Prolapse of the uterus is a consequence of the disease. Prolapse of the uterus in women: causes, symptoms, treatment, consequences. Sex during uterine prolapse

Prolapse of the uterus is a change in the location of the internal organs of the female reproductive system with a partial or complete exit of the uterus to the outside through the genital slit. During the development of the pathology, the patient feels severe pain and tension in the sacrum, a feeling of a foreign body in the genital slit, impaired urination and bowel movements, increased pain during sex, and discomfort during movement.

Prolapse of the cervix and vagina is characterized as a hernial protrusion, which manifests itself with improper functioning of the pelvic floor muscles. Following the uterus, the vagina, bladder, and rectum begin to move.

Before a doctor diagnoses a prolapsed uterus, the patient is first diagnosed with prolapse of the penis. An incomplete protrusion can be recognized by the outward displacement of only the cervix, and a complete prolapse is characterized by a protrusion of the organ entirely from the genital slit.

The disease is formed in the weak half of humanity in any age category. In girls under 30 years old, the disease develops in 10% of cases, from 30 to 40 years old, pathology affects 40% of women. In old age, the anomaly is diagnosed in 50% of cases.

Etiology

Provoking factors for the appearance of uterine prolapse can be:

pelvic muscle injury;
hereditary anomalies in the development of the genital area;
violation of the innervation of the muscles of the pelvic floor;
operations on the genitals;
tribal activity;
advanced age of women;
carrying weights;
genetic predisposition;
early gynecological ailments.

Displacement and prolapse of the uterus are interrelated processes that develop sequentially. A pathological effect is formed due to the weakening of the ligaments and muscles of the pelvic floor diaphragm. The disease begins to progress with damage to the perineum, multiple pregnancies, frequent childbirth, bearing large children, surgical interventions on the genitals.

Uterine prolapse in women is also formed with excess body weight, high intra-abdominal pressure and tumors in the abdomen. All these reasons provoke a deterioration in the functionality of the musculoskeletal apparatus.

Classification

The process of omission and protrusion of the uterus from the genital slit takes place in several stages:

the first is characterized by weakness of the pelvic floor muscles, sagging of the vaginal walls and an open genital slit;
the second is partial prolapse of organs. Together with the walls of the vagina, the bladder and rectum descend;
the third - occurs before the genital gap;
fourth - incomplete prolapse of the uterus is manifested by the exit of part of the organ outside the vagina;
fifth - a complete change in the location of the organ - prolapse from the genital slit.

Symptoms

There are not so many clinical signs of the disease, however, the appearance of an abnormal placement of the uterus or its cervix is quite difficult to notice, so the diagnosis of the disease is not difficult. Symptoms of the disease are characterized by such signs:

pressure in the lower abdomen;
, passing to the sacral part and lumbar region;
sensation of a foreign object in the vagina;
difficult or excessively frequent urination;
spotting may appear;
pain attacks during sex;
constipation;
failure in the menstrual cycle;
increased pain during menstruation.

In the initial stages of the formation of an organ displacement, the symptoms can be very mild, or even not appear at all. She worries a woman when the disease begins to progress and at stages 2–4 of uterine prolapse, while the symptoms become more pronounced.

Diagnostics

When identifying the above symptoms, the patient should immediately seek help from a doctor. To examine the condition of a woman and her genitals, a gynecologist performs the following procedures:

gynecological examination in the mirrors;
microscopy of vaginal discharge;
cytological analysis of cervical smears;
colposcopy;
Ultrasound of the pelvic organs.

If a woman has found a displacement of the bladder into the zone of uterine prolapse, then the doctor needs to conduct an examination of the urinary system. A rectal examination is performed if the rectum and intestines are involved in the pathological process.

Treatment

After determining the disease and its etiology, doctors can begin therapy. It is possible to treat the disease of the female genital organs conservatively or surgically. To prescribe a course of therapy, the physician needs to know the following nuances:

stage of development of the anomaly;
concomitant diseases;
the importance of preserving childbearing function;
surgical and anesthetic risk;
damage to the colon, its sphincters and bladder.

After identifying these indicators, the therapy technique is determined. Treatment of uterine prolapse at the initial stages is carried out by conservative methods without radical intervention. A woman needs to use special drugs that contain estrogens.

As part of conservative therapy, a woman is also prescribed physical education and massages. However, it is worth remembering that in therapeutic exercises there should be light movements that do not greatly strain the lower abdomen, since with such a disease, the patient is strictly prohibited from heavy loads.

