What does uterine prolapse affect? Prolapse of the uterus: features of the development of pathology and possible consequences

Omission - the uterus is a pathology that immediately attracts attention, primarily with unpleasant sensations. Most often, such an organ as the uterus changes its usual position due to the weakness of the ligaments of the uterus and pelvic muscles. The muscles and ligaments themselves lose their elasticity due to the aging of the body. Therefore, older women are more susceptible to this pathology.

Prolapse of the uterus, the symptoms and consequences of which largely depend on the general condition of the woman's body, disrupts the work of neighboring organs. First of all, the bladder and intestines are drawn into the pathological process. They also begin to change their position, up to falling out.

The only way out in case of complications is surgery. This path is most often not the best for a woman, as it deprives her of many opportunities.

But in terms of maintaining health, surgery may be the only optimal way out, allowing you to somehow correct the situation. Prolapse of the uterus can lead to its infringement and anesthesia of tissues. Numerous ulcers may appear on the body of the uterus. Such ulceration can lead to the formation of a malignant tumor, which will further complicate the position of the woman.

Treatment

Conservative treatment makes sense to carry out only at the initial stages of uterine prolapse. If complications arise, these measures will not give any result. The same can be said about the treatment prescribed by folk medicine. No herbs are able to reverse the changes that occur in the body.

In addition to such an extreme method of treatment as removal of the uterus, there are several other methods that can correct the situation. But in each case, the choice of treatment method is selected by doctors on an individual basis. This may be calcography, a method in which surgeons try to strengthen the walls of the uterus. In colpoperineoplasty, the perineum and vagina are sutured. If necessary, doctors can reduce the length of the ligaments.

Symptoms of uterine prolapse and the consequences of complications cannot but affect a woman's lifestyle. When the uterus is removed, a woman's life practically does not change. After the postoperative pain has passed, apart from psychological problems, there are no other sources of concern.

Women who have undergone such an operation consider themselves inferior. Many of them believe that the absence of the uterus will significantly accelerate the aging process of the body, will contribute to the development of obesity. Removal of the uterus is equated with premature menopause and it is believed that all the symptoms of the latter will necessarily appear. In fact, none of this would happen if the ovaries were preserved. Because it is the ovaries that affect the hormonal background of a woman.

After surgical treatment of uterine prolapse, doctors recommend taking care of your health more carefully. If a woman underwent strengthening of the ligamentous apparatus, then of course she will be prohibited from lifting weights. A special issue will be the possible onset of pregnancy.

It will be necessary to make such an important decision only after a preliminary conversation with a doctor who will explain all the consequences and possible complications and features of the course of pregnancy in the presence of such a pathology.

Doubts may be caused by the need to strengthen the muscles of the small pelvis through exercise. In fact, when the uterus prolapses, physical exercises are necessary, but any load should be dosed and directed mainly to one muscle group, which are designed to maintain the uterus in its normal position.

Women diagnosed with uterine prolapse, especially with its complicated form, should be periodically observed by a doctor. In this case, the doctor will have time to detect negative processes in time.

So the growth of fibroids, fibromas, cysts will create an additional load on the uterus and its supporting apparatus, which can worsen the condition of a woman and make all attempts by doctors to keep the uterus in a certain position in vain. For women with this type of pathology, a special diet has been developed that stimulates the growth of the synthesis of female hormones. Thus, the work of the uterus is stimulated and normalized.

Doctors during the prolapse of the uterus and in the period after the treatment of its complications advise patients to eat as much fiber as possible and not be limited to eating only foods with a high content of it. They are strongly advised to purchase fiber specifically in pharmacies.

It is very important for women in this condition to avoid constipation. In case of violation of the stool associated with constipation, during bowel movement, you have to strongly strain the uterus, which cannot but lead to a deterioration in the condition of the ligaments and muscles that hold the uterus.

One of the most common gynecological diseases in women, especially in adulthood, is the prolapse of the uterus. This is a process in which there is a displacement of the genital organs below what is permissible, up to their loss from the perineum. Pelvic organ prolapse - this is the name of this disease all over the world. Its occurrence is possible at any age. About 30% of the beautiful half of the population suffer from this disease. About 50% are women of Balzac age, 40% are from 30 to 45 years old, and only 10% of cases are diagnosed with prolapse in women at a younger age.

Causes of uterine prolapse

Heavy physical activity on a regular basis.
Complicated or multiple natural births.
Injuries of the genital organs and operations on them.
Weak perineal muscles are usually a physiological feature associated with age.
Defects in the development of the pelvic organs.
High intra-abdominal pressure, the causes for which can be chronic constipation, obesity, swelling of internal organs, severe bronchitis.

Stages of the disease

There are cases of sudden diagnosis of uterine prolapse. As a rule, this happens due to an injury, but in general, the problem develops gradually, not occurring in one day. As the disease progresses, 4 degrees of its development are determined.

In the first stage, the uterus is lowered to the level of the vagina, but it does not extend beyond the perineum.

The second level is characterized by partial prolapse of the uterus. If the muscles are tense, it can peek out of the genital gap. Already at this stage, the disease is diagnosed without problems by the woman herself.

In the third degree, incomplete prolapse of the penis is diagnosed. Without tension, the cervix and part of the uterus are visible.

And the last, most difficult form of pelvic organ prolapse is the fourth. At this stage, the entire body of the uterus comes out of the perineum.

Symptoms of pelvic organ prolapse

Signs of uterine prolapse are quite noticeable, and it is impossible not to pay attention to them.

