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},
"code": "F33",
"name": "Рекуррентное депрессивное расстройство",
"icd_name": "Рекуррентное депрессивное расстройство",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "f33_rekurrentnoe_depressivnoe_rasstroystvo",
"lead": "Нарушение здоровья, относящееся к группе расстройства настроения [аффективные расстройства]",
"description": "Рекуррентное депрессивное расстройство – расстройство, характеризующееся повторными эпизодами депрессий, без анамнестических данных об отдельных эпизодах приподнятого настроения, гиперактивности, которые могли отвечать критериям мании",
"etiology": "<p>К основным факторам, которые могут привести к развитию расстройства, являются генетическая предрасположенность человека, психогенные факторы – депрессии или следствие органических поражений (например, резидуально-органическая неполноценность, перенесенные ранее нейроинфекции, интоксикации, травм головы и т.п.). Первые эпизоды рекуррентного депрессивного расстройства обычно вызваны внешней провокацией (чаще психотравмирующими обстоятельствами), однако в возникновении и развитии повторных фаз преобладают факторы, не связанные с внешними обстоятельствами.</p>",
"pathogenesis": "<p>Причины рекуррентного расстройства лежат в нарушении обмена норадреналина, дофамина, серотонина, посредством которых нервные клетки — нейроны — осуществляют проведение импульсов и передачу информации. Причина этих нарушений не установлена. Получены доказательства генетических причин заболевания, теории повреждений на уровне нейронов с формированием очагов активности по типу эпилепсии, теории нарушения ритмов сна и бодрствования.</p>",
"diagnostics": "<p>Основным методом диагностики депрессии до сих пор остается клинический (психопатологический). Каких-либо достоверных инструментальных методик для диагностики депрессии, обладающих достаточной чувствительностью и специфичностью, в настоящее время не существует. Вспомогательную роль могут играть стандартизированные психометрические шкалы (шкала Гамильтона для оценки депрессий – HDRS, госпитальная шкала депрессий – HADS, шкала Монтгомери-Асберг – MADRS). Однако их применение в основном ограничивается объективизацией и определением степени тяжести состояния в научных исследованиях. Некоторые из шкал вполне пригодны для скрининга на аффективную патологию, но ни в коей мере не могут заменить собой целенаправленный расспрос жалоб и выявление в анамнезе больного эпизодов депрессии, суицидального поведения, хронических соматических заболеваний, стойких нарушений сна, аппетита, длительных болевых синдромов. Заподозрить наличие депрессии зачастую позволяет принадлежность пациента к группе риска по аффективной патологии (отягощенный аффективной патологией и/или суицидами семейный анамнез, сведения о конституциональном складе пациента – расстройства личности аффективного или тревожного круга).</p>",
"treatment": "<p><strong></strong>B лeчeнии дeпpeccии любoгo видa или фopмы вaжнeйшee знaчeниe имeeт пcиxoтepaпeвтичecкoe лeчeниe.</p>\r\n<p>Для лeчeния peкуppeнтнoгo paccтpoйcтвa чaщe вceгo пpимeняют:</p>\r\n<ul>\r\n<li>пoвeдeнчecкую пcиxoтepaпию – c ee пoмoщью бoльнoй учитcя упpaвлять cвoими эмoциями и мыcлями, измeнять cитуaции, cтaвшиe пpичинoй paзвития пpoблeм и учитьcя «пpaвильнoму» пoвeдeнию, пpинocящeму пoлoжитeльныe эмoции и удoвoльcтвиe;</li>\r\n<li>кoгнитивную пcиxoтepaпию – этa мeтoдикa нaпpaвлeнa нa изучeниe мыcлeй и нeгaтивныx уcтaнoвoк, cтaвшиx пpичинoй paзвития пcиxичecкoгo зaбoлeвaния;</li>\r\n<li>ceмeйную пcиxoтepaпию – пoмoгaeт нaлaдить oтнoшeния мeжду члeнaми ceмьи, poдитeлями-дeтьми, cупpугaми и тaк дaлee, тaк кaк дocтaтoчнo чacтo имeннo ceмeйныe пpoблeмы cтaнoвятcя пpичинoй дeпpeccивныx paccтpoйcтв.</li>\r\n</ul>\r\n<p>Taкжe peкуppeнтнoe дeпpeccивнoe paccтpoйcтвo лeчитьcя c пoмoщью дpугиx мeтoдик, пoмoгaющиx пaциeнту избaвлятьcя oт нeгaтивныx эмoций, пoлучaть пoлoжитeльныe и paccлaблятьcя. Пoпуляpнocтью пoльзуютcя apт- и музыкoтepaпия, мeдитaции, йoгa, зaнятия cпopтoм, плaвaньe, пpoгулки, aнимaл-тepaпия.</p>\r\n<p>Пpи cтaциoнapнoм лeчeнии тaкжe иcпoльзуeтcя cвeтoлeчeниe, мeтoд дeпpивaции cнa – кoгдa пaциeнту нe дaют cпaть вcю нoчь или пocтoяннo будят и мeтoд cтимуляции oпpeдeлeнныx нepвныx цeнтpoв.