With the ineffectiveness of such procedures, the patient is prescribed the establishment of a pessary. These are special rings with different diameters. They are made of thick rubber and filled with air inside, which allows these rings to be resilient and elastic. They are introduced by the doctor into the woman's vagina and are some kind of support for the organ. The uterine rings, when the uterus prolapses, rest against the walls of the vagina and stop the cervix in one place.

Quite often, such an operation is performed on women in old age or when carrying a child. When such rings are introduced into the vagina, a woman needs to be regularly treated with folk remedies, that is, douching with decoctions of herbs, potassium permanganate or furacilin.

If necessary, doctors perform more traumatic types of surgery with suturing of the ligaments and muscles of the organ.

Additionally, a diet is prescribed to normalize the work of the gastrointestinal tract, wearing a bandage and gymnastics.

tighten the lower abdomen;
imitate attempts;
perform a "bike";
"boat" in the supine position;
walking up the stairs.

There are a lot of exercises to strengthen the muscles of the pelvic floor, however, doctors recommend choosing those that will not be difficult to give. It is necessary to strain the muscles in the lower abdomen moderately so as not to provoke the appearance of complications.

Wearing a bandage is also considered an effective remedy for uterine prolapse. It perfectly supports the female organs at the right level. It must be worn temporarily, no more than 12 hours a day. Periodically, you need to give the body a rest and relax, for this it is advisable to remove the bandage during rest.

Complications

If, after the birth of a child or with frequent physical exercises, a woman's uterus began to change its location and shape, then urgent help from a doctor is needed. With untimely provision of medical care, the uterus becomes covered with cracks, which lead to the formation of bleeding ulcers, bedsores and their infection.

Prolapse of the cervix provokes a violation of the blood supply to the organ and the appearance of stagnation. Complete prolapse of the uterus can lead to infringement and necrosis of the organ.

Prevention

To prevent uterine prolapse in women of young or old age, you can follow simple rules:

no need to carry weights;
normalize stool;
reduce body weight;
exercise your pelvic floor muscles.

In order to prevent the formation of an ailment in the postpartum period, it is undesirable for a woman to carry weights.

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Diseases with similar symptoms:

The prolapse of the uterus is its unnatural position when the organ is below its anatomical and physiological boundaries. This happens due to the weakness of the pelvic muscles after pregnancy, as well as the uterine ligaments. Most clinical cases are accompanied by a displacement or a very low location of the organ, when it is as close as possible to the bottom of the vagina. Among the complications, the main one is the risk of prolapse of the uterus from the vaginal opening.

Omission of the uterus is a diagnosis that does not leave indifferent any woman. A very common disease among women in the age group from 35 to 60 years, which is usually detected in the later stages.

The main cause of organ prolapse is the weakening of the pelvic floor. Usually this phenomenon is typical for women after childbirth, after physical exertion. The uterus, as it were, partially hangs down, and often falls out of the abdominal cavity together with the vagina, accompanied by minor discomfort.

Prolapse of the uterus can also occur in young nulliparous women who, actively involved in sports, abruptly stop exercising. There is a chronic weakening of the connective tissue, ligaments, muscles, which leads to prolapse of the organ.

What it is?

Prolapse of the uterus is the incorrect position of the uterus, the displacement of its bottom, as well as the displacement of the cervix below the level of the normal border due to the weakness of the muscle fibers of the pelvic floor and ligaments.

Pathology is accompanied by a number of characteristic symptoms: a feeling of pressure, a feeling of discomfort, patients are disturbed by pulling pains in the abdomen and vagina. Patients may experience difficulty urinating, vaginal discharge. The disease is complicated in some cases by partial or complete prolapse of the organ.

Reasons for development

Weakness of the muscular-ligamentous apparatus of the uterus can be caused by a number of factors.

Causes of uterine prolapse include:

surgical interventions on the organs of the reproductive system;
age-related muscle weakness;
violations of the innervation of the muscles of the pelvic floor;
substantial and regular physical activity (weight lifting);
pathology of the connective tissue of the ligaments;
congenital malformations in the pelvic area;
family (genetically determined) predisposition;
trauma during childbirth;
hormonal imbalance during menopause;
neoplasms (cysts, fibroids, fibromyomas).

During childbirth, significant perineal tears (in particular, with the breech presentation of the fetus) in some cases lead to serious muscle damage. Injuries can also be obtained by a woman in labor when obstetricians use a vacuum extractor and obstetric forceps. Benign neoplasms increase the load on the ligaments of the pelvic region, which may well provoke uterine prolapse. One of the predisposing factors may be a strong chronic cough, in which the muscles of the diaphragm are constantly tensed.

Usually in the development of the disease there is a combination of two or more factors.

