Bleeding after coagulation of the cervical canal polyp. Removal of a polyp of the cervical canal: indications, types of surgery, rehabilitation

What is a cervical canal polyp?

Polyp of the cervical canal- This is a benign formation that grows into the lumen of the cervix. Such outgrowths are formed from connective tissue and can be covered with flat multilayered, high cylindrical or immature epithelium of the endocervix. They are attached to with the help of a leg (thin or thick). The place of their localization is the depth of the external cervical os. If the cervical polyp is located on a long stalk, then it can protrude into the vaginal lumen, then the gynecologist is able to visualize it during a standard examination.

All polyps have blood vessels that grow into them as they form. It is their number that determines the color of education. The fewer of them, the paler the polyp. With a developed vascular network, it can have a rich burgundy color. The more fibrous cells in the structure of the polyp, the denser the outgrowth will be. The size of the tumors varies from very microscopic to very impressive. The larger they are, the brighter the clinical signs of pathology. The maximum size of the cervical polyp is 40 mm, although formations rarely grow to such volumes. The minimum diameter is 2 mm.

It is not uncommon for this disease to be detected during pregnancy - polyps are detected in 22% of women bearing a child. It is worth knowing about the existence of false cervical polyps or pseudopolyps. They are formed within a few weeks after conception, do not have legs. The structure of the cervical pseudopolyp is represented by a transformed endometrium. If a pregnant woman is diagnosed with such an education, then she should be under special control by a gynecologist. When a pseudopolyp does not affect the process of bearing a fetus, it is simply observed. If there is a threat of termination of pregnancy, then the formation is subject to removal, which is carried out during gestation, without waiting for delivery. Polyps can be combined into groups, or they can grow singly.

According to available statistics, this pathology is quite common and is recorded in women at different ages. However, more often cervical polyps occur after 40 years. Among other neoplasms of the cervix, which are benign in nature, polyposis is diagnosed no more often than in 25% of cases. Doctors consider this pathology background. The presence of multiple cervical polyps increases the risk, therefore, requires regular monitoring by a doctor and timely treatment.

Symptoms of polyps of the cervical canal

The latent course of the pathological process is a fairly common characteristic of polyps. Small formations with a wide stem almost do not betray themselves. They are diagnosed, as a rule, by chance, when a woman goes to the doctor about another disease of the genital area. It is worth noting that with polyposis of the cervical canal, 70% of women have concomitant gynecological diseases.

The fact that there is a polyp in the body can be suspected after its damage, infection, ulceration or inflammation.

In this case, the neoplasm manifests itself as follows:

Bloody discharge, which can often be observed after intimacy or gynecological examination. Also, polyps are sometimes injured by sanitary tampons. This is especially true for tumors on a long stalk that extend beyond the boundaries of the external uterine os into the lumen of the vagina;

If the polyp has undergone necrosis or become inflamed, then in the period between the woman may begin. In all other cases, this is not typical for polyps;

When the formation is infected, a woman will find leucorrhoea that has a mucopurulent character. Large polyposis growths are more often subject to such a process;

Drawing pains also occur with large polyps. They are due to the fact that, due to a large outgrowth, the pharynx of the cervix is ​​​​not able to close properly;

Abundant mucous discharge appears when the polyp presses on the glands of the cervical canal;

If a large formation is found in a pregnant woman, then this may threaten her with a miscarriage, starting from the early period of gestation. Such risks are due to the fact that the polyp causes reflex irritation of the uterus, which causes it to contract involuntarily.

The structure of the formations affects the symptoms of cervical polyposis.

Depending on the cellular composition of the tumor, a woman is dominated by certain signs:

With fibrosis symptoms are extremely poor. This is due to the structural features of such a polyp. It has no glands, which means it does not secrete mucus. The fibrous stroma is dense and weakly penetrated by blood vessels, which reduces the possibility of injury to the polyp and the risk of bleeding;

glandular polyps produce more mucus, which can increase intermenstrual flow. But there will not be too many of them, since fibrous formations most often have a small size (up to 10 mm);

Glandular fibrous tumors- These are formations of a mixed type, they give the most pronounced symptoms. A brighter clinical picture of the disease is due to the size, which can reach 25 mm or more. In this case, the woman complains of pain, notes contact bleeding and increased discharge between cycles.

Doctors are inclined to believe that the formations localized in the cervical canal are formed under the influence of a number of provoking factors:

Canal injury. Various damages negatively affect the structural state of the epithelium lining the cervical canal. Of particular danger are diagnostic curettage, abortion, aspiration biopsy, hysteroscopy. Often the cervical canal suffers due to an incorrectly installed intrauterine device. In addition, it can be damaged during childbirth, especially if they were accompanied by traumatic obstetric manipulations. After an injury, the epithelium starts the healing process, it is regeneration that causes the growth of polyps. New mucous cells may divide too actively. Moreover, the injury does not have to be extensive at all, sometimes a microscopic wound is enough;

Structural changes in the surface of the cervix. Often the formation of polyps is preceded by such pathologies as true and false erosions, as well as leukoplakia;

Sexual infections. When a woman's immune defenses are reduced, diseases of the vaginal epithelium such as trichomoniasis, gonorrhea, chlamydia and many others pose a threat to the cervical canal. Rising from the vagina, microorganisms begin to infect the cervical canal, disrupting the natural composition of the mucus located there. Local inflammation occurs, as a result of which the mucous membrane becomes looser and more easily injured. The protective response of the cervical epithelium is an increase in its own area due to cell division. As a result of this process, a polyp or a group of them is formed;

