, take measures to strengthen their connective tissue well before pregnancy. In addition, exercise in the postpartum phase is one of the most important preventive measures.
The regression disorder cannot be avoided in every case by taking these steps. Especially after multiple pregnancies, the phenomenon of subinvolutio uteri puerperalis can occur despite all efforts. However, the risk is at least reduced by means of the preventive measures.
The follow-up care of the subinvolutio uteri puerperalis directly follows the regression therapy of the uterus. The patients should also continue to exercise in everyday life and thus promote natural recovery. The illness or regression disorder often follows a lack of exercise. If this is the case, targeted exercise therapy may be enough for recovery.
In other cases, the self-efforts are merely a support. If necessary, the gynecologist also recommends drug treatment, which can, however, be followed by physiotherapeutic aftercare. This type of aftercare is also suitable as a preventive measure. Even before pregnancy, women can train and strengthen their connective tissue.
This is where prevention and aftercare go hand in hand. However, especially after a multiple pregnancy, the risk of regression disorders is very high. If there is also a bloody discharge, the patients must pay particular attention to personal hygiene. Then they also need a certain period of rest.
Only when the increased discharge stops should you start physiotherapeutic aftercare and treat your body with caution. Close observation of physical changes will help identify any problems. The doctor or midwife will help the patient with questions and give tips for effective recovery therapy.
You can do that yourself
Many of the affected women are symptom-free. You are not restricted in your everyday life by the Subinvolutio uteri puerperalis and therefore do not have to take any special measures.
In patients with heavy, bloody discharge, on the other hand, particularly strict personal hygiene is required. The weekly flow should ideally be caught with large, unscented and air-permeable bandages. To avoid infections, these must be changed regularly. Under no circumstances should women with subinvolutio uteri puerperalis use tampons or menstrual cups. They can impede the outflow of the weekly discharge and aggravate the regression disorder. Sexual intercourse is also discouraged.
In the case of subinvolutio uteri puerperalis, it is generally helpful for affected women to assume the prone position. It is helpful if a small pillow roll is pushed under at navel height. However, if pain occurs, this measure is not recommended. Abdominal massages or abdominal compresses with essential oils and placing ice packs on the abdomen of those affected can also bring relief. However, it is always advisable to consult a midwife.
Especially after a caesarean section, these measures should generally not be carried out without consulting a doctor. A few weeks after the birth, recovery can also be supported by movement and physical activity such as targeted recovery exercises.