Symptoms

In women of different ages, uterine prolapse has quite noticeable symptoms:

pulling pains that often radiate to the lower back;
pressure in the pelvis;
constipation;
frequent urge to urinate;
sensation of a foreign object in the vagina;
the presence of a large amount of mucus or blood. With large blood loss, anemia can develop;
pathology of the menstruation cycle (soreness, violation of periodicity);
inability to live sexually due to pain during sexual intercourse or the impossibility of performing them (in the later stages).

If the prolapse of the uterus is not diagnosed in time and not started to be treated, then the woman will experience an increase in dysuric pathologies, which will be manifested by urinary incontinence or, conversely, difficulty urinating. In turn, this will contribute to the risk of infectious diseases of the urinary system, which include pyelonephritis, urethritis.

stages

Depending on the degree of prolapse, 4 degrees of the disease are distinguished:

Grade 1 is characterized by a slight drooping of the organ into the vagina;
2 degree - displacement of the organ to the entrance to the vagina;
3 degree is diagnosed after the protrusion of the uterine body outside the vagina;
Grade 4 - when the uterus completely falls out of the peritoneum.

The symptoms of uterine prolapse at stages 2, 3 and 4 can be determined by the girl herself - it is enough to feel the tissues of the organ protruding from the vagina. Signs of uterine prolapse are often characterized by a change in the position of the bladder or even the rectum. The prolapse of the uterus is diagnosed by a gynecologist after childbirth, who, according to the stage of the pathology, can prescribe either conservative therapy (a bandage for prolapse of the uterus) or surgery.

Diagnostics

To establish a diagnosis, complaints are collected, anamnesis is studied and a gynecological examination is performed. A rectovaginal examination is mandatory. During the examination, the degree of prolapse, the presence or absence of rectocele and cystocele are established.

Each patient undergoes a colposcopy. In addition, the following tests are prescribed:

smear on the microflora of the vagina;
smear for cytology;
determination of hormonal status;
general and bacteriological analyzes of urine.

It is also mandatory to conduct a gynecological ultrasound with a vaginal sensor (in the presence of pathological changes in the pelvic organs, the issue of their removal is decided). Excretory urography is prescribed in the presence of cystocele, ultrasound of the kidneys according to indications. If a pathology is detected on a gynecological ultrasound, hysteroscopy with diagnostic curettage of the uterus is prescribed.

How to treat uterine prolapse?

The specialist prescribes treatment, having determined the degree of prolapse of the uterus. It depends on the extent to which the uterus has sunk, on how much other organs have suffered, whether the woman is going to give birth in the future. The method of treatment recognized by the doctor can be conservative and surgical.

Conservative treatment

This method is used in the initial stages of the disease. The doctor prescribes medication at home, namely drugs with estrogens. Additionally, ointments with metabolites are prescribed.

When the uterus is lowered, a special set of exercises is carried out, as well as massage. If the operation cannot be performed (there are contraindications), the doctor prescribes pessaries to the woman. These are rings of different sizes, made of high quality rubber. When they are introduced into the vagina, the uterus has a kind of support that prevents its further displacement. To normalize bowel function, experts recommend a special diet.

It is now also very common to wear a bandage to keep the genitals in position. Wearing a bandage during the period of bearing a child will lead to the fact that the organs will not fall. If the completed course of treatment did not bring any result, they proceed to surgical exposure.

Uterine prolapse exercises

A decrease in the tone and elasticity of the pelvic floor muscles creates conditions for a possible displacement of the genitals. Specially designed gymnastics for this muscle group can prevent unwanted processes of prolapse of the uterus and other genital organs, and in patients with prolapse of the uterus, it is included in the therapeutic measures.

Therapeutic exercises during uterine prolapse are aimed at increasing muscle tone, improving blood circulation and preventing inflammatory processes.

The most popular among doctors and patients is the Kegel technique - a set of exercises for the pelvic muscles, named after its developer. The essence of the method is to train the muscles surrounding the vagina, rectum and urethra (urethra) by maximum contraction for 3 seconds and subsequent relaxation. These therapeutic exercises do not require a visit to the gym or a physical therapy room, they can be performed in any position, they can be repeated in the shower or before going to bed in bed.
Another popular Kegel exercise is associated with a woman's ability to self-hypnosis: the patient is asked to imagine the muscular pelvic floor in the form of a kind of "elevator", on which she rises to the very top and descends back. The ascent begins from the “basement floor” (complete relaxation), gradually the woman slightly tightens the pelvic muscles, rises to the “first floor” and lingers for a couple of seconds in this position (lift stop), then continues to move up, stopping at each impromptu “floor” . The higher it rises, the stronger the muscle tension. On the fifth "floor" it reaches its maximum. The downward movement is accompanied by a gradual relaxation of the muscles.
Each Kegel exercise is repeated many times throughout the day, performing a total of 50 to 100 contractions per day.

