Нейродермит – Neurodermatitis

In most women, uterine contractions simply press the sloughed-off endometrial tissue down its usual path through the mouth of the womb (the cervix) and out of the body via the vagina. The woman prone to endometriosis, however, experiences another phenomenon: because she may have a contracted uterus or a right cervix, all the menstrual blood cannot easily How out through the vagina. Rather, some of the blood-filled endometrium is forced up through the fallopian cubes, pushes backward out of the tubes, and is sprayed into the abdominal cavity, where it may attach itself to pelvic organs, producing the condition of endometriosis. Menstrual cramps and pain—known technically as dysmenorrhea—the first symptoms of endometriosis, are the result of this retrograde menstrual bleeding.

Dr. John A. Sampson, a researcher and practitioner in Albany, New York, is responsible for naming the disease in 1927. Dr. Sampson theorized that this hacking up of endometrial tissue, which he called retrograde menstruation, was the most probable cause of endometriosis. Dr. Sampson proposed an explanation as to how the endometrial tissue is flushed out of the fallopian tubes and into the abdominal cavity; but there is still no explanation for why the endometrial tissue implants itself in these abnormal sites.

It has been proved that nearly all women will experience retrograde menstruation, but that many women will reject the tissue while others become victims of endometriosis. Their implants «suck.» Sampsons theory has yet to be disputed, although a number of other researchers have discovered immunological, hereditary, and structural connections, as well as a link between the amount of menstrual blood pushed through the tubes and the severity of the disease.

The tragedy of tins disease is that it can go undetected until it has done irreversible damage. Equally heartbreaking is a woman’s fatalistic attitude toward menstrual cramps. When endometriosis takes hold, it has a distinct way of invading every aspect of a woman’s life, and this invasion begins early on, with cramps. Most women who try to cope with monthly bouts of mild to severe and debilitating cramps will seek relief from the pain with familiar remedies: heating pads, hot water bottles, or over-the-counter painkillers like aspirin. They do not connect their cramps to any process other than menstruation.

It does not occur to them that they may have endometriosis because they do not know about it. Since they don’t know how endometriosis can incapacitate their reproductive system as well as other organs, they don’t seek medical help. But these women aren’t to blame. More than likely, they have been taught that menstrual discomfort, like contractions during childbirth, is not only natural but part of being a woman. Where seeking medical help for childbirth is understood, consulting a doctor for «just cramps» is often considered frivolous and self-indulgent.

*10\43\4*

So far this chapter has dealt with pain management in general. However, dyspareunia — painful intercourse — is a problem that needs to be dealt with more specifically because of the physical and emotional stresses involved. This section has been written to give you some insight into the possible ways that might help you to overcome or cope with this particular problem.

When a woman does not want her partner to know she suffers from dyspareunia she may try to ‘put up with it’ for a number of reasons. Some women may feel they would be letting their partners down while others fear that their partner may leave them for someone else. For those who try to keep dyspareunia a secret from their partner, there is the possibility that when you try to avoid intercourse because of the pain, he is going to interpret this as rejection. For a woman wanting to become pregnant, avoiding sexual intercourse because of the pain is not going to help so she may pretend that everything is normal.

Equally, there may be problems when your partner is aware of dyspareunia. He may try to avoid sex so that he does not hurt you and this in turn may leave you feeling confused — particularly if your partner does not say why he is avoiding sex.

On an emotional level, it can destroy your self image — if you let it. The combination of a chronic illness and sexual difficulties is a tough hurdle to overcome. Add to this a decrease in libido

(sometimes caused by the hormonal treatment) and the problem of infertility and you can appreciate why this condition can cause so much heartache.

Dyspareunia can also be a result of other physical problems. Hormonal treatment can result in a dry vagina because of a lack of oestrogen and it may cause thrush which should be treated by your doctor. Some women may experience vaginismus which is an involuntary painful spasm of the vaginal muscles as a result of anticipated pain.

In order to overcome dyspareunia you must communicate! Talk to your partner and share your feelings. Work together and be honest with each other. Help your partner to understand how the pain affects you. Understand that he has feelings and needs love and attention as well.

Relax and give yourselves time. Intercourse may be less painful if you take the time to become fully aroused beforehand. Deep penetration usually causes the most pain so experiment with different positions until you find one that is more comfortable.

Explore other satisfying sexual activities that do not involve penetration. Show affection to each other in different ways such as kissing, hugging, masturbation and massage.

If you are having difficulty coping with the many emotional and physical problems associated with dyspareunia do not feel too embarrassed to seek professional advice. Your gynaecologist or GP should be able to suggest appropriate sources of support.

*81\83\2*

Most bowel symptoms are not due to the presence of endometriosis on the surface of the bowel itself, but rather are usually related to irritation from implants located on adjacent organs or tissues, such as in the Pouch of Douglas, or due to adhesions from these implants pulling on the bowel.

The range of bowel symptoms varies. The most common include diarrhoea and/or constipation, painful bowel movements, rectal pain, wind pain and abdominal bloating. Other less common bowel symptoms may include lower back pain, pain during rectal examinations, abdominal cramping, rectal bleeding, blood in the stools, urgency to open bowels, nausea and/or vomiting. These symptoms may be present throughout the month but are usually worse during menstruation. Exercise, sexual intercourse and vaginal examinations can also trigger these symptoms.

Research by the Endometriosis Association indicates that bowel symptoms are far more common than is generally acknowledged. In fact, 49% of women in its survey reported that they had experienced bowel pain prior to a diagnosis of endometriosis.

In the unusual cases where endometriosis is located on the bowel, the implants are usually confined to the outer layer of the bowel wall; it is uncommon for endometriosis to be found in the inner layer of the bowel wall. If implants are located on the bowel itself the symptoms experienced may include any of the symptoms mentioned above. In rare circumstances a partial obstruction of the bowel may develop as a consequence of scarring and adhesions from endometrial implants encircling and constricting the bowel.

Bladder symptoms-Implants on the bladder, or on adjacent organs, may cause a range of symptoms including bladder pain, blood in the urine, pain or burning when passing urine and urinary frequency.

Infertility-Infertility is one of the most common symptoms and is thought to affect approximately 30% to 40% of women with endometriosis.

*21\83\2*