Nonspecific infection. The growth of a neoplasm can be stimulated by such pathologies as vulvovaginitis, endomyometritis;

Violations of the microflora of the vagina. The longer an imbalance of bacteria is observed in the vagina and the more often fluctuations in the level of acidity occur, the more favorable the environment becomes for the growth of the epithelial layer of the cervical canal;

Disorders of the ovaries. It is with ovarian dysfunction in women that polyps in the cervical canal are most often detected. They are accompanied by diagnoses such as endometrial polyposis,. Therefore, doctors suggest that excess estrogen is a powerful stimulator of the growth of the epithelium lining the cervical zone;

Physiological processes. Hormonal surges in a woman's body occur constantly. With the exception of menstruation, they occur during adolescence, at the time of bearing a child and at the time a woman enters.

Unexplained etiology. It is worth noting that polyps are not always formed under the influence of provoking factors. Sometimes the occurrence of such neoplasms cannot be explained by one reason or another. In this case, indicate cervical polyposis of unknown etiology.

An outgrowth localized in the cervical canal, despite mild symptoms, poses a threat to a woman's health.

The danger lies in the following:

Polyps can transform into a malignant tumor causing cervical cancer. Although such changes occur infrequently, nevertheless, the risk of rebirth exists. Therefore, doctors recommend removing such formations, regardless of their size and structure;

The risk of developing uterine bleeding increases. This threat is due to the fact that the polyp has its own blood vessels, and it can reach 30 mm in size. When its wall is damaged, blood loss often occurs. Almost always, it ends on its own, however, regular repetitions lead to anemia. The level of red blood cells and hemoglobin falls, which negatively affects the woman's well-being;

The presence of a polyp can affect the course of pregnancy extremely negatively, up to spontaneous abortion. Other threats during gestation against the background of cervical polyposis include isthmic-cervical insufficiency, as well as a low location of the placenta;

Tumor necrosis in the absence of medical care, which consists in surgical intervention, can cause the death of nearby tissues, blood poisoning and the death of a woman;

Hematometra is another danger of a cervical polyp. Due to the fact that the tumor has a large size and the ability to move, as well as its inflammation, the cervical canal can be blocked. As a result, menstrual blood will begin to accumulate in the uterine cavity, as its natural outflow will be disturbed. A complication can be suspected by the absence of menstrual bleeding on time, the blood can leak out, but it will have an unpleasant odor and its volume will be much less than it should be. In addition, the woman will experience pain in the lower abdomen, and the uterus will stretch and increase in size. If timely assistance is not provided, an inflammatory process can begin, up to sepsis and death.

In connection with such serious threats to the health and even life of a woman, polyps must be removed as soon as possible after they are discovered.

Diagnosis of polyps of the cervical canal

In order to detect the presence of such formations, sometimes only a standard gynecological examination is enough. During its conduct, the doctor detects thickened and hypertrophied walls of the cervix. Outgrowths protrude from the cervical canal, having a characteristic shape and color.

To confirm the diagnosis, a woman needs to undergo a cervicoscopy. In fact, this is a normal examination of the mucous part of the cervical canal. For a better view, the doctor uses a mirror or expander, as well as binocular optics. The shade of the polyp has an important diagnostic value. So, its cyanotic or purple color indicates the blocking of blood flow in certain vessels and oxygen starvation of the tumor. If the polyp is white, then this is a sign of keratinization. Such a neoplasm acquires greater strength and elasticity.

Cervicoscopy allows you to visualize not only large, but also small polyps. The technique provides information about their structure, possible inflammation, necrosis or ulcerative processes. In addition, a targeted biopsy can be performed during the procedure. The resulting material is then sent for histological examination.

When tumors are found in the cervical canal, it is imperative to conduct an ultrasound examination, which allows you to determine their presence in the uterine cavity. Due to the fact that the treatment of such formations is always operational, a preliminary examination of the smear using the methods of bacterial culture and PCR is necessary. If a woman has infections, they are first eliminated from the body.

Answers to popular questions

Should a cervical polyp be removed? Education found in the cervical canal is subject to mandatory removal. You should not refuse the operation, even if the polyp has a very small size. The need for resection is due to the tense oncological situation in the world.

Can a cervical canal polyp disappear on its own? The formation cannot self-destruct, which is why there are no drug treatment schemes for such tumors.

How long does bleeding last after removal of a cervical canal polyp? If a low-traumatic method of getting rid of the neoplasm was chosen, then spotting may not be observed at all. Sometimes spotting may continue for up to 48 hours. Gradually, they become less and less, and after three days they completely disappear.

What does heavy menstruation mean after removal of a polyp of the cervical canal? When the formation is removed from the body, menstruation should return to normal. Her character can additionally be affected by the age of the woman and the number of removed polyps. Menstruation after surgery should normally become less abundant and less painful. If, on the contrary, their volume has increased or the cycle has broken, then you should consult a doctor for advice.

Removal of polyps of the cervical canal - 5 methods

When a woman decides on the choice of a surgical technique, it is important for her to remember that after any operation she will have to undergo a curettage procedure for the entire cervical canal. Only in this way will it be possible to get rid of pathological cells that can lead to a relapse of the pathology. There are several methods aimed at removing cervical growths.