From the whole complex of exercises for each particular patient, several of the most suitable ones are selected, or the complex is recommended to be performed in full. The popularity of the Kegel system is explained by the fact that simple exercises can be performed at any time and in any conditions, for example, while sitting at work or on public transport.

The complex of therapeutic exercises for prolapse of the uterus includes strengthening the abdominal muscles (anterior abdominal wall). The good condition of the abdominal muscles helps to maintain normal intra-abdominal pressure, which prevents the displacement of organs.

Another popular method is physiotherapy exercises according to the Yunusov method. It includes voluntary contractions of the pelvic muscles during the act of urination up to the cessation of the flow of urine. In women with a predisposition to uterine prolapse, therapeutic exercises act as an effective prevention, and if there is an initial stage of the process, it can become the only therapeutic measure.

Regular visits to the pool, cycling and dosed physical activity can replace a significant part of the exercises.

Operation

This problem is often solved with surgery. This method has been used for quite a long time. But before, doctors performed abdominal operations. Surgery was performed if the woman wanted to preserve her childbearing function. Today, the operation is performed laparoscopically. Already on the third day after the intervention, the woman is discharged. The recovery period lasts about a month.

There are no scars after laparoscopy. This reduces the likelihood of adhesions. The operation does not have any effect on the condition of the vagina. Therefore, a woman can have a normal sex life after recovery. The essence of the operation is that the uterus is supported in the form of a mesh. The latest technologies and materials make it possible to leave the mesh inside the body.

At the same time, nothing threatens the health of a woman. The material is elastic. During pregnancy, the mesh simply stretches. The operation allows you to achieve good results in the shortest possible time. A woman does not need to train muscles or use other methods of conservative therapy.

Relapses are excluded. During the operation, the surgeon, if necessary, corrects the position of the intestines, bladder and vagina.

Content

Prolapse of the body of the uterus is an anatomical disorder in which the reproductive organ is shifted down into the vaginal area. Pathology has a feature of progression, in connection with which the non-treatment of this disease leads to a complete out of the genital gap. In medicine, this condition is called "prolapse of the pelvic organs."

Simultaneously with the uterus, some other organs are also subjected to displacement: the vagina, cervical canal, rectum and bladder. As a result of a strong omission, even the ovarian region can be affected, which threatens to cause serious complications. Uterine prolapse is most often diagnosed in women during menopause (almost 50%), but women of younger childbearing age are not immune from the development of the disease.

Causes of pathology

main cause of prolapse there is a loss of elasticity of muscle tissues and ligaments that hold the uterus in its anatomically correct position.

There are many factors as a result of which the ligamentous apparatus is damaged and stretched.

Age. It is women over the age of 50 who often turn to a specialist with such a problem. The reason for this is menopause changes in the body of a woman and the suspension of the production of estrogen (the female sex hormone). In addition, starting at a fairly young age, prolapse rapidly progresses during menopause, manifesting itself in many different symptoms.
Injuries and fractures. A fracture of the pelvic bones often causes damage to the ligamentous apparatus and muscle tissue. As a result, they lose their elasticity and the uterus, under the weight of its own weight, begins to gradually sag. Injuries during various gynecological operations also often become the causes of the development of prolapse. Even incorrectly applied sutures can cause loss of elasticity of muscle tissues and cause prolapse.
Multiple or difficult births. A woman who has gone through two or more natural births is much more prone to uterine prolapse than a woman who has not given birth. The birth process, which has passed with any complications, can also provoke the onset of the disease. Aggravating factors during childbirth include:

multiple ruptures of the perineum;
output of a large fruit;
prolonged attempts leading to tissue swelling;
use of medical forceps.

Complications during pregnancy. An increased amount of amniotic fluid, delayed delivery, pregnancy with twins or triplets, the age of the patient over 35 years old - all this puts additional stress on the ligaments and muscle tissue of the small pelvis and can cause prolapse.
Obesity or sudden loss of a large amount of weight. An excessive amount of body fat in women puts an increased burden on the pelvic area. Due to this pressure, the ligaments holding the uterus are stretched and the reproductive organ gradually descends into the vaginal area. With weight loss, already stretched muscles, without sufficient elasticity, “sag” and do not provide sufficient support to the pelvic organs.