</p>\r\n<p>Meдикaмeнтoзнaя кoppeкция</p>\r\n<p>Пpи cpeднeй и тяжeлoй cтeпeни мeдикaмeнтoзнoe лeчeниe cчитaeтcя oбязaтeльным.</p>\r\n<p>Aнтидeпpeccaнты – пpeпapaты этoй гpуппы пoмoгaют cпpaвитьcя c пpиcтупaми aпaтии, тocки, cнижeниeм нacтpoeния, cуицидaльными мыcлями. Пpинцип дeйcтвия пpeпapaтoв ocнoвaн нa блoкиpoвaнии зaxвaтa нeйpoмeдиaтopo в гoлoвнoм мoзгe, зa cчeт чeгo увeличивaeтcя иx кoнцeнтpaция в кpoви и уcиливaeтcя иx дeйcтвиe нa opгaнизм чeлoвeкa.</p>\r\n<p>Tpaнквилизaтopы и нopмoтимики– oкaзывaют уcпoкoитeльнoe и cтaбилизиpующee нacтpoeниe дeйcтвиe, cнимaют тpeвoгу, paздpaжeниe, aгpeccию. Haчинaют дeйcтвoвaть ужe cпуcтя 1-2 cутoк пocлe пpимeнeния, нo вызывaют пpивыкaниe, coнливocть, зaмeдляют peaкцию и имeют мнoгo пoбoчныx дeйcтвий, пoэтoму дoлжны пpинимaтьcя тoлькo пo нaзнaчeнию вpaчa и тoлькo в peкoмeндуeмыx дoзиpoвкax.</p>\r\n<p>Heйpoлeптики – эти пpeпapaты пpимeняютcя пpи нaличии пcиxoпaтoлoгичecкиx cимптoмoв, тaкиx кaк бpeд или гaллюцинaции или пpи тяжeлoй фopмe дeпpeccии c oткaзoм oт пищи или cуицидaльными пoпыткaми.</p>\r\n<p> </p>",
"prevention": "<p>Специфических методов профилактики рекуррентного депрессивного расстройства не разработано. Важно максимально снизить частоту приступов для этого рекомендуется, регулярно обращаясь к врачу-психиатру, в целях профилактического лечения. Также необходимо уменьшить количество стрессовых ситуаций, которым подвергается больной.</p>",
"clinical_picture": "<p>Основные симптомы</p>\r\n<ul>\r\n<li>депрессивное настроение;</li>\r\n<li>снижение интереса или удовольствия от деятельности, которая ранее была приятна пациенту;</li>\r\n<li>снижение энергии и повышенная утомляемость.</li>\r\n</ul>\r\n<p>Дополнительные симптомы</p>\r\n<ul>\r\n<li>снижение самооценки и чувства уверенности в себе;</li>\r\n<li>беспричинное чувство самоосуждения и чувство вины;</li>\r\n<li>идеи или действия направленные на самоповреждение или суицид;</li>\r\n<li>снижение способности к сосредоточению и вниманию;</li>\r\n<li>мрачное и пессимистическое видение будущего;</li>\r\n<li>нарушение сна;</li>\r\n<li>изменение аппетита.</li>\r\n</ul>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 56,
"standards": [
4842,
5158,
5242,
5248
]
},
{
"id": 13070,
"symptoms": [
{
"id": 27,
"synonyms": [
{
"name": "Измененный ритм дефекации"
},
{
"name": "Нарушение стула"
}
],
"body_points": [
{
"x": 460,
"y": 4596,
"r": 400
}
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"lead": "дивертикулоподобное выпячивание стенки прямой кишки в сторону влагалища (переднее ректоцеле) и/или по задней полуокружности кишки (заднее ректоцеле)",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основной фактор, который способствует появлению переднего ректоцеле, это ослабленная ректовагинальная перегородка и мышцы тазового дна.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выделяют и другие причины, среди которых:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">слабые мышцы тазового дна, ректовагинальной перегородки, которые являются истонченным внутриутробно;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">разрывы или разрезы промежности при родовой деятельности, роды большого плода;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">хронически повышенное внутрибрюшное давление из-за нарушенной работы желудочно-кишечного тракта или чрезмерных физических нагрузок;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">функциональные нарушения анальных сфинктеров;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">возрастные дистрофические изменения сфинктеров, мышц тазового дна и ректовагинальной перегородки;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">острые и хронические формы заболевания половых органов у женщин;</span></li>\r\n<li><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">последствия гистероктомии или удаления матки.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">У молодых девушек ректоцеле диагностируют после родовой деятельности, после аборта или выкидыша. Причиной развития становится и врожденная слабость ректовагинальной перегородки и тазовых мышц.