Diathermocoagulation

This method has been around for quite some time. During the procedure, excision occurs, as well as cauterization of the polyp. For this purpose, the doctor uses an electroknife. A high-frequency current passes through the device. As a result, the polyp cells get burned and die. At the place of its attachment, a wound is formed, which is covered with a crust from above. It is an additional protection against infection and bleeding. However, this method has certain contraindications. The operation is not prescribed to a woman if she is carrying a child, has not given birth before, and also suffers from a bleeding disorder.

Nevertheless, diathermocoagulation has an undoubted advantage, which lies in the ubiquity of the technique, which makes it accessible to every woman.

However, giving preference to such an intervention, it is worth remembering its shortcomings:

After cauterization, a polyp will remain in place, which can complicate future childbirth;

The recovery process can take several months;

With incorrect rejection of the formed crust, bleeding may open;

The procedure is quite painful.

However, the procedure is used everywhere, as it is not only affordable, but also makes it possible to get rid of polyps attached to the cervical canal with a wide stem.

Cryodestruction

To implement this intervention, low temperatures are used, which can reach minus 80 degrees. The polyp itself is exposed to liquid nitrogen. The affected area is frozen, after which it is cut off. In place of the former polyp, a healthy epithelial tissue of the cervical canal is formed. Cryodestruction is a modern way to get rid of polyposis growths, so it has a number of advantages, including the absence of bleeding and pain. In addition, this method is suitable for women who do not have children, since after the intervention there will be no scar on the cervical canal, which means that there will be no complications during childbirth.

The only significant drawback of the procedure can be called a long tissue recovery time. It can take up to two months. Also, a woman who decides to undergo cryodestruction may face the fact that in small towns there is no possibility of carrying out the procedure.

Laser polypectomy

The doctor has the opportunity to use a laser to remove a cervical polyp when it is single and not too large. During the procedure, the doctor monitors its progress with the help of a hysteroscope. A significant disadvantage of this technique is that it cannot be used to remove several formations. In addition, the cost of laser cauterization is quite high, and there is no guarantee that a relapse will not occur in the near future.

However, surgery using a laser beam has its advantages. Firstly, the risk of perforation of the wall of the cervical canal is significantly reduced, since the doctor independently regulates the intensity of the laser exposure and the depth of its penetration into the tissues. Secondly, there will be no bleeding during the procedure, as the blood vessels instantly coagulate. Thirdly, the recovery period is very short, and after a few days the woman will stop any discharge, and menstruation will begin without delay.

Amputation of the cervix

The indication for removal of the cervix, together with the polyps present in it, is a recurrent pathology. In addition, the cervical canal is removed if it is found that the neoplasm has already been malignantly degenerated or has atypical cells. You can perform the procedure in all of the above ways, the doctor gets access to the cervix using a laparoscope. In this case, the cone-shaped part of the neck is removed, as well as the mucous membrane lining the cervical canal. At the same time, the uterus itself does not suffer, and an intact mucous membrane begins to form again in the cervical canal.

Hysteroscopic method

This method of removing cervical formations is the safest, most modern and painless for a woman. To carry out the procedure, a special instrument is required - a hysteroscope. The doctor introduces it into the vaginal cavity, into the desired area of ​​the cervical canal. Having examined each neoplasm with the help of an existing camera, the surgeon removes them using miniature scissors (resectoscope) or a loop for this. She throws herself on the leg of the polyp and unscrews it at the very base. If a resectoscope is used, the polyp is simply cut off. The choice of instrumentation depends on the size of the cervical formation. To minimize the possibility of relapse, the place where the leg was attached is cauterized.

The time that is optimal for performing hysteroscopy is the end of the menstrual cycle. The operation is not carried out later than 10 days from the end of the last menstruation.

Despite the advantages of the procedure, which are its safety, painlessness, and the ability to carry out a thorough curettage, hysteroscopy can not be used in every case. For example, it is not performed if a woman is carrying a child, if she has a pathological narrowing of the cervical canal, infectious, or inflammatory processes.

After the removal of the cervical polyp has been carried out, the treatment does not end there.

It is forbidden to visit baths, saunas, steam rooms for two months, as excessive overheating of the body can cause bleeding;

You should not lift weights, you must abandon physical exertion;

A visit to the doctor should be regular, which is associated with the possibility of recurrence of polyps and the risk of their malignancy;

Sexual life is banned for the next half a month. You should also avoid swimming in open water to minimize the risk of infection;

The use of tampons during menstruation is prohibited. Within two months it is worth using sanitary pads;

Intimate hygiene should be especially thorough, which will also avoid infection and infection of the wound. For washing in the first days after the intervention, you can use antiseptic agents, for example, Miramistin or potassium permanganate solution;

Pregnancy planning should be postponed for the period recommended by the doctor. Most often, the break does not exceed six months, although sometimes it can be somewhat shorter;

Sometimes, in order to avoid infection after the operation (especially after amputation of the cervix), the doctor recommends taking antibacterial drugs for several days;

If any pathological discharge from the vagina is detected or if there is heavy blood loss, a medical examination is necessary.

After the removal of polyps, the woman continues to be registered with the gynecologist, since the formations can recur. For this reason, she should be examined every six months, keeping in mind the asymptomatic course of the disease.

In terms of prognosis, cervical polyps recur in about 30% of cases. There are no specific preventive measures. It is only important to exclude any traumatic situations for the cervix and to get rid of endocrine and gynecological pathologies in a timely manner.

As for the effective drug therapy of the cervical polyp, it does not exist. To date, there is not a single remedy that can eliminate such a neoplasm from the body or reduce the severity of the pathological process.