Feeling of heaviness in the vagina.
Frequent, difficult urination and defecation.
Pain for both partners during intercourse.
Uncharacteristic discharge from the vagina, often with an admixture of blood.
Menstrual irregularities with profuse bleeding.

Starting from the second degree of the disease, a woman can easily identify a prolapse of the genital organs herself. During the progression of the disease, the signs of uterine prolapse become even more noticeable, they are aggravated. Urinary incontinence is manifested, a woman is prone to urological infectious diseases, such as cystitis, pyelonephritis, urethritis.

Diagnosis of the disease

At the first stage, a woman cannot independently recognize this problem. Regular monitoring by a gynecologist is important. Having examined the woman, the doctor immediately diagnoses the prolapse of the uterus. If for some reason he has doubts, he will send you for an ultrasound examination, based on the results of which a decision will be made. Early diagnosis will prevent a painful syndrome and enable treatment without surgical intervention. To exclude all types of infections that could become concomitant factors with prolapse, it is necessary to visit a urologist and proctologist.

There are two types of pelvic organ prolapse. Cystocele is a prolapse of the anterior wall of the uterus, it is characterized by symptoms from the urinary system. Urinary stasis or incontinence develops, chronic cystitis is often observed. The second type of prolapse is a rectocele, a prolapse of the posterior wall of the uterus. In this case, women experience intestinal dysfunction, chronic constipation, foreign body sensations in the vagina. Pyelonephritis with prolapse of the posterior wall also becomes a frequent occurrence.

Childbirth and prolapse: how to avoid the disease?

The prolapse of the walls of the uterus is not uncommon during pregnancy or after childbirth. This is due to hormonal changes in the body. Under their action, the uterus softens, preparing for childbirth, its muscles weaken. During pregnancy, a woman needs to be more prudent and follow some rules to prevent genital prolapse, especially if she has encountered this problem before.

Do sport. You need to do various exercises. When the uterus is lowered, not even to a large extent, they will not allow further development of the disease.
Protect yourself from heavy lifting. Including, if you have a small child, try to shift the mission of carrying the baby to other relatives.
Wear a bandage daily when the uterus is prolapsed or to prevent the development of the disease.
Stick to a balanced diet.
For one urination, squeeze the jet several times, thus performing gymnastics for the genitals.
While walkingtighten and relax your vaginal muscles thereby tightening the vulva.

The doctor should take delivery in a conservative way, minimizing the traumatism of the woman's organs.

Treatment of uterine prolapse at home

Pregnant women are wondering how to treat uterine prolapse, having learned this diagnosis at a gynecologist's appointment. If the disease is at the initial stage, and it does not harm the child, in addition to preventive measures, no additional measures are required. If desired, some folk methods will not harm.

For example, you can brew two tablespoons of lemon balm in a glass of boiling water and leave overnight in a thermos to infuse. Take a third of a glass half an hour before meals. This decoction will be useful for diseases of the genital organs and for the nervous system of a pregnant woman.

The second option: mix equal proportions of coltsfoot with lemon balm and oregano, pour boiling water. Allow the infusion to brew and consume 2/3 cup before meals.

Also, a bandage when lowering the uterus will become an indispensable assistant. In general, this item should be in the everyday life of every woman expecting a baby, and even more so for those who are faced with the problem of genital prolapse.

Another folk remedy in the fight against this disease is a bath with cypress broth. Boil a glass of nuts in two liters of water, add this infusion to a warm bath, but not hot, stay in it for 15 minutes a day.

It is not uncommon for uterine prolapse after childbirth. Photos are sometimes horrifying with what a neglected form can lead to. Therefore, if this problem has affected you after the birth of the baby, do not postpone its solution for later, go to the doctor! Only a gynecologist can prescribe high-quality treatment and prevent the disease from developing to the fourth degree.

What to do with uterine prolapse?

If there is prolapse of the vaginal walls of the initial stage, conservative therapy is possible. Treatment includes a whole range of procedures. If the therapy proposed by the doctor does not work, and surgical intervention is contraindicated for some reason, the patient is given pessaries - these are special uterine rings. Their purpose is to maintain the genital organs. In the third or fourth stage, after examination by specialized specialists, as a rule, surgical intervention is necessary. Colpoplasty is recommended, the essence of the method is to suture the walls of the vagina to their previous size.

There are two types of this procedure:

Colporrhaphy - excision of excess tissue in the vagina.

Colpoperineorrhaphy - suturing the back wall and tightening the muscles of the vulva.

Uterine prolapse exercises

Gymnastics, aimed at restoring the work of the muscles of the vagina, is very important in the fight against this problem. It can also be used to prevent disease.

Standing on all fours, while inhaling, you must simultaneously raise your left leg and right arm. After doing five times, swap them and repeat the exercise.
The posture is the same. As you inhale, lower your head down, while strongly squeezing and retracting the muscles of the small pelvis and perineum. As you exhale, relax, head up, back straight. Repeat at least 10 times.

Effective are exercises for lowering the uterus, which are performed lying on your back.

Hands along the waist, legs slowly tear off the floor and wind up behind the head, trying to touch the rug with toes. We repeat 10 times.
Raise your legs at a 90 degree angle. For each leg 8-10 times.
Bending the legs at the knees, raise the pelvis, pulling in the muscles of the anus, and as you exhale slowly return to the starting position. Do 10 repetitions.

Kegel Method

A successful gynecologist of the mid-20th century, Arnold Kegel, developed exercises for prolapse of the uterus, which are successfully practiced today and were named after him.