The reasons for which the omission is also possible are:

infectious and inflammatory processes of the genital organs;
the presence of tumor growths;
diseases accompanied by persistent cough;
regular constipation;
hereditary predisposition;
congenital anomalies in the structure of the ligamentous apparatus and internal genital organs;
neurological diseases that violate the innervation of the genitourinary system;

Kinds

In order to more accurately diagnose omission, the pathology is divided into several main stages:

Stage 1 - the body of the uterus and its cervix are displaced to the upper part of the vagina;
Stage 2 - the uterus is at the entrance to the vagina, but does not go beyond it;
Stage 3, incomplete prolapse - the cervical canal and the body of the uterus partially come out, this is especially evident during moments of tension or when coughing;
Stage 4, complete prolapse from the genital slit - the body of the uterus and the cervical canal come out completely.

How is determined

You should consult a doctor immediately upon detection of warning signs. Prolonged delay in treatment may develop a slight descent into complete prolapse of the uterus, which will require its removal.

At the initial stage, the symptoms of the disease may not be obvious, but their combination should alert the woman.

Signs of 1 and 2 stages of omission:

pain sensations of a pulling nature in the lower abdomen, sacrum and lower back;
small bleeding not associated with menstruation, the amount of mucous secretions also increases;
feeling of heaviness in the lower abdomen;
discomfort or pain during intercourse;
the nature of menstruation changes - it becomes too plentiful or scarce;
constipation becomes more frequent;
in the second stage of the disease, there is a sensation of a foreign body in the vagina;
discomfort while sitting and walking for a long time;
there are problems with urination (frequent urge, urinary incontinence, cystitis).

Now a woman can independently determine that the uterus has descended into the inside of the vagina by feeling the inside with a finger. She should not experience any pain.

The progression of such a pathology as uterine prolapse contributes to the addition of more and more new symptoms and a deterioration in the general condition of the woman. Due to the displacement of the bladder, dysuric disorders may increase, it is possible to attach infectious and inflammatory processes of the genitourinary system, for example, pyelonephritis, urethritis and cystitis. Diagnosis, with omission, can also reveal problems in the work of the intestines, due to the protrusion of the rectum.

Diagnostics

The detection of pathology always begins at the examination in the gynecological chair. For further diagnosis and establishing the stage of prolapse, the specialist performs rectal and vaginal examinations. Such an analysis allows you to establish how much the prolapse has progressed, as well as the degree of displacement of the walls of the vagina. Without fail, women with such a pathology are assigned a colposcopy.

Additionally, a number of the following examinations may be prescribed:

curettage of the uterine cavity of a diagnostic nature;
Ultrasound of the pelvic organs;
hysterosalpingoscopy;
urine culture tank;
smear, to determine the microflora of the vagina;
vaginal smear for atypical cells;
excretory urography;
computed tomography of the pelvis;
bacteriological examination of urine to exclude inflammatory processes.

If the pathology was caused by tumor growths, the patient needs to undergo a biopsy test to determine the nature of this tumor.

In addition, patients diagnosed with uterine prolapse should consult and be examined by specialists such as a urologist and a proctologist. Examination of these doctors will allow to exclude or detect diseases of the genitourinary system (cystocele) and rectum (rectocele).

Treatment

I would like to point out right away that severe prolapse and prolapse cannot be eliminated without surgery. To the complete removal of the uterus, however, most specialists try to apply only as a last resort. Basically, operations to eliminate prolapse are based on strengthening and shortening the ligamentous apparatus, as well as fixing the uterus itself.

Recently, more and more often operations are performed using alloplastic materials, which are a special synthetic mesh to which the attachment is made. The risk of recurrence after this method is much lower than after a simple strengthening of the ligaments.

As a rule, all operations prescribed to eliminate prolapse are carried out in conjunction with plastic surgery of the vaginal walls. The procedures are usually carried out using a vaginal approach, but sometimes intervention is possible through an incision in the anterior wall of the peritoneum.

Complete resection of the uterus is performed only in cases of severe complications, due to the advanced age of the patient or in the extreme stages of prolapse, when no other treatment is known to bring the desired result.

Conservative methods of treatment are possible in the initial stages of prolapse or as a prevention of pathology.

Postoperative rehabilitation, as a rule, does not take much time and within a few weeks the woman is fully restored and returns to a normal lifestyle. To exclude the occurrence of any complications during the recovery period, patients should strictly adhere to all appointments and recommendations of a specialist.

Prolapse of the uterus is one of the forms of prolapse (displacement, prolapse) of the pelvic organs. It is characterized by a violation of the position of the uterus: the organ is shifted down to the entrance to the vagina or even falls out of it. In modern practice, this disease is considered as a variant of the hernia of the pelvic floor, which develops in the area of the vaginal entrance.

Doctors in the description of this disease and its varieties use the concepts of "omission", "prolapse", "genital prolapse", "cystorectocele". The prolapse of the anterior wall of the uterus, accompanied by a change in the position of the bladder, is called a "cystocele". The prolapse of the posterior wall of the uterus with the capture of the rectum is called "rectocele".