Therefore, if a woman is offered to take medications with a diagnosis of "cervical canal polyp", then it will be directed only to the treatment of comorbidities that have become provocateurs of tumor growth:

So, hormonal therapy helps to establish hormonal balance, reduce the number of circulating estrogens, increase the amount of progesterone. This will help reduce the risk of recurrence of polyps after their removal. Doctors prescribe either oral contraceptives of the combined type (Zhanin, Regulon, etc.), or gestagens (Utrozhestan, Norkolut, etc.). You should tune in to a long-term intake of hormonal drugs, since they are not able to have a significant effect on the body at one time. The minimum course takes three months;

Antibacterial therapy is indicated when polyps develop against the background of infection or inflammation of the genital organs. Drugs are selected on an individual basis, it depends on the specific disease;

Non-steroidal anti-inflammatory drugs are prescribed for such background infections as adnexitis or cervicitis;

Education: Diploma "Obstetrics and Gynecology" received at the Russian State Medical University of the Federal Agency for Health and Social Development (2010). In 2013, she completed her postgraduate studies at the NMU. N. I. Pirogov.

A cervical canal polyp is a benign neoplasm that forms in the passage of the uterine cervix. Such tumors consist of connective tissue covered with epithelium on top. The polyp is connected with the surface of the cervix by a thin stem. Pathology implies surgical treatment.

Indications

An operation to remove a polyp is indicated if:

• polyps have reached a size of 10 or more centimeters (such neoplasms clog the lumen of the cervix, can cause infertility and miscarriages);
• age after 40 years (due to hormonal changes, an exacerbation of the course of the disease is possible);
• failure of conservative treatment;
• problems with conception due to large polyps;
• adenomatous tumor neoplasms (prone to degeneration into a malignant form).

Contraindications

Removal of the polyp of the cervical canal can be canceled or postponed until the patient's condition returns to normal. A contraindication to surgery is:

• inflammation in the pelvic organs and the genitourinary system;
• the period of bearing and feeding a child;
• menstruation (the operation is carried out in the interval from 4 to 8 days of the cycle);
• malignant tumors;
• bleeding in the uterine cavity (provoked by pathological processes or menopause).

ATTENTION! Any chronic disease (in an acute form) can be a reason to cancel the operation. The final decision in this case is made by the attending physician, who conducts a detailed diagnosis of the patient's body.

Operation progress

During surgery, the patient is under general anesthesia or local anesthesia (the method of anesthesia depends on the size of the benign tumor). The patient occupies a reclining position on the gynecological chair. After that, the doctor examines the polyp using a hysteroscope inserted into the uterus. When the localization of the neoplasm is determined, the specialist twists or excised the polyp and its leg, and with the help of a curette scrapes the mucous from the cervical canal and the inner surface of the uterus. This helps to prevent recurrence by removing cells that can form a polyp again.

If the polyp is single or small in size, curettage is not performed.

Upon completion of the manipulations, the removed tissues are sent for histological examination in order to exclude the possibility of the transformation of polyp cells into a malignant form.

Types of operations to remove polyps

There are five methods for removing polyps, each of which is actively used in medicine today.

Diathermocoagulation

The doctor uses an electric knife to remove the neoplasm. Due to the precise action of high-frequency current, atypical tissues are excised, and a burn covered with a crust appears at the site of attachment of the polyp. The crust protects the wound from infection and bleeding.

ATTENTION! The technique is indicated mainly for women who have given birth and do not plan children, since a postoperative scar can provoke complications during pregnancy.

Cryodestruction

The procedure is based on thermal exposure. The polyp is frozen with liquid nitrogen (temperature can reach -80C). After that, the atypical area is removed. The wound is covered with epithelial tissue. The procedure can be prescribed to women who do not have children, since after cryodestruction there are no scarred tissues left.

The recovery period after the operation reaches 2 months.

Laser polypectomy

The technique is used in cases where the polyp is single and did not have time to reach a large size. The doctor controls the progress of the operation with a hysteroscope, and the polyp itself is removed with a laser beam. The surgeon regulates the intensity of exposure and the depth of penetration of the laser, so that healthy tissues are not cauterized. There is no risk of bleeding, as small vessels are coagulated during the procedure. Laser polypectomy has a short recovery period. The menstrual cycle after the operation is not disturbed.

Amputation of the cervix

Amputation is resorted to in the case of recurrent polyposis or the degeneration of the neoplasm into a malignant form. The excision of the neck fragment is carried out by one of the previously listed methods. Access to the working area is organized using a laparoscope. The surgeon removes the cone-shaped part of the cervix and the mucous membrane of the cervical canal. After removal of the mucosa, the cervical canal is re-covered with a lining.

The operation allows you to get rid of the pathology, while maintaining the reproductive function.

Hysteroscopic polyp removal

The method is based on the use of a hysteroscope. The specialist inserts an instrument into the cervical canal through the vagina and uses a camera to examine the polyp. Then the neoplasms are excised with a medical loop or resectoscope. The site of attachment of the polyp to healthy tissues is cauterized to prevent recurrence.

Hysteroscopic removal is the safest of the listed methods (due to the use of an optical instrument).

Postoperative period

The postoperative period lasts from several days to several months (the duration of rehabilitation depends on the method of removal).