Squeeze and relax the muscles of the pelvis and vagina for 30 seconds. Do 3-4 approaches. With muscle strengthening, you can increase the procedure time to several minutes or more.
During urination, hold the stream for 10-15 seconds. In this case, the legs are widely spaced, and the retention occurs exclusively with the muscles of the vagina.

Summing up, it should be noted that for any changes or discomfort on the part of the female organs, immediately go to a specialist. Only a doctor can tell you how to treat uterine prolapse and prescribe an individual and necessary therapy for you. Do not self-medicate and take care of your health!

A change in the position of the uterus is called prolapse, omission. In the initial period, the disease is latent and asymptomatic, but in the future it can cause serious consequences. What are the symptoms and treatment of uterine prolapse, what is the danger of this disease.

Causes of physiological bias

Normally, in a healthy woman, the uterus is located at an equal distance relative to the walls of the pelvic ring, rectum, and bladder. The hollow muscular organ has a fairly good physiological mobility, the position may vary slightly, taking into account the filling of the nearby bladder and rectum. The normal location of the organ is also affected by its own tone.

Prolapse is a gynecological pathology in which the organ receives an anatomical and physiological displacement from the weakened muscles, fascia and ligamentous apparatus of the pelvic floor.

A patient with a pathology that has arisen in the initial stages complains of a feeling of pressure, discomfort, pulling soreness in the lower third of the abdominal cavity. With the development of the disease, problems with urination begin, the woman discovers a large amount of pathological vaginal discharge mixed with blood. A displaced and lowered organ can give a severe complication - partial, complete prolapse.

When the organ continues to descend and the disease progresses, the woman experiences physical and moral suffering. Possible complete loss of performance.

Displacement degrees

With complete or incomplete omission, nearby organs of the small pelvis are involved in the pathological process. If, together with the uterus, the anterior wall of the vagina is involved in the process, it is called a cystocele, if the back is called a rectocele.

The condition of pelvic organ prolapse is classified into three degrees:

At the first stage of the pathology (omission), the uterus partially shifts down, but the cervix is still located in the vaginal cavity. The patient has no complaints, the pathology is discovered by chance, during a gynecological examination.
The second stage is incomplete (partial) prolapse. The organ is lowered into the vaginal cavity, the neck is visible at the entrance to the vagina.
At the third stage, the body and bottom of the organ partially extend beyond the boundaries of the genital slit.
At the fourth stage (complete prolapse), the vaginal walls are completely turned outward, the walls of the organ can fall in a level lower than the external reproductive organs. The body with the bottom of the organ completely protrudes beyond the boundaries of the genital slit.

The pathological process may involve intestinal loops, rectum, bladder. The displacement of the internal organs is palpated by the doctor through the walls of the vagina.

Reasons for bias

According to statistics, the disease is more common in mature women from 35 to 55 years old (half of cases), and at a younger age, every tenth is susceptible to pathology.

The main prerequisite for changing the position of the organ is the weakness of the muscular, ligamentous apparatus of the pelvic organs. In young women, the disease can provoke violations of the anatomical structure of the pelvic organs (congenital malformations), trauma to muscle structures, prolonged depression and stress. Possible uterine prolapse after childbirth.

Reasons for dropping:

Operational interventions.
Hormonal imbalance in combination with connective tissue dysplasia, excessive physical activity in menopause.
Overweight.
Violations of intestinal motility (frequent constipation).
Chronic cough.
abortion.
Hormonal insufficiency.
Numerous and prolonged childbirth.
birth trauma
Neoplasms of malignant and benign nature of the pelvic organs.
Neurological diseases in which the innervation of the urogenital diaphragm is impaired.

Basically, in order to develop a disease, one cause is not enough. Usually, organ prolapse is the result of several adverse factors.

Omission of the uterus after childbirth as a complication is equally common both after natural delivery and after caesarean section.

Symptoms of the initial stage

In the initial stages, the pathology is asymptomatic. With the progression of the disease, when the mixing intensifies, the patient develops a pulling pain, a feeling of pressure in the lower third of the abdominal cavity. The pain radiates to the sacrum, lower back, groin. A woman feels that there is a foreign body in the vagina, sexual contacts become uncomfortable and painful.

The following is one of the violations in the menstrual sphere:

Hyperpolymenorrhea - heavy menstruation with preserved periodicity.
Algodysmenorrhea - menstruation with constant pain syndrome and accompanied by disturbances in the work of the intestines and psycho-emotional disorders.

Between menstruation, leucorrhoea is abundant, sometimes there are streaks of blood in them.

In the initial stage, the patient begins to be disturbed by discomfort during movements.

Pregnancy with uterine prolapse is usually impossible.

Cervical prolapse is a serious obstacle to healthy conception and gestation. The probability of fading, intrauterine death of the fetus reaches 95%.

Symptoms of the developed disease

By the beginning of the second stage, in half of the cases, disorders in the urological sphere are added: difficulty in urination or frequent urination, stagnation in the organs of the urinary system. From chronic stagnation, ascending infection develops first in the lower and then in the upper sections: cystitis, pyelonephritis. The woman is suffering from urinary incontinence.

At the second and third stages of the disease, overdistension of the ureters and expansion of the renal-pelvic system are observed. The lowered neck is prone to injury, and the risk of developing oncological pathology in a woman increases.

Of the proctological complications that occur in 30% of cases, a woman is concerned about constipation and colitis. Possible incontinence of feces, gases.

What does a prolapsed uterus look like: shiny or matte, with cracks or abrasions. From traumatization while walking and sitting on a swollen surface, ulcerations and bedsores are formed. The wound surfaces of the mucosa bleed and quickly become infected.

