Hematometrocolpos Definition, Symptoms, Causes, Treatment

Hematometrocolpos is an uncommon congenital anomaly that is rarely identified in the emergency room. During the process of genitourinary development, the hymen, which is a component of the urogenital sinus, does not perforate in nearly one out of every two thousand females. Lower abdomen and pelvic pain that occurs on and off is a characteristic symptom of hematometrocolpos in adolescent females.

In early adolescence or during the neonatal period, hydrometrocolpos or hematometrocolpos may form as a result of vaginal blockage. The most prevalent causes of this blockage include a hymen or membrane that is imperforate, vaginal atresia or stenosis, and cloacal abnormalities. It is possible for bleeding or secretions to significantly enlarge the vagina, giving it the appearance of a huge, spherical mass with a tubular shape. 

On sonography, a big, elongated mass with a thin, homogeneous wall and low-level internal echoes can be seen just below the bladder. The echoes may shift when the patient's position changes, demonstrating their fluid nature. Comparatively speaking, the uterus is smaller than the vagina and has less echogenic material. The vagina could grow so big that it blocks the distal ureters and results in hydronephrosis.

Definition

Hematometrocolpos is a medical term for a blood-filled, swollen uterus and vagina, typically caused by a mechanical or anatomical barrier that prevents the menstrual blood from draining.

Hematometrocolpos is an unusual condition that happens when the uterus fills up with blood from a woman's period. Infrequent menstruation, persistent pelvic pain, and a pelvic mass are the common symptoms. A nonperforated hymen is the most common cause of this condition; however, a transverse vaginal septum or a "uterus didelphys," sometimes known as a "double uterus," are also examples of rare congenital defects that can also cause it.

Symptoms

Patients typically report experiencing abdominal discomfort, pelvic pain, and vomiting when they first visit their doctor. Back discomfort, constipation, urine retention, or urinary incontinence are some of the less common symptoms that can occur. During a physical examination, a palpable pelvic mass and a protruding hymen—which is frequently blue or white in color—are signs of hematometrocolpos.

Causes

Vaginal obstruction can lead to the development of hydrometrocolpos or hematometrocolpos during early adolescence or during the neonatal period, respectively. The three most common reasons for this occlusion are cloacal anomalies, vaginal atresia or stenosis, and an imperforate hymen or membrane. The vagina may appear to be a large, spherical mass with a tubular shape if there is substantial bleeding or discharge.

Treatment

For women with an imperforate hymen, a small procedure is required to excise the excess hymen membrane. In order to remove any tissue that is obstructing the menstrual flow, it is typically treated surgically with a hymenotomy or other procedure. To prevent the wound from healing on its own, the patient must also follow the postoperative instructions that instruct them to apply dilators into the vagina for a few minutes on a daily basis for the first few days after surgery. When the patient has fully recovered from surgery burning sensation and cramps will go away and the patient can go back to her routine life. 

Contrary to an imperforate hymen, which is simple to treat, surgically treating a transverse septum might be challenging if the procedure is not well planned. Particularly if the septum is thick, postoperative problems including re-obstruction and vaginal stenosis and may develop. Transperineal ultrasonography and MRI are the most frequent methods used to determine the septum's thickness and placement before attempting to remove it.