During this time, the woman will have to follow the recommendations and restrictions:

• it is forbidden to expose the body to thermal effects (steam rooms, baths, etc.);
• physical activity should be avoided;
• it is necessary to monitor the condition of the cervical canal in order to detect complications and relapses in time (the doctor prescribes scheduled visits to the patient);
• intimate life can be resumed only 15 days after the removal of the polyp;
• it is forbidden to use hygienic tampons;
• it is forbidden to swim in open water (because the risk of infection is very high);
• accidental pregnancy should be avoided and planned conception should be postponed for up to 6 months from the date of surgery;
• in the presence of vaginal discharge, pain and discomfort, you should consult a doctor unscheduled and urgently.

Immediately after the operation, it is necessary to revise the rules of intimate hygiene and use antiseptics for washing. This will help prevent inflammation and infection of the wound. Your doctor may prescribe antibiotic pills.

The prognosis for recurrence is 30% of the total number of cases. After the operation, a woman gets on an indefinite gynecological record and undergoes an examination every six months. As preventive measures, it is necessary to control the work of the endocrine and reproductive systems (blocking pathologies at the initial stage), to avoid injuries of the cervix.

Discharge and menstruation

After removal of the polyp, slight bleeding is acceptable, which lasts several days (episodic) and mucous discharge. Mucus appears as a natural reaction of the body to damage and has a disinfecting effect.

Surgical intervention acts not only as a general stress factor, but also injures the cervical canal (as a result, the structure of the endometrium changes). Against this background, the menstrual cycle may go astray. If the operation was successful, after 5-8 weeks the cycle should resume, and after 6 months it should be completely normal.

If the first menstruation after the operation is too heavy and lasts longer than 7 days, you should consult a gynecologist. Sharp pains radiating to the back or lumbar should also become an alarming factor.

Possible Complications

Any surgical intervention aimed at restoring or maintaining a woman's health is fraught with complications. A specific complication of the operation to remove polyps is the recurrence of the pathology. Other consequences of the operation include:

• adhesions and scarring of tissues (if a large area of ​​the cervical canal has been damaged, the body may respond to this by forming connective tissue that replaces the epithelium);
• infection of wounds (the body becomes susceptible to pathogens);
• the development of a cancerous tumor (cells can be reborn if the polyp was not completely removed);
• damage to the cervical canal with medical instruments;
• internal bleeding on the background of spasm of the uterine neck.

Complications in the form of adhesions and scarring can lead to further infertility and obstruction of the cervix.

- tumor-like formations emanating from the cylindrical epithelium of the endocervix and growing into the lumen of the cervix. Polyps of the cervical canal usually manifest themselves as leucorrhea, contact bleeding, pulling pains. Diagnosis of cervical polyps includes a vaginal examination, colposcopy, cervicoscopy, histological analysis of cervical scraping. Removal of the polyp of the cervical canal is performed by unscrewing its legs and cauterizing the bed, followed by curettage of the mucous membrane of the cervix.

Diagnosis of polyps of the cervical canal

The main principles for the diagnosis of cervical canal polyps are their visual detection, study using colposcopy (cervicoscopy), ultrasound, knife biopsy of the cervix with curettage of the cervical canal.

During a gynecological examination in the mirrors, thickening and hypertrophy of the cervix and bright pink polypoid formations of a round or cluster shape protruding from the cervical canal are visualized. Polyps covered with stratified epithelium with keratinization processes have a whitish color; in violation of blood circulation in the polyp, it acquires a dark burgundy or purple color. In polyps prolapsing into the vaginal lumen, depending on the number of stromal elements, a soft or hard-elastic consistency is determined.

Colposcopy and cervicoscopy allow you to see small polyps of the cervical canal, examine in more detail their structure, the presence of inflammation, necrosis, ulceration of the surface, as well as other existing changes in the cervix. To exclude endometrial polyps in the uterine cavity, a gynecological ultrasound is performed.

After a visual examination, a biopsy is performed with fractional curettage of the walls of the cervix and a histological examination of the material. Before the surgical removal of polyps of the cervical canal, smears are examined for infections by bacteriological and PCR methods. In case of detection of STDs, their preliminary course therapy with control of cure is indicated.

Treatment of polyps of the cervical canal

Any polyps of the cervical canal are an indication for removal. Under aseptic conditions, after exposing the cervix with mirrors, the polyp of the cervical canal is captured with a fenestrated forceps and removed by twisting movements. Then, the cervical canal is scraped with a curette, achieving a thorough removal of the polyp pedicle. The polyp bed is additionally processed by a cryogenic or radiofrequency method. With echographic signs of changes in the endometrium, hysteroscopy is performed with diagnostic curettage of the uterine cavity.

Polyps located close to the external pharynx are excised wedge-shaped with a catgut suture. Polyps localized in the upper cervical canal require targeted removal under hysteroscopic control. The removed material is sent for histological examination to study the good quality of the cervical canal polyp. In the future, depending on laboratory data, anti-inflammatory or hormonal therapy may be prescribed.

Recurrent cervical canal polyposis is an indication for cone amputation of the cervix. Removal of polyps of the cervical canal during pregnancy is performed if the size of the formation exceeds 10 mm, its rapid growth, bleeding, signs of necrosis or initial malignancy (dyskaryosis) of the polyp are noted.

Complications of polyps of the cervical canal

Relapses of cervical canal polyps develop with incomplete removal of the tumor stem. In rare cases, thermal burns are noted due to cauterization of the polyp bed, stricture and stenosis of the cervix. Unremoved cervical canal polyps can provoke bleeding, maintain genital tract infections, cause cervical infertility factor, and become malignant. Pregnancy management in patients with cervical canal polyps requires the prevention of spontaneous miscarriage, ICI, premature birth, cervical dystocia.