From congestion in the pelvis, the mucous membrane becomes cyanotic, swelling spreads to nearby tissues.

Sex during the prolapse of the uterus, as a rule, is impossible: discomfort, pain, discomfort. During sexual contact, vaginal eversion can occur, which can cause severe psychological trauma in a woman.

Physiological prolapse

By late pregnancy, cervical prolapse is normal, which indicates the imminent onset of labor. The pelvic organs are preparing for the birth of the fetus: they move it closer to the exit, providing a physiological position for passing through the birth canal.

Physiological prolapse of the cervix in late pregnancy can be determined by the following symptoms:

The contours of the abdomen are changing.
Digestive discomfort subsides.
The pressure on the diaphragm is relieved. Shortness of breath goes away, it is easier for a woman to breathe.
Frequent urge to urinate.
Difficulty walking.
Sleep disorders.

Such signs of uterine prolapse, if they appear three weeks before the expected birth, are considered normal, do not threaten pregnancy and the normal birth of a child.

If the pathology is detected before 36 weeks, then in order to prevent the threat of interruption, the pregnant woman is hospitalized for preservation.

Diagnostic measures

Prolapse of the cervix and the degree of prolapse is determined by the gynecologist during the examination. Before treating uterine prolapse, the specialist takes into account complaints, anamnestic data (the number of births and abortions, concomitant diseases, heavy physical labor).

After a vaginal and rectal examination, a specialist determines the degree of displacement in the small pelvis. At the next stage, endoscopic and transvaginal ultrasound are prescribed. With the help of these diagnostic procedures, the doctor determines how much blood circulation is disturbed and how much the work of adjacent organs is disrupted.

To determine the causes of uterine prolapse, additionally assigned:

Colposcopic examination.
Hysterosalpingoscopy study.
Ultrasound examination, computed tomography.
Bakposev vaginal flora.
Urine culture for bacterial flora.
Excretory urographic study.

The gynecologist appoints consultations of related specialists: proctologist, urologist, endocrinologist.

A woman with a confirmed diagnosis is put on a dispensary record.

Therapeutic measures

The choice of therapeutic tactics takes into account the severity, the presence of concomitant pathologies, age and constitutional data, concomitant sphincter disorders in the bladder and rectum.

If complete uterine prolapse is observed in older women, the degrees of anesthetic and surgical risk are assessed.

According to the aggregate data, the choice of therapeutic tactics is determined: surgical or conservative.

Conservative therapy

If in pathology there are no violations in the work of adjacent organs, the body of the uterus is located above the genital slit, conservative therapy is indicated. In the treatment without surgery for prolapse of the uterus, gymnastics, massage, the use of special tampons, pessaries are included. In conservative therapy, the doctor may include special replacement therapy, vaginal drugs with metabolites and estrogens.

Physiotherapy

To strengthen the abdominal muscles with the muscles of the pelvic floor, therapeutic exercises are prescribed - a set of Kegel and Yunusov exercises.

Methods allow you to prevent the causes and consequences of uterine prolapse, and they can be used at home. A course of gymnastics prevents urinary and fecal incontinence, sexual dysfunction, and the development of hemorrhoids. Conditions in which gymnastics is shown:

Difficult childbirth.
Gynecological injuries.
Pregnancy planning, preparation for childbirth.
Prolapse of the uterus after childbirth in the initial stage.

As a preventive measure, a gymnastic course is indicated for women with congenital weak muscular and ligamentous apparatus, with overweight.

Gynecological massage course

The procedure can only be effective if it is performed by a highly qualified specialist. The objectives of the procedure: strengthening the muscular and ligamentous apparatus of the organ, eliminating minor prolapse, improving blood flow and lymph flow. Gynecological massage gives a chance to restore the normal position of the uterus without surgery. The course of procedures improves the physical and psycho-emotional state, normalizes the menstrual cycle and bowel function.

On average, the procedure lasts 15 minutes. The course of treatment is from 15 to 20 procedures.

Gynecological massage should be carried out exclusively by a specialist. For self-treatment, the procedure is strictly prohibited!

Obstetric pessaries

What to do in old age with uterine prolapse? Usually, surgery is contraindicated for older patients, and therefore vaginal pessaries are used as conservative methods.

A pessary is an obstetric device made in the form of a small plastic or silicone ring. They are installed along the vaginal walls to fix the organs in a physiological position.

Pessaries are also used for the treatment and prevention of uterine prolapse during pregnancy, with uterine prolapse after childbirth.

But this treatment has its drawbacks:

It is ineffective if the organ falls out completely.
Pessaries and tampons can cause pressure sores.
Requires regular disinfection.
Require regular visits to the doctor.
Only a doctor should install and remove the pessary.

The use of pessaries requires daily douching from a decoction of chamomile, furacilin, a pink solution of manganese.

A woman should visit a specialist twice a month.

home treatment

In the initial stages of the disease, when the uterus is partially lowered, the attending physician may prescribe a course of herbal infusions.

What herbs are used to treat the uterus with folk remedies:

Astragalus root tincture.
Herbal collection of white cassava, linden flowers, alder roots, lemon balm.
Quince infusion.
Herbal collection of St. John's wort, calendula, burnet.

In order for the course of treatment at home to be effective, herbal medicine must be supplemented with gymnastics.

Surgery

With the prolapse of the uterus, surgery is inevitable if conservative methods to cure the pathology were ineffective.