Prevalence

According to modern foreign studies, the risk of prolapse requiring surgical treatment is 11%. This means that at least one in 10 women will undergo surgery for this disease during their lifetime. In women after surgery, in more than a third of cases, a recurrence of genital prolapse occurs.

The older the woman, the more likely she is to have this disease. These conditions occupy up to a third of all gynecological pathology. Unfortunately, in Russia, after the onset, many patients do not go to the gynecologist for many years, trying to cope with the problem on their own, although every second of them has this pathology.

Surgical treatment of the disease is one of the frequent gynecological operations. Thus, in the United States more than 100 thousand patients are operated on annually, spending 3% of the entire healthcare budget on this.

Classification

Normally, the vagina and cervix are tilted back, and the body of the organ itself is tilted forward, forming an angle open to the front with the axis of the vagina. The bladder is adjacent to the anterior wall of the uterus, the posterior wall of the cervix and vagina is in contact with the rectum. From above the bladder, the upper part of the body of the uterus, the intestinal wall are covered with peritoneum.

The uterus is held in the pelvis by the force of its own ligamentous apparatus and by the muscles that form the perineal region. With the weakness of these formations, its omission or loss begins.

There are 4 degrees of the disease.

The external uterine os descends to the middle of the vagina.
The cervix, along with the uterus, moves down to the entrance to the vagina, but does not protrude from the genital gap.
The external pharynx of the cervix moves outside the vagina, and the body of the uterus is higher without going out.
Complete prolapse of the uterus into the perineum.

This classification does not take into account the position of the uterus, it determines only the most prolapsed area, often the results of repeated measurements differ from each other, that is, there is poor reproducibility of the results. These shortcomings are deprived of the modern classification of genital prolapse, adopted by most foreign experts.

Appropriate measurements are taken with the woman lying on her back during straining, using a centimeter tape, uterine probe or forceps with a centimeter scale. Point prolapse is evaluated relative to the plane of the hymen (the outer edge of the vagina). Measure the degree of prolapse of the vaginal wall and shortening of the vagina. As a result, uterine prolapse is divided into 4 stages:

Stage I: the most drop-down zone is more than 1 cm above the hymen;
Stage II: this point is within ±1 cm of the hymen;
Stage III: the area of maximum prolapse is more than 1 cm below the hymen, but the length of the vagina is reduced by less than 2 cm;
Stage IV: complete prolapse, reduction in the length of the vagina by more than 2 cm.

Causes and mechanism of development

The disease often begins at the woman's fertile age, that is, before the onset of menopause. Its course is always progressive. As the disease develops, there are dysfunctions of the vagina, uterus, and surrounding organs.

For the appearance of genital prolapse, a combination of two factors is necessary:

increased pressure in the abdominal cavity;
weakness of the ligamentous apparatus and muscles.

Causes of uterine prolapse:

a decrease in estrogen production that occurs during menopause and postmenopause;
congenital weakness of the connective tissue;
trauma to the muscles of the perineum, in particular, during childbirth;
chronic diseases accompanied by impaired blood circulation in the body and increased intra-abdominal pressure (intestinal diseases with constant constipation, respiratory diseases with prolonged severe cough, obesity, kidney, liver, intestines, stomach).

These factors in various combinations lead to weakness of the ligaments and muscles, and they become unable to hold the uterus in a normal position. Increased pressure in the abdominal cavity "squeezes" the organ down. Since the anterior wall is connected to the bladder, this organ also begins to follow it, forming a cystocele. The result is urological disorders in half of the women with prolapse, for example, urinary incontinence when coughing, physical effort. The posterior wall, when lowered, "pulls" the rectum behind it with the formation of a rectocele in a third of patients. Often there is a prolapse of the uterus after childbirth, especially if they were accompanied by deep muscle ruptures.

Increase the risk of disease multiple births, intense physical activity, genetic predisposition.

Separately, it is worth mentioning the possibility of vaginal prolapse after amputation of the uterus for another reason. According to different authors, this complication occurs in 0.2-3% of operated patients with a removed uterus.

Clinical picture

Patients with pelvic organ prolapse are mostly elderly and senile women. Younger patients usually have early stages of the disease and are in no hurry to see a doctor, although the chances of successful treatment in this case are much greater.

feeling that there is some kind of formation in the vagina or perineum;
prolonged pain in the lower abdomen, in the lower back, tiring the patient;
protrusion of a hernia in the perineum, which is easily injured and infected;
painful and prolonged menstruation.