Prevention of polyps of the cervical canal

The conditions for the prevention of polyps of the cervical canal are: the passage of a regular dispensary examination, the prevention and timely treatment of gynecological and endocrine pathologies, the exclusion of traumatic effects on the cervix. If suspicious symptoms appear, you should immediately undergo an examination by a gynecologist.

When undergoing a gynecological examination, as well as when a colposcopy is performed, a cervical canal polyp is diagnosed quite often. This is a tumor-like neoplasm that originates from the cylindrical epithelium of the endocervix and grows into the lumen of the cervix.

Just like an endometriosis polyp, a cervical canal polyp can cause many unpleasant consequences. This pathology can lead to infertility and miscarriage. In some cases, benign formations are malignant. That is why the polyp of the cervical canal must be removed when planning a pregnancy.

The operation to remove the polyp is not difficult, however, it can still be accompanied by various complications. You need to understand how the body should normally function after the procedure, what is the norm and what is pathology. This will help to avoid a number of unpleasant consequences.

Source: gynekolog-i-ya.ru

Doctors identify several factors that affect the nature of the discharge:

• The size and appearance of the tumor. The larger the polyp, the more blood vessels it contains. After removing a large polyp, bleeding will be stronger than when removing a small one. In this case, the thickness of the stem and its volume also play a role.
• The presence or absence of an inflammatory process. If, after the removal of the polyp, an infection has entered the genital tract, the discharge will acquire an unpleasant odor and a greenish or yellowish tint. As it is right, they are plentiful and do not turn for a long time.
• Type of surgical intervention. Bleeding is minimal after laser removal of the polyp and cryodestruction. If the polyp was removed by unscrewing the stem, the bleeding will be prolonged and profuse.
• Vascularization - the degree of blood supply to the polyp. The more the neoplasm feeds on blood, the stronger the bleeding will be after its removal.
• Ingrown legs. If the polyp has grown deep, then it will be quite difficult to remove it. During the operation, the surgeon may also damage healthy vessels and tissues. In such cases, the rehabilitation period is somewhat more difficult and lasts longer.

Vaginal discharge after removal of the polyp of the cervical canal always changes. Normally, a woman has an increase in mucus volume and slight bleeding. You shouldn't be afraid of it. It's quite normal. Vaginal mucus has antibacterial properties. It protects the reproductive organs from infection.

Blood after modern procedures for the removal of a polyp is present in a meager amount. Thus, vaginal discharge after surgery looks like an ichor, a mixture of mucus and blood. In the first days after the procedure, the discharge is relatively abundant, but over time, their number gradually decreases. This indicates that the wound is healing.

If the operation was performed correctly and the woman does not have any complications, light bleeding will be observed for no more than a week.

Complications

Complications after removal of the polyp of the cervical canal may be as follows:

Inflammatory damage to the reproductive organs. This can happen if a woman has untreated infectious diseases of the pelvic organs, if she does not follow the rules of hygiene, or if the surgical instruments were not sterile enough.

The essence of the treatment of this problem is the use of antibacterial drugs. They can be given intravenously or intramuscularly, taken by mouth, or used topically. The gynecologist should select the drug based on which microorganism has become the causative agent of the disease.

Perforation of the uterine wall. This can happen if the doctor is not experienced enough, with insufficient expansion of the cervix or loose walls of the organ. If the damage is minor, they heal on their own. Large wounds are usually sutured. To prevent the development of an infectious process, then antibacterial agents are necessarily prescribed.

Hematometra - a violation of the evacuation of blood and its accumulation in the uterine cavity. This problem can occur with spasmodic contractions of the cervix. In this case, the woman abruptly stops the discharge and severe pain occurs. The essence of the treatment of hematomera is to create conditions for the evacuation of the contents. To stop the pain, doctors can prescribe painkillers, and the infection that has joined is eliminated with antibiotics.

• a significant increase in the volume of vaginal discharge;
• the presence of an unpleasant odor in the discharge;
• the occurrence of pain in the lower abdomen and / or in the lumbar region;
• increase in body temperature to subfebrile indicators;
• deterioration in well-being in general;
• abrupt cessation of vaginal discharge.

All of the above symptoms should not be normal. When they occur, you must undergo a medical examination. Do not forget that various health problems are easier to eliminate precisely in the initial stages.

Content

A polyp of the cervical canal is called a local proliferation of cylindrical epithelium, which has the appearance of a growth of predominantly benign etiology. It is known that polyps of the cervical canal tend to grow in its cavity.

Cervical polyps cannot be attributed to a rare pathological condition. Their detection occurs in 25% of cases. Moreover, polyps of the cervical canal can be detected in women at any age. Despite the fact that cervical polyps are recorded even during pregnancy, they are inherent mainly in women after forty years.

Neoplasms can have a different structure and shape. In particular, polyposis neoplasms are located both on a stalk and on a wide base. Polyps can progress in groups and look like a bunch of grapes. Sometimes polyposis has a single character.

Usually neoplasms are about a centimeter in size. However, their size can vary from a few millimeters to two or three centimeters. If the cervical polyp is small, it can progress without symptoms for many years. Large formations often block the lumen of the cervical canal and are accompanied by certain symptoms. In order to prevent complications, large cervical polyps need to be removed.

The causes and factors of the appearance of polyposis are not well understood by scientists. As the main versions, hormonal disorders, inflammation and trauma of the epithelium in history are considered. It was revealed that in 70% of cases polyposis is accompanied by other gynecological diseases. While in healthy patients, polyposis is practically not detected.