Possible methods of surgical intervention:

Plastic surgery with strengthening of the muscular apparatus. Indications: uterine prolapse in women planning to give birth; prolapse of the uterus after childbirth.
An operation to strengthen and shorten the muscular and ligamentous apparatus, followed by fixation to the uterine wall. Indications: incomplete prolapse of the uterus.
An operation to strengthen the musculoskeletal apparatus, followed by circular stitching.
An operation to fix to nearby organs (to the sacrum, pubic bone, pelvic ligamentous apparatus). Indications: full confluence of the cervix.
Operation with narrowing of the lumen of the vaginal wall. Indications: prolapse of the cervix in older patients.
Complete surgical removal of the organ.

After surgical treatment of uterine prolapse, a recovery period begins, which lasts two months.

To avoid complications and prevent recurrent uterine prolapse, the patient in this period is recommended:

Completely avoid sexual intercourse.
Avoid physical activity, heavy lifting.
Exclude baths, use a shower for hygiene procedures.
Do not use tampons.

For patients diagnosed with uterine prolapse, surgical treatment is supplemented with a course of conservative therapy: gymnastics, special dietary nutrition, lifestyle adjustments with the exclusion of physical activity, and drinking regimen.

Forecast

A favorable prognosis can only be if the woman consulted a doctor in time and fully underwent qualified therapy. If it was previously believed that prolapse and conception are incompatible concepts, then in modern gynecology it is believed that with this pathology it is possible to become pregnant and bear a fetus. The main thing: the earlier cervical prolapse is diagnosed, the easier the treatment and recovery process is.

Prolapse of the uterus in women is a pathology characterized by a displacement of the organ relative to its normal position. It can lead to a change in the location of other organs or complete prolapse of the uterus. Treatment is surgical, but at the initial stages, correction with exercises at home is possible. The effectiveness of gymnastics is quite high, subject to regular performance. Prevention is an active lifestyle and the rejection of bad habits.

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Description

Under the prolapse understand the displacement of the fundus of the uterus relative to its normal position. Omission leads to various consequences, the most unpleasant of which is the complete prolapse of the organ. Patology occurs mainly in the climatic period, but can develop earlier.

Inside the abdominal cavity there is a muscular frame that holds the organs so that they do not go beyond it. It is formed from several layers of muscles that make up the pelvic floor. Each of them is surrounded by connective tissue.

The main functions of the muscular frame are:

keeping organs in the abdominal cavity in a normal position;
promotion of the fetus during the straining period of childbirth;
maintaining optimal intra-abdominal pressure.

The uterus in its normal position is also supported by the ligamentous apparatus, which consists of a round and wide ligament. The reasons for lowering the body are a violation of muscle tone and weakening of the ligaments. The uterus can be located at the entrance to the vagina or completely go outside.

The reasons

The following factors directly affect the displacement of the genitals:

Cause	Description
birth trauma	Complications during childbirth occur due to improper actions of midwives, large fetus, multiple pregnancy
weight lifting	Pathology develops with regular lifting of a load weighing more than 10 kg
Chronic constipation	Constant straining causes microtrauma and weakening of the ligamentous apparatus
Tears in the perineum	The main reason for their appearance is a difficult birth or an episiotomy. Can also occur with physical impact
Surgery	Any intervention on the pelvic organs increases the likelihood of developing adhesive disease and reducing muscle contractility. The most common of these is a caesarean section.
Nerve disorders	Caused by pathologies of the nerves that innervate the pelvic organs
Hormonal disruptions	The development of pathology contributes to a decrease in the production of estrogen in menopause
Connective tissue dysplasia	Varicose veins, hernias, joint dysplasia
Other reasons	Persistent cough, anomalies in the development of the reproductive organs, obesity, hereditary predisposition, the presence of neoplasms in the uterine walls

Omission after childbirth

Not always pathology occurs in women during menopause. Although rare, prolapse also occurs in young patients (postpartum form of the disease).

Reasons are:

complications during childbirth;
multiple pregnancy;
bad heredity;
violation of the rules of nutrition;
lifting weights while carrying a child;
low physical activity.

Stages and symptoms

Most often, pathology occurs in adulthood and old age. The cause is muscle atony, which progresses due to the fact that many women do not pay attention to early symptoms.

The first signs include a feeling of growth in the vagina or perineum. The condition is exacerbated by pain in the lower abdomen of unknown etiology. It gradually passes into the lower back, disrupting the usual way of life. Accompanied by causeless irritation and fatigue.

As the next stage develops, a hernia forms in the perineum. She is regularly exposed to infections and injuries that worsen the general condition of a woman. Menstruation is painful and long.

Degrees of uterine prolapse

The late stage of the pathology leads to concomitant disorders and is characterized by a change in the location of the pelvic organs. They move into the vagina and below it. Prolapse of other organs may develop. Most often, a cystocele (omission of the anterior wall of the vagina) or a rectocele (omission of the posterior wall) is formed.

The symptomatology of the disease is difficult for timely diagnosis. The omission may not cause pain for a long time.

The most striking symptoms:

constipation;
pain during intercourse;
soreness in the lower abdomen;
heaviness in the vagina;
feeling of finding a foreign body;
leakage of urine.

There are 4 degrees of uterine prolapse:

1. The remote point of the uterus is located above the ring of the vulva.
2. Becomes flush with the vulva.
3. Falls lower by 1 cm.
4. There is a complete prolapse of the organ.

There is a classification of Malinovsky, according to which there are threedegree of omission:

1. The cervix is at the level of the entrance to the vagina.
2. The body of the uterus is higher than the entrance to the vagina, the cervix is lower.
3. Both the body and the cervix are lower.

