Atony
The content of the article:
- Causes
- Kinds
-
Signs of atony
- Atony of the bladder
- Stomach atony
- Atony of the uterus
- Intestinal atony
- Muscle atony
- Diagnostics
-
Treatment
- Treatment of uterine atony
- Treatment of stomach atony
- Intestinal atony treatment
- Treatment of bladder atony
- Treatment of muscle atony
- Prevention
Atony is a pathological condition characterized by the loss of skeletal muscles and muscles of the hollow organs of normal physiological tone. Atony is not an independent disease, but is a symptom that accompanies the development of various pathologies of internal organs and the nervous system.
Atony is the loss of muscle tone
Causes
The development of atony can be caused either by damage to muscle tissue (loss, loosening, softening), or by insufficient influence of the nervous system on muscle fibers. Most often, both of these causes are present in the pathological process.
Common risk factors for developing atony are:
- diseases of the nervous system;
- endocrine disorders;
- infectious diseases;
- malnutrition.
The cause of atony can be a violation of the influence of the nervous system on muscle fibers.
The development of bladder atony can be caused by:
- inflammation of the nerve roots of the lumbar spinal cord;
- dysfunction of the nerve endings responsible for the correct contraction of the muscular wall of the bladder;
- prostate adenoma;
- chronic stress;
- hormonal imbalance;
- groin injury;
- infectious diseases of the genitourinary system;
- obesity;
- systematic irregular emptying of the bladder, as a result of which the stretching of its walls gradually develops;
- elderly age;
- postpartum period.
Atony of the stomach develops as a result of disturbances in the innervation of its walls. This may be due to the following reasons:
- diffuse peritonitis;
- myocardial infarction;
- severe pneumonia;
- stenosis of the pyloric stomach;
- thrombosis of the vessels of the stomach walls;
- spinal cord injuries and diseases;
- severe course of some infectious diseases (brucellosis, botulism, legionellosis, Lyme disease, typhoid fever).
Atony of the uterus, accompanied by profuse bleeding, can occur in the postpartum period. Much less often, this pathological condition occurs as a complication of a spontaneous miscarriage or medical abortion. The predisposing factors for the development of uterine atony are:
- repeated childbirth;
- multiple pregnancy;
- polyhydramnios;
- large fruit;
- young primiparous (under 18 years old);
- complicated course of pregnancy (threat of termination, toxicosis);
- rapid childbirth;
- low placentation or placenta previa;
- pathology of the development of the uterus.
Atony of the uterus can develop in the postpartum period
The development of intestinal atony can lead to:
- sedentary lifestyle;
- inappropriate nutrition (low fiber content in the diet and an increased content of high-calorie foods, especially carbohydrates);
- chronic stress;
- taking certain medications (intestinal sorbents, antacids, antiepileptic and antiulcer drugs, antidepressants, morphine-like analgesics, antispasmodics);
- intestinal microbiocenosis disorders;
- intestinal infections;
- helminthiasis;
- smoking;
- hypothyroidism;
- obesity;
- oncological pathology;
- pregnancy;
- menopause.
More than 80 different diseases can cause the development of hypotension or muscle atony. Most often, the development of this pathological condition is due to:
- dysfunctions of the central nervous system (cerebellar ataxia) and genetic disorders;
- congenital diseases affecting the neuromuscular apparatus (type I spinal muscular atrophy, congenital myasthenia gravis);
- malformations of the muscular system (muscular dystrophy);
- asphyxia of newborns;
- infectious diseases (sepsis, botulism);
- craniocerebral trauma;
- hereditary metabolic diseases;
- congenital diseases of the connective tissue, occurring with the destruction of collagen molecules;
- congenital pathologies of the thyroid gland;
- severe forms of reactive jaundice caused by ABO or Rh incompatibility of the blood of the fetus and mother;
- chromosomal abnormalities (Prader-Willi syndrome, Down's disease).
Kinds
Atony is congenital and acquired.
Depending on localization:
- atony of the stomach;
- skeletal muscle atony;
- atony of the bladder;
- intestinal atony;
- atony of the uterus.
Signs of atony
The clinical manifestations of atony are diverse and are determined by which muscles are involved in the pathological process.
Atony of the bladder
Atony of the bladder can manifest itself in two conditions:
- Urinary incontinence, expressed in varying degrees. Urine may drip or leak when intra-abdominal pressure rises, such as coughing, sneezing, laughing, or lifting heavy objects. In children of the first years of life, urine leakage can occur with severe crying, screaming.
- Lack of urge to urinate. Even with a full bladder, the patient does not feel the urge to empty it, or they are expressed in a slight feeling of heaviness in the lower abdomen. To empty the bladder, the patient is forced to strongly strain the muscles of the anterior abdominal press. During the act of urination, urine flows in a weak stream. Complete emptying of the bladder is not observed.