Structure

The cervical canal is located in the inner part of the cervix. The surface of the cervical canal is lined with a single-layer cylindrical epithelium, the cells of which cause the velvety and red tint of the mucosa.

In the cervical canal, many glands of the submucosal layer function. The glands are part of the defense mechanism against infections. They continuously produce mucus that fills the cervical canal like a plug. In addition, mucus is distinguished by its alkaline reaction and its bactericidal properties. Thus, the narrowness of the channel itself and the produced secret prevents the penetration of pathogenic microflora into the sterile uterine cavity.

From the inside, the surface of the cervical canal is formed by multiple folds. That is why the channel resembles a spindle. The cervical canal forms two constrictions. The narrowing near the base of the cervix is ​​the external os. In this area, the stratified squamous epithelium of the visible vaginal part of the cervix connects to the cylindrical single-layer tissue of the cervical canal. This area is called the transformation zone.

The internal os is formed by a narrowing of the cervical canal in the upper part, which is connected to the uterine cavity. The external and internal pharynx are formed by means of a connective tissue that differs in density. Narrowings are a kind of dampers that do not allow the infection to spread.

Polyps are usually located in the area of ​​​​the external pharynx, as well as in the middle or at the top of the cervical canal. Most neoplasms have a long stalk and protrude into the vaginal lumen. Such a polyposis can be diagnosed during a general gynecological examination.

The surface of the formation may consist of cylindrical and squamous epithelium. Polyps covered with different types of epithelium differ in color.

Neoplasms contain a significant number of vessels that germinate during the formation of the polyp. This structure leads to bleeding when the surface is damaged.

In most cases, polyposis does not manifest itself. Small formations are often detected by chance. If they are large, bleeding may occur.

Polyposis of the cervical canal is detected during pregnancy in 22% of cases. Usually neoplasms are small in size and are not accompanied by a clinical picture. In such cases, pregnant women are shown observation, and treatment is carried out after childbirth and finding out the causes of the pathology.

In the process of diagnosing polyposis, several basic research methods are used, for example, ultrasound, colposcopy. Removal of a polyp of the cervical canal is not a guarantee of a complete cure. In 15% of cases, after removal, relapses of polyposis occur. Therefore, treatment after removal is also aimed at preventing recurrence of the pathology.

The reasons

Gynecologists emphasize that the exact cause of polyposis is unknown. Nevertheless, several factors provoking focal growth of the epithelium are considered as the main causes.

1. Trauma of the cervical canal. Violation of the integrity of the tissue can occur as a result of abortion, curettage, probing of the uterine body, hysteroscopy, incorrect installation of the spiral, hysteroscopy. Trauma can occur during childbirth. In the process of healing of the epithelium, its excessive growth occurs. Moreover, polyposis can develop even with minor damage to the tissue of the cervical canal.
2. Structural changes in the epithelium. Pseudo-erosion and leukoplakia can provoke the development of polyposis.
3. Inflammatory process caused by specific and non-specific microorganisms. Sexual infections with concomitant immune disorders penetrate into the area of ​​the cervical canal. This leads to a qualitative change in the composition of the mucus and tissue edema. Against the background of edema, the epithelium becomes vulnerable and loose. Over time, the inflammatory process leads to the growth of cervical tissue and the formation of a polyp. Nonspecific inflammations that cause polyposis include vaginitis, cervicitis, and endometritis.
4. Bacterial vaginosis. Fluctuations in the acidity of the vagina and a violation of the composition of the intimate microflora are favorable conditions for the activation of opportunistic and pathogenic microorganisms.
5. Violation of the functioning of the ovaries. Often, polyposis is combined with such hormone-dependent pathologies as endometriosis, polyps of the inner layer of the uterus, endometrial hyperplasia. Gynecologists believe that these pathologies can be based on a single mechanism of occurrence - hyperestrogenism, which affects the processes of epithelial growth. Nevertheless, it should be borne in mind that sometimes hormonal changes can be triggered by long-term stress, obesity, diabetes and thyroid pathologies.
6. Physiological reasons. In this case, they mean the changes that occur during pregnancy and menopause. Hormonal changes cause excessive growth of cellular elements.

Despite some relationship between some factors and the development of polyposis, sometimes the cause of the pathology cannot be identified.

Symptoms

Small neoplasms are not accompanied by a clinical picture and are found when a woman contacts her for another reason. As a rule, these are polyps located on a wide base.

Often, signs of polyposis develop with the appearance of various complications. In gynecological practice, they are somewhat more often accompanied by complications of education, which are attached to the mucosa by means of a thin stalk. This type of polyp is distinguished by the exit of the surface beyond the external pharynx directly to the cervical surface. Thus, pedunculated polyps can easily be injured, for example, during the use of tampons, examination by a doctor, intimacy, douching.

The clinical picture of cervical polyposis usually includes.

1. Acyclic selections. This symptom is characteristic of the development of necrosis or inflammation.
2. Mucus secretions. Mucopurulent discharge appears with a concomitant inflammatory process. As a rule, this occurs with the growth of large polyps that narrow the lumen of the cervical canal. As a result, favorable conditions are created for the development of inflammation. The appearance of mucous secretions can be noted with pressure on the glands of the cervical canal.
3. Pain syndrome. Pain often occurs with large formations that interfere with the closure of the external pharynx. If the pain is intense, accompanied by cycle disorders, endometriosis or fibroids may be present.

If characteristic symptoms appear, you should consult a doctor and conduct a differential diagnosis.