Diagnostics

Only a gynecologist can determine the presence of prolapse, relying not only on complaints, but also on examination data. A rectovaginal examination is performed, which provides information on the degree of organ prolapse and possible complications. A colposcopy is required.

To confirm the diagnosis, the following studies are carried out:

cytology;
microbiological examination of the smear;
hormonal analyses.

Also nominated:

vaginal ultrasound;
Ultrasound of the kidneys;
hysteroscopy of the uterus;
excretory urography.

Treatment

In the treatment of the disease, different methods are used. Their choice depends on the following factors:

stage of uterine prolapse;
accompanying diseases;
the need to restore childbearing function;
age indicators;
pathology of the sphincter of the bladder and rectum;
possible risks of the operation.

If the body of the organ does not extend beyond the vagina, conservative methods of therapy can be used. For this are used:

exercise therapy - increases the tone of the pelvic muscles;
Kegel gymnastics;
therapeutic gynecological massage;
hormone therapy with estrogens (helps improve muscle tone);
limitation of physical activity.

In elderly patients, there are many contraindications for surgical intervention, so they are prescribed tampons or a pessary. The latter is a special device that looks like a ring. It is inserted into the vagina to fix the cervix, creates support and does not allow the body of the organ to fall further.

Installation of a pessary

The main disadvantage is the inadmissibility of a long stay in the vagina due to the possible development of bedsores. To prevent their formation, the genital organs are douched with antiseptic solutions. Gynecological examinations when using a pessary are carried out twice a month. The device is inserted for a month, after which they take a break for 10 days.

Diet

Nutritional adjustment is extremely important in the treatment of prolapse. Its purpose is to increase muscle tone. For this, the following requirements must be met:

minimizing fatty foods;
eating more protein
the predominance of vegetables and fruits rich in vitamins in the menu;
consumption of dairy and dairy products.

Surgical intervention

There are several methods of surgical intervention:

Surgical shorteningmuscles and ligaments. The uterus is attached to the pubic joint or ligamentous apparatus of the pelvis. The procedure is accompanied by an increased risk of recurrence. This is due to the fact that ligaments tend to stretch over time.
Alloplasty. The most advanced method. A special synthetic mesh is used, which fixes the body of the uterus, preventing it from falling. It is used in the event that conservative methods of treatment do not lead to positive dynamics, and surgery is inevitable. In addition to the physiological restoration of the correct arrangement of organs, the operation helps to eliminate defects in urination and defecation.
Sewing of the vaginal walls. Used to fix the body of the uterus. It is done transvaginally.

Alloplasty

Folk methods

Traditional medicine recipes are used only with the permission of a doctor and give positive results in combination with traditional therapy and exercise.

The most effective folk remedies are:

Quince. Improves the tone of the muscles of the uterus and rectum. It is used as a compote for daily use. Water and dry fruits are mixed in a ratio of 10: 1 and boiled over low heat.
Datura. 20 g of grass are taken for 7 liters of water, steamed and infused for 30 minutes. The decoction is added to the bath.
Melissa. The leaves of the plant are steamed overnight in a thermos. Take half a glass daily.
Elecampane. 1 st. l. herbs pour half a liter of vodka, insist for 10 days in a cool place. Take 1 tsp. in the morning, on an empty stomach.

Physical exercises

Exercise helps to eliminate pathology at an early stage of development. The main condition is regular daily performance.

Most effective:

Standing on all fours within 10-15 minutes immediately after sleep.
Push ups. Starting position - kneeling. It is necessary to lower the body until the chest touches the floor, then return to the starting position.

Exercises for the press help in the treatment of prolapse:

For the lower: lifting the legs from a prone position.
For the top: lifting the body.
Exercises "Scissors", "Bicycle" and "Birch".

Kegel gymnastics is considered the most popular and effective. The main essence of this set of exercises is the tension of the muscles of the perineum. There are no contraindications for carrying out, you can perform them at any time. The effect comes only with regular practice. Every day you need to do several approaches.

Regular repetitions of Kegel exercises lead to the return of the uterus to its normal position, help get rid of urinary incontinence and restore elasticity to the muscles of the perineum and pelvis.

Consequences and prevention

The most serious consequences that occur if prolapse is not treated are:

Prolapse of the uterus from the genital slit- happens most often.
Prolapse of the bowel ring. An extremely serious pathology that can lead to death.
Eversion of the vagina. Complicates the course of the disease, may lead to the need to remove the uterus.
Violations of the performance of other organs: dysfunction of the bladder and intestines, lowering of other organs and their prolapse.

To prevent the development of complications, women are advised to listen to the recommendations of a gynecologist:

do not lift weights weighing more than 3 kg;
ride a bike 2-4 times a week;
apply the “woman on top” position during intercourse;
wear a special bandage to reduce the likelihood of uterine prolapse.

Prolapse of the uterus- this is the displacement of the uterus down, followed by "bulging" into the vaginal cavity through the pelvic floor.

The exit of the female pelvis is closed by three powerful muscle layers that form the so-called "pelvic floor". The muscles that form this layer are arranged in the form of tiles, which provides the greatest strength to the entire muscle conglomerate. To increase the strength of muscle tissue, each pelvic floor muscle is reinforced with fascia, which is a sheath of dense connective tissue fibers.

The importance of the functions of the pelvic floor muscles cannot be overestimated:

- The muscles of the pelvic floor provide a permanent location of the internal genital organs, as well as the neighboring bladder and rectum.

- Physiological pass with the active participation of the pelvic floor muscles, which contribute to the promotion of the fetus outward. After the end of childbirth, the pelvic floor returns to its original state.