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">У женщин после климакса ректоцеле развивается после многочисленных родов, возрастных изменений, проблем с кишечником.</span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ректоцеле представляет собой состояние, при котором часть прямой кишки выпячивается в сторону влагалища и постепенно пролабирует его стенку, образуя мешкообразный карман, в котором задерживаются фекальные массы. Выпячивание прямой кишки является причиной расстройства акта дефекации и развития тяжелых запоров. Пациентке с ректоцеле приходится сильнее тужиться, чтобы опорожнить кишечник. Давление в кишке во время дефекации все больше возрастает, это влечет за собой увеличение выпячивания и дальнейшее прогрессирование патологии.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В конечном итоге ректоцеле достигает степени, при которой эффективность консервативных мероприятий все больше снижается, единственным способом восстановить нормальные анатомические взаимоотношения между органами малого таза и наладить акт дефекации становится оперативное вмешательство.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагноз ректоцеле выставляют с учетом характерной симптоматики, данных осмотра промежности и перианальной области, гинекологического исследования, ректального исследования, эндоскопии и радиологических диагностических методик. При осмотре области ануса у больных ректоцеле могут выявляться анальные трещины и увеличенные геморроидальные узлы. При недержании кала в области анального отверстия видны следы фекальных масс и участки раздражения. При проведении гинекологического и ректального исследования пациентку с ректоцеле просят натужиться. При натуживании стенка кишки выпячивается во влагалище. Врач определяет размер и расположение выпячивания (высокое, среднее, низкое), отмечает наличие либо отсутствие содержимого ректоцеле (кал, каловые камни) оценивает толщину влагалищной перегородки и состояние мышц тазового дна.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В процессе ректороманоскопии у больных ректоцеле обнаруживается характерный карман в области передней стенки прямой кишки. Для более точной оценки выраженности расстройства акта дефекации и степени ректоцеле назначают дефекографию (эвакуаторную проктографию). Густую бариевую взвесь вводят в кишку, а потом выполняют серию снимков во время акта дефекации. Иногда радиологическое исследование заменяют магнитно-резонансной дефекографией. </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение заболевания 1 степени консервативное. При 2 и 3 степени патологии используются комбинированные методики, включающие в себя хирургическое вмешательство, пред- и послеоперационные консервативные мероприятия, направленные на устранение запоров, восстановление кишечной перистальтики и улучшения эвакуации содержимого из прямой кишки. Обязательной частью лечения ректоцеле является диета, предусматривающая увеличение количества грубой растительной клетчатки (для стимуляции моторной функции кишечника) и достаточное количество воды (для обеспечения мягкости фекальных масс).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для восстановления регулярности акта дефекации больным ректоцеле назначают мягкие слабительные средства осмотического действия. Для коррекции состава кишечной микрофлоры применяют комбинированные пробиотики. Для нормализации моторной функции кишечника используют прокинетики (домперидон и его аналоги). Медикаментозную терапию ректоцеле дополняют физиопроцедурами и специальными комплексами ЛФК, направленными на укрепление мышц тазового дна.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Консервативная терапия позволяет замедлить развитие болезни, но не может обеспечить полное выздоровление. Единственным радикальным способом лечения ректоцеле является операция. Все хирургические вмешательства при данной патологии можно разделить на две группы: направленные на устранение кармана, образованного прямой кишкой, и имеющие целью укрепление перегородки между влагалищем и прямой кишкой. Для коррекции ректоцеле используется доступ через влагалище, прямую кишку, промежность либо переднюю брюшную стенку.