Additional signs of uterine prolapse arising from the pathology of neighboring organs:

episodes of acute urinary retention, that is, the inability to urinate;
urinary incontinence;
frequent urination in small portions;
constipation;
in severe cases, fecal incontinence.

More than a third of patients experience pain during sexual intercourse. This worsens the quality of their life, leads to tension in family relationships, negatively affects the woman's psyche and forms the so-called pelvic descent syndrome, or pelvic dysynergy.

Often develops varicose veins with swelling of the legs, cramps and a feeling of heaviness in them, trophic disorders.

Diagnostics

How to recognize uterine prolapse? To do this, the doctor collects an anamnesis, examines the patient, prescribes additional research methods.

A woman needs to tell the gynecologist about the number of births and their course, surgeries, diseases of internal organs, mention the presence of constipation, bloating.

The main diagnostic method is a thorough two-handed gynecological examination. The doctor determines how much the uterus or vagina has sunk, finds defects in the muscles of the pelvic floor, performs functional tests - a test with straining (Valsalva test) and cough. A rectovaginal examination is also carried out to assess the condition of the rectum and structural features of the pelvic floor.

To diagnose urinary incontinence, urologists use a combined urodynamic study, but when organs are prolapsed, its results are distorted. Therefore, such a study is optional.

If necessary, endoscopic diagnostics is prescribed: (examination of the uterus), cystoscopy (examination of the bladder), sigmoidoscopy (study of the inner surface of the rectum). Typically, such studies are necessary if cystitis, proctitis, hyperplasia, or cancer are suspected. Often, after the operation, a woman is referred to a urologist or proctologist for conservative treatment of identified inflammatory processes.

Treatment

Conservative treatment

Treatment of uterine prolapse should achieve the following goals:

restoration of the integrity of the muscles that form the bottom of the small pelvis, and their strengthening;
normalization of the functions of neighboring organs.

Prolapse of the uterus of the 1st degree is treated conservatively on an outpatient basis. The same tactic is chosen for uncomplicated genital prolapse of the 2nd degree. What to do with the prolapse of the uterus in mild cases of the disease:

strengthen the muscles of the pelvic floor with the help of therapeutic exercises;
refuse heavy physical activity;
get rid of constipation and other problems that increase intra-abdominal pressure.

Is it possible to pump the press when the uterus is lowered? When lifting the body from a prone position, intra-abdominal pressure increases, which contributes to further pushing the organ out. Therefore, therapeutic exercises include tilts, squats, leg swings, but without straining. It is carried out in a sitting and standing position (according to Atarbekov).

At home

Treatment at home includes a diet rich in vegetable fiber, reduced in fat. It is possible to use vaginal applicators. These small devices produce electrical stimulation of the muscles of the perineum, strengthening them. There are developments in SCENAR therapy aimed at improving metabolic processes and strengthening ligaments. Can be performed.

Massage

Gynecological massage is often used. It helps to restore the normal position of the organs, improve their blood supply, and eliminate discomfort. Usually, from 10 to 15 massage sessions are performed, during which the doctor or nurse, with the fingers of one hand inserted into the vagina, lifts the uterus, and with the other hand, circular massage movements are made through the abdominal wall, as a result of which the organ returns to its normal place.

However, all conservative methods can only stop the progression of the disease, but not get rid of it.

Is it possible to do without surgery? Yes, but only if the prolapse of the uterus does not lead to its prolapse outside the vagina, does not impede the function of neighboring organs, does not cause the patient trouble associated with an inferior sex life, and is not accompanied by inflammatory and other complications.

Surgery

How to treat uterine prolapse III-IV degree? If, despite all conservative methods of treatment or due to the patient's late request for medical help, the uterus has gone beyond the vagina, the most effective method of treatment is prescribed - surgical. The purpose of the operation is to restore the normal structure of the genital organs and correct the disturbed functions of neighboring organs - urination, defecation.

The basis of surgical treatment is vaginopexy, that is, fixing the walls of the vagina. With urinary incontinence, the strengthening of the walls of the urethra (urethropexy) is simultaneously performed. If there is weakness of the muscles of the perineum, they are plastic (recovered) with strengthening of the neck, peritoneum, supporting muscles - colpoperineolevathoroplasty, in other words, suturing of the uterus during prolapse.

Depending on the required volume, the operation can be performed using transvaginal access (through the vagina). This is how, for example, removal of the uterus, suturing the walls of the vagina (colporrhaphy), loop operations, sacrospinal fixation of the vagina or uterus, strengthening the vagina with the help of special mesh implants are performed.

With laparotomy (an incision of the anterior abdominal wall), the operation for prolapse of the uterus consists in fixing the vagina and cervix with its own tissues (ligaments, aponeurosis).