- The pelvic floor is a support not only for the pelvic organs, but also for other internal organs. It is involved in the regulation of normal intra-abdominal pressure.

In its permanent place, the uterus is also fixed by its ligamentous apparatus - the round and wide ligaments of the uterus.

Any processes associated with a violation of the muscle tone of the pelvic floor and a weakening of the ligamentous apparatus of the uterus lead to a change in its normal location in the pelvic area.

There is a completely erroneous opinion that uterine prolapse is present only in older women. Meanwhile, statistics say that out of a hundred young women under 30, every tenth has a different degree of uterine prolapse, out of a hundred women aged 30-45 this pathology occurs in forty, and after 50 years it can already be found in half of a hundred. These facts suggest that age is not always the cause of uterine prolapse, in some cases it contributes to the aggravation of the process that arose in younger years.

Prolapse of the uterus is often hereditary and is found in close female relatives - mothers, grandmothers or sisters.

Sometimes, along with the uterus, neighboring organs also descend - the bladder, rectum or part of the intestine.

Treatment of uterine prolapse depends on many factors and is selected for each patient individually. Prevention of uterine prolapse in the initial stages of the development of pathology is very effective. If you do not seek help in a timely manner, the process can progress up to uterine prolapse.

Causes of uterine prolapse

With a weakening of the tone of the muscles and ligaments that should hold the uterus in a certain constant position, it descends beyond the physiological boundaries. This is due to the following reasons:

- Traumatic injuries of the pelvic floor muscles;

- Constitutional features (infantilism, asthenic constitution);

- Obstetrical traumatic situations. During complicated childbirth, very traumatic methods of delivery are sometimes used: the imposition of obstetric forceps, manual extraction of the fetus with breech presentation, etc.;

- Postponed severe surgical operations on the genitals;

- Numerous births reduce the tone of the pelvic floor muscles;

- Deep ruptures of the perineum of any origin;

- Heavy physical labor associated with heavy lifting;

- Increased intra-abdominal pressure caused by diseases of the abdominal organs or chronic constipation;

- Congenital malformations in the pelvic area;

- Diseases of the connective tissue, which is manifested by the presence of hernias or prolapse of other internal organs;

- Violation of the production of sex steroids (mainly estrogens) affects the ability of muscle tissue to contract;

- Elderly age. With age, muscle tissue loses elasticity, atrophic changes occur. Estrogen deficiency in old age contributes to further weakening of the muscles and ligaments of the pelvic floor.

In the development of the process of uterine prolapse, not one provoking factor dominates, but a combination of them.

In any woman, a slight prolapse of the uterus during pregnancy is not a pathology. Along with the growth and increase in the size of the fetus, the uterus also increases and may shift slightly downward. An exception is the prolapse of the uterus during pregnancy in women who have suffered from this disease before. In this case, it is caused by other reasons, and it can aggravate it and stop prematurely.

Thus, prolapse of the uterus is part of the general disorders of the body and should not be treated in isolation like a local process.

Symptoms of uterine prolapse

There are no characteristic symptoms of uterine prolapse. Each patient experiences this condition individually. The process takes a long time, and small deviations in well-being may not attract the attention of a woman. Much less often, prolapse of the uterus occurs quickly.

In most cases, patients with displacement of the genitals experience abdominal pain, varying in intensity and duration, which can shift to the lumbar region and sacrum. Sometimes patients indicate the appearance of aching pains in the lower abdomen after a long stay on their feet. After changing the position of the body, the pain subsides. Often, prolapse of the uterus provokes pain during intimacy.

The uterus that has shifted down presses on the surrounding tissues, which irritates the nerve endings of the vagina, causing a sensation of a foreign body.

Prolapse of the uterus may be accompanied by the appearance of leucorrhea, bloody discharge and menstrual dysfunction (heavy and / or painful menstruation).

Sometimes women themselves, during hygiene procedures or after physical exertion, find themselves in an abnormal location of the genitals and go to the doctor in the absence of other symptoms.

The prolapse of the uterus provokes a change in the anatomically normal arrangement of neighboring organs. Following the uterus, the bladder and / or rectum are displaced (to varying degrees), which leads to a change in their normal functioning - urination disorders (dysuria, frequent urination) and defecation (constipation) appear. Urinary disorders are much more common than disorders of the rectum. In severe cases, a harmless inflammation in the urethra or bladder is joined by a secondary pathogenic flora that can spread to the kidneys.

A long-term displacement of the genital organs leads to the development of local inflammatory processes (colpitis, cervicitis, vaginitis, and others). In the absence of proper treatment, inflammation ascends to the pelvic area, and the clinic of genital prolapse is supplemented by symptoms of endometritis, adnexitis, salpingoophoritis, etc.

The most reliable sign of uterine prolapse is the result of a visual gynecological examination. During the examination, the woman is asked to push (as during childbirth) to see how the position of the vaginal walls, cervix and uterus changes. The diagnosis of uterine prolapse after examination in the mirrors does not cause difficulties.

The main diagnostic criterion for uterine prolapse is the localization of all anatomical changes within the vagina above the border of the genital slit. If the pathological process goes beyond the genital gap partially or completely, they talk about the prolapse of the genitals, which is evidence of the progression of the prolapse process. However, the omission of the genitals does not always end in prolapse.

The uterus moving down causes changes in the position of the walls of the vagina. In some patients, uterine prolapse is accompanied by vaginal prolapse, but this scenario is not mandatory. The vagina moves unevenly. Distinguish the omission of only the anterior or only the posterior wall of the vagina, as well as both walls together. During examination in the mirrors, the uterus is visualized outside the entrance to the vagina, with physical muscle tension (straining), it is not shown from the genital gap.