Atony of the bladder is accompanied by urinary incontinence and lack of urge to urinate
Atony of the bladder is often observed in women in the postpartum period. A woman does not feel the urge to urinate for a long time. With a significant overstretching of the bladder, a feeling of heaviness in the suprapubic region of the abdomen may appear. The urge to urinate occurs suddenly, the woman does not have time to respond to it. This form of bladder atony does not require treatment and goes away on its own in 30-40 days after childbirth. To speed up the restoration of the tone of the muscles of the bladder, women in childbirth are advised to perform special exercises.
Stomach atony
The main signs of stomach atony are:
- feeling of heaviness and pressure in the epigastrium;
- bloating in the stomach;
- pain in the upper abdomen;
- heartburn;
- bad breath;
- belching with food and a large volume of air;
- fast saturation with small amounts of food;
- recurrent vomiting (abundant vomit, greenish color).
Atony of the stomach is manifested by heartburn, pain in the upper abdomen, belching
A sudden and rapidly developing atony of the stomach leads to its acute expansion, which is accompanied by a sharp pain in the abdomen, pallor of the skin, pouring cold sweat, arterial hypertension and tachycardia. When palpating the abdomen in the projection of the stomach, a noise in the form of a splash is determined, and with percussion, tympanitis (drum sound). When a probe is introduced into the stomach, a significant volume of stagnant contents leaves it, which helps to improve the patient's condition.
Atony of the uterus
The main symptom of uterine atony is bleeding from the genital tract, which can quickly lead to the development of hemorrhagic shock. When examining the patient, a flabby uterus is determined, with indistinct, poorly defined contours.
If a woman is not provided with timely qualified medical care, atonic bleeding can change to coagulopathic, in which the flowing blood stops forming clots (DIC syndrome). This condition is life-threatening.
Intestinal atony
The main sign of intestinal atony is constipation (the frequency of bowel movements is less than three times a week, while the feces are characterized by increased dryness and hardness). In addition, intestinal atony has the following manifestations:
- nausea;
- abdominal discomfort;
- frequent belching;
- ineffectual urge to defecate;
- flatulence;
- feeling of heaviness in the abdomen.
With intestinal atony, there are unsuccessful urge to defecate
Intestinal atony is often accompanied by the development of autonomic disorders and increased fatigue. Due to a violation of the absorption of nutrients from the intestine, patients may develop iron deficiency anemia, hypovitaminosis.
The most severe manifestation of intestinal atony is a paralytic form of intestinal obstruction, which is clinically manifested by the following symptoms:
- severe abdominal pain;
- delay in stool and gas discharge;
- asymmetry and bloating;
- repeated vomiting.
Muscle atony
Muscle atony is manifested by a lack of resistance in the joints when performing various passive movements, which leads to joint laxity and a pathological increase in the range of motion, which is fraught with injuries.
Diagnostics
Diagnosis of atony is not difficult. It is much more difficult to establish the cause of the development of this symptom. For this, various instrumental and laboratory diagnostic methods can be used, for example:
- Ultrasound;
- magnetic resonance and computed tomography;
- blood for hormonal status;
- coprogram;
- feces for dysbiosis;
- radiography of the passage of barium;
- genetic research;
- endoscopic examinations;
- general urine analysis;
- bacteriological culture of urine;
- excretory urography;
- coagulogram.
Methods for diagnosing atony depend on the complaints that the patient presents
Treatment
Treatment of atony is aimed at eliminating the cause that caused its development, that is, the underlying disease.
Treatment of uterine atony
With uterine atony, massage of the uterus is performed and ureterotonics are administered. With continued bleeding, an examination of the uterine cavity (manual or instrumental) is performed. If it is not possible to eliminate the atony of the uterus by conservative methods, and the ongoing bleeding threatens the patient's life, then surgical intervention is indicated - amputation (removal) of the uterus. At the same time, active therapy of hemorrhagic shock is carried out.
Treatment of stomach atony
With the development of gastric atony, treatment begins with the installation of a thick gastric tube, through which gastric contents are evacuated. Patients are prescribed diet food (table number 2 according to Pevzner). Drug therapy is carried out by means that enhance the contractile activity of the stomach. In addition, the underlying disease is treated.
Intestinal atony treatment
The scheme of complex therapy of intestinal atony includes:
- diet food (table number 3 according to Pevzner);
- compliance with the drinking regime;
- introduction of wheat or oat bran into the diet;
- increased levels of physical activity.
If necessary, patients can be prescribed prokinetics - drugs that improve motility and increase intestinal tone.
With intestinal atony, a therapeutic diet is indicated
Treatment of bladder atony
Treatment of bladder atony should be directed to the underlying disease. To reduce the severity of signs of pathology, symptomatic therapy is performed, which includes behavioral and drug correction.
Physiotherapy (Kegel exercises, myostimulation) has a good effect in atony of the bladder.
In acute urinary retention, the placement of a urinary catheter is indicated. To prevent the development of bacterial inflammation, broad-spectrum antibiotics and uroseptics are prescribed.
Treatment of muscle atony
Treatment of muscle atony is aimed at improving impulse conduction, as well as their trophism. Physical therapy is effective in many cases.
Prevention
Prevention of the development of atony is aimed at preventing diseases and pathological conditions, accompanied by its development.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