Sometimes laparoscopic access is also used - a low-traumatic intervention, during which it is possible to strengthen the walls of the vagina and suture defects in the surrounding tissues.

Laparotomy and vaginal access do not differ in long-term results. Vaginal is less traumatic, with less blood loss and the formation of adhesions in the pelvis. Application may be limited due to lack of necessary equipment or qualified personnel.

Vaginal colpopexy (cervical strengthening by access through the vagina) can be performed under conduction, epidural anesthesia, intravenous or endotracheal anesthesia, which expands its use in the elderly. This operation uses a mesh-like implant that strengthens the pelvic floor. The duration of the operation is about 1.5 hours, the blood loss is insignificant - up to 100 ml. Starting from the second day after the intervention, the woman can already sit down. The patient is discharged after 5 days, after which she undergoes treatment and rehabilitation in the clinic for another 1-1.5 months. The most common long-term complication is erosion of the vaginal wall.

Laparoscopic surgery is performed under endotracheal anesthesia. During it, a mesh prosthesis is also used. Sometimes amputation or extirpation of the uterus is performed. The field of operation requires early activation of the patient. An extract is carried out on the 3-4th day after the intervention, outpatient rehabilitation lasts up to 6 weeks.

Within 6 weeks after the operation, a woman should not lift weights of more than 5 kg, sexual rest is required. Within 2 weeks after the intervention, physical rest is also necessary, then you can already do light housework. The average period of temporary disability is from 27 to 40 days.

What to do in the long term after the operation:

do not lift weights more than 10 kg;
normalize stool, avoid constipation;
treat respiratory diseases accompanied by cough in time;
long-term use of estrogen suppositories (Ovestin) as prescribed by a doctor;
do not engage in certain sports: cycling, rowing, weightlifting.

Features of the treatment of pathology in the elderly

Gynecological ring (pessary)

Treatment of uterine prolapse in the elderly is often difficult due to comorbidities. In addition, often this disease is already in an advanced stage. Therefore, doctors face significant difficulties. To improve the results of treatment, at the first signs of pathology, a woman should contact a gynecologist at any age.

Therefore, a bandage will provide significant assistance to a woman when the uterus is lowered. It can also be used by younger patients. These are special supportive panties that tightly cover the abdominal area. They prevent prolapse of the uterus, support other organs of the small pelvis, reduce the severity of involuntary urination and pain in the lower abdomen. Choosing a good bandage is not easy, a gynecologist should help with this.

A woman must perform therapeutic exercises.

With a significant prolapse, a surgical operation is performed, often this is the removal of the uterus through a vaginal access.

Effects

If the disease is diagnosed in a woman of fertile age, she often has the question of whether it is possible to become pregnant with the prolapse of the walls of the uterus. Yes, there are no special obstacles to conception in the early stages if the disease is asymptomatic. If the omission is significant, then before the planned pregnancy it is better to be operated on 1-2 years before conception.

Preservation of pregnancy with proven uterine prolapse is fraught with difficulties . Is it possible to bear a child with this disease? Of course, yes, although the risk of pregnancy pathology, miscarriage, premature and rapid birth, bleeding in the postpartum period is significantly increased. In order for the pregnancy to develop successfully, you need to constantly be observed by a gynecologist, wear a bandage, use a pessary if necessary, engage in physiotherapy exercises, and take medications prescribed by a doctor.

What threatens the prolapse of the uterus in addition to possible problems with carrying a pregnancy:

cystitis, pyelonephritis - infections of the urinary system;
vesicocele - saccular dilation of the bladder, in which urine remains, causing a feeling of incomplete emptying;
urinary incontinence with irritation of the skin of the perineum;
rectocele - expansion and prolapse of the ampulla of the rectum, accompanied by constipation and pain during bowel movements;
infringement of intestinal loops, as well as the uterus itself;
eversion of the uterus with its subsequent necrosis;
deterioration in the quality of sexual life;
a decrease in the overall quality of life: a woman is embarrassed to go out into a public place, because she is constantly forced to run to the toilet, change incontinence pads, she is exhausted by constant pain and discomfort when walking, she does not feel healthy.

Prevention

The prolapse of the walls of the uterus can be prevented in this way:

minimize prolonged traumatic childbirth, if necessary, excluding the straining period or performing a caesarean section;
timely identify and treat diseases accompanied by increased pressure in the abdominal cavity, including chronic constipation;
in the event of ruptures or dissection of the perineum during childbirth, carefully restore the integrity of all layers of the perineum;
recommend women with estrogen deficiency hormone replacement therapy, in particular, with menopause;
assign patients at risk of genital prolapse special exercises to strengthen the muscles that form the pelvic floor.