The muscular frame of the small pelvis is organized in such a way that each individual organ is involved in maintaining the other. The front wall of the vagina serves as a support for the bladder, when it moves down, it drags it along. The bladder descends and begins to bulge into the vaginal cavity, forming a cystocele. A similar process occurs with the participation of the posterior wall of the vagina and rectum, forming a rectocele.

Some patients get confused in terms and give incorrect names to this pathological process. The uterus is a hollow organ that resembles a pear. It has a bottom, front and back wall. The prolapse of the uterus and the prolapse of the walls of the uterus are different names for the same process, but the prolapse of the walls of the uterus is not a competent term. Since the uterus descends along with its walls, it is wrong to talk about the prolapse of the anterior wall of the uterus and / or the prolapse of the posterior wall of the uterus - the uterus cannot move down, leaving one of its walls in place. Therefore, the prolapse of the anterior wall of the uterus is impossible from a physiological and anatomical point of view, but there is a prolapse of the anterior wall of the vagina. Similarly, posterior uterine prolapse does not exist as a medical term and refers to posterior vaginal prolapse.

The process of prolapse of the uterus accompanies the prolapse of the cervix and / or its elongation (elongation). During a gynecological examination, the prolapse of the cervix is well visualized.

Colposcopy, examination of smears and cultures from the vagina is mandatory for all patients with genital prolapse. When the uterus is displaced or prolapsed, hypertrophy (increase in volume) of the cervix, pseudo-erosion, endocervicitis, cervical canal polyps are often observed.

Ultrasound examination clarifies the location of the uterus and pelvic organs, diagnoses inflammatory processes.

The combination of pregnancy and uterine prolapse is not always harmless. If before the onset of pregnancy, the expectant mother knew about her diagnosis and underwent appropriate examinations and treatment, pregnancy can proceed without serious complications. The course of pregnancy depends on the degree of prolapse of the genitals, the weight of the woman and the fetus, and many other factors. The most common complication of pregnancy with uterine prolapse is, therefore, expectant mothers with such a pathology are more often placed in a hospital "for preservation".

Examination of women with the omission of the genitals, as necessary, is carried out in conjunction with a urologist and a proctologist, in order to establish a cystocele or rectocele, special examinations are carried out. It is important in the diagnosis to establish the presence of extragenital pathology in patients, since prolapse of the uterus often occurs against the background of endocrine and metabolic pathologies.

If surgical treatment of genital prolapse is expected, the examination complex is expanded by additional diagnostic methods.

Degrees of uterine prolapse

During a gynecological examination of patients with genital prolapse, the degree of uterine prolapse is determined, which plays the role of an important diagnostic criterion.

It is very important to differentiate prolapse of the uterus and/or vaginal walls from prolapse (complete or partial). The genital fissure was taken as a visual diagnostic boundary. If the uterus is displaced downward and does not go beyond the border of the genital slit, they speak of its omission, if this border is partially or completely violated, this is a prolapse of the uterus. Similarly regulate the process of displacement of the vagina and cervix. The degree of uterine prolapse clearly characterizes the process of moving the uterus to the genital slit and is determined visually during a general gynecological examination.

The first degree of prolapse of the walls of the vagina and uterus can be observed at the very beginning of the process of their displacement. On examination, the uterus is displaced downward, but the cervix remains within the vagina.

The second degree of prolapse is diagnosed if the cervix is located on the eve of the vagina or below it, and the body of the uterus is visualized in the vagina.

Further development of the displacement process leads to the fact that the uterus and a significant part of the vagina are located outside the genital gap - the third degree.

Correctly establishing the degree of uterine prolapse is extremely important for determining further tactics of examination and therapy.

Treatment of uterine prolapse

Choosing the right treatment tactics for uterine prolapse can be difficult. Should be considered:

- Age of the patient. It is much easier to restore normal muscle tone if the muscle tissue does not undergo age-related changes. In addition, complex surgical procedures are not always indicated for elderly patients.

- At what stage is the pathological process, that is, to determine its degree.

- The presence of concomitant gynecological diseases.

- Is there a need to restore menstrual function in case of its violation.

Does the patient plan to become a mother in the future?

- Features of dysfunction of the bladder and / or rectum (if any).

- In some cases, when uterine prolapse is combined with extragenital pathology, the choice of the method of therapy is carried out jointly with doctors of other specialties.

If the displacement of the uterus is expressed slightly and does not cause any inconvenience to the woman, no specific treatment is required, and one can limit oneself to methods of preventing further progression of the displacement of the uterus.

If the uterus is located within the vagina, and the functioning of adjacent organs is not impaired, therapy can be started with conservative methods. Before starting treatment, it is necessary to bring the patient's lifestyle to the physiological and age norm. Exclusion of excessive physical activity, a balanced diet, weight loss and treatment of foci of chronic infection will have a beneficial effect on the body's ability to stop the progression of the disease.

The goal of conservative therapies for genital displacement is to strengthen the pelvic muscles and prevent further displacement. Treatment includes:

- Kegel exercises for the vaginal muscles. An increase in the tone of the muscles of the vagina prevents the aggravation of the process of displacement of the uterus. Also prescribed for prophylactic purposes.

- Therapeutic exercises for prolapse of the uterus according to the Yunusov method.

- Lubrication of the vaginal mucosa with ointments with estrogens and metabolites to improve elasticity and reduce atrophy processes (used in menopause and postmenopause).

- The use of pessaries (uterine rings) in older women in