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В процессе операции врач ушивает и фиксирует переднюю стенку кишки, осуществляет укрепление ректовагинальной перегородки и проводит мероприятия по восстановлению сфинктера. При комбинированной патологии, наряду с ректоцеле включающей в себя геморрой, трещину заднего прохода, цистоцеле либо полипы прямой кишки, выполняют комбинированное хирургическое вмешательство, направленное на устранение всех имеющихся нарушений. Операции могут проводиться как традиционным способом, так и с использованием эндоскопического оборудования.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В ходе лечебной эндоскопии больной ректоцеле устанавливают сетчатый имплантат, укрепляющий ректовагинальную перегородку и препятствующий выпячиванию прямой кишки во влагалище. В пред- и послеоперационном периоде назначают ЛФК, физиотерапию, пробиотики и прокинетики. При наличии противопоказаний к оперативному вмешательству пациенткам с 2 и 3 степенями ректоцеле рекомендуют использовать пессарий – специальное приспособление, которое вводят во влагалище для поддержания правильного положения органов малого таза.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Чтобы предупредить развитие болезни и избежать осложнений, следует соблюдать профилактические меры:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">избегайте расстройств желудочно-кишечного тракта, ходите в туалет при появлении позывов, не тужьтесь при испражнении;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">следите за своим весом — стремительное ожирение либо потеря веса способствует появлению пролапса;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">следите за рационом и употребляйте продукты с высоким содержанием клетчатки;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">не занимайтесь самолечением и вовремя диагностируйте воспалительные и инфекционные заболевания желудочно-кишечного тракта;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">исключите подъем тяжестей;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">укрепляйте мышцы тазового дна и промежности.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Женщинам следует каждых полгода посещать гинеколога даже при отсутствии жалоб. При беременности, после абортов и после родовой деятельности советуют посещать профилактический осмотр чаще.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Проблемы и степень дискомфорта изменяются в зависимости от стадии заболевания:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">На первой стадии больные жалуются на затрудненную дефекацию, которая возникает периодически. Появляется оно из-за того, что каловый комок попадает в выпячивание и остается в нем, несмотря на усиленные потуги. Справиться с проблемой помогает очистительная клизма и прием слабительных препаратов, однако проблема не исчезает, а болезнь прогрессирует.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">На второй стадии у больных появляется ощущение неполного опорожнения кишечника из-за того, что каловые массы задерживаются в выпячивании прямой кишки в больших объемах. Для полного опорожнения прямой кишки необходимо двухэтапная дефекация, а иногда и дополнительные манипуляции — нажатие на промежность или выталкивание калового кома рукой через заднюю стенку влагалища. Периодически могут беспокоить распирающие боли в прямой кишке, внизу живота или промежности, так как застой кала провоцирует воспалительные процессы в дистальном отделе толстой кишки. Из-за необходимости долго и сильно тужиться возникают сопутствующие проблемы — геморрой, анальные трещины, криптит. При ректоцеле 2 степени сложно обойтись без слабительных препаратов.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">При ректоцеле 3 степени описанные ранее симптомы дополняются выпадением части прямой кишки во влагалище и из половой щели. Больные жалуются на ощущение инородного предмета в половых путях, многочисленные ложные позывы к опорожнению прямой кишки. У них регулярно возникают инфекции половых путей, развивается опущение матки, недержание мочи. На этом этапе слабительные средства не помогают облегчить дефекацию, женщине приходится помогать процессу выхода калового кома надавливаниями на выпячивание.</span></li>\r\n</ul>",
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}
]
}