Types and diagnostics

Due to the fact that polyps are often located on a thin stalk and go beyond the external pharynx, they are well defined by visual examination of the cervix. It is noteworthy that neoplasms are distinguished by a variety of external characteristics:

• size from a few millimeters to 2-3 millimeters;
• mushroom-shaped, leaf-shaped, oval or round shape;
• long stem or wide base.

Polypous formations of the cervical canal contain many vessels that usually shine through the epithelial canal, causing a dark pink color. This is what polyps look like, whose surface is covered with a cylindrical epithelium. Whitish polyps are formed with the participation of stratified squamous epithelial tissue.

bluish color of the polyp may indicate torsion of the leg or injury, which leads to impaired blood circulation.

The consistency of the polyps of the cervical canal can be both soft and dense. It depends on the amount of fibrous tissue in the neoplasm. Dense polyps have a significant amount of fibrous tissue in their composition.

If the doctor visualizes polyposis during the examination, he recommends that the patient undergo a colposcopic examination, which allows you to examine the formation in detail, study the structure and exclude the possibility of pathological conditions of the epithelium.

However, accurate information about the structure of the polyp of the cervical canal can be obtained only after a histological diagnosis, which is always performed after the direct removal of the formation.

According to histological analysis, polyposis can be of several varieties.

1. The glandular type develops in relatively young women, for example, in the reproductive cycle. These are polyps with a size of 1 cm. The structure of glandular neoplasms suggests the content of glands localized in a chaotic manner.
2. The fibrous type is typical for older women. Polyps include dense fibrous tissue with few glands. The difference from the previous variety lies in the ratio of types of fabric. For example, fibrous polyps are more dense.
3. Glandular fibrous type called otherwise mixed. The ratio of the two types of tissue is equivalent. Such polyps can reach large sizes.

The greatest danger is represented by adenomatous polyps, which are a precancerous form. After their removal, the patient is recommended a course of chemotherapy.

The choice of treatment tactics depends on the polyposis structure. If the polyp is located high, it is not possible to detect it during visual examination and colposcopy. In such cases, ultrasound is used, which is performed using a vaginal probe. Usually, with polyposis, there is a deformation of the lumen of the cervical canal.

If concomitant gynecological diseases are suspected, additional research methods may be carried out.

Treatment tactics

Medical treatment is ineffective, since the polyp can only be eliminated by removing it. However, in some cases, small lesions are treated conservatively with anti-inflammatory drugs. With the complete disappearance of polyposis, it can be concluded that the diagnosis was incorrectly made. In this case, they speak of a pseudopolyp, that is, the formation of an inflammatory nature.

If, against the background of anti-inflammatory therapy, the neoplasm decreases, this means that the inflammatory process has been eliminated. Subsequently, the pathology is treated with removal.

Drug treatment of polyposis before removal is required only in the presence of an inflammatory process. In such cases, removal is performed after prior antibiotic therapy.

Removal of polyps of the cervical canal is not performed during menstruation. Removal is advisable to carry out in the first half of the cycle. When removing, different techniques can be used, after which the material is sent for histological examination. Moreover, not only the neoplasm, but also the surrounding tissues are subject to research. Histological examination is necessary to exclude a precancerous and malignant process.

Treatment after removal is prescribed in accordance with the results of the histological analysis. after removal do not need additional therapy. Fibrous polyps of the cervical canal grow in elderly patients and have a high risk of malignancy. That is why, usually, when this variety is detected, an additional examination is carried out and the issue of subsequent therapy is decided.

Mixed polyps of the cervical canal are often the result of hormonal disorders. After their removal, hormone therapy is prescribed to prevent the occurrence of relapses.

If removal is not possible The patient is prescribed anti-inflammatory and hormonal treatment.

There are no specific methods of prevention. To avoid the development of polyposis, women should maintain hormonal function at the proper level, treat inflammatory pathologies in time and avoid abortions.

Removal techniques

Before removing the polyp, the patient is usually hospitalized. Removal is performed under anesthesia. Polyps growing on a stalk are unscrewed, and then the bleeding is eliminated. After removal, curettage of the cervical canal is shown. Removal of cells from surrounding tissues helps prevent recurrence. In addition, all material is sent for histological examination in order to identify a possible precancerous and malignant process.

Removal of polyps can be performed in several ways.

1. Diathermocoagulation. The formation is removed with a special electric knife. Removal resembles cauterization, after which a scab remains on the mucous membrane, covering the wound. Under this crust, epithelial tissue heals and regenerates. After the end of regeneration, the crust is rejected over time. Removal by diathermocoagulation is effective for small neoplasms that grow on a wide stalk. After such removal, scar tissue may remain.
2. Cryodestruction. Removal with liquid nitrogen involves exposing the polyp to low temperatures, which leads to its freezing. Then the neoplasm is cut off. After such removal, there is no scar. However, the healing process takes about two months.
3. Laser polypectomy. This is a classic removal, during which the polyp is captured with a laser loop, and then eliminated with a laser scalpel.
4. Hysteroresectoscopy. This is the safest and most painless removal, which is performed using a hysteroscope. Removal has a number of advantages, for example, the ability to visualize the mucous membrane of the canal and the uterine cavity. This allows you to carry out the removal with maximum accuracy.

After removal, the tissue is sent for histological examination. Despite the fact that the polyp refers to a benign pathology, in some cases signs of malignancy are revealed. To prevent the development of precancerous and malignant diseases, gynecologists carry out conization or amputation of the cervix, depending on the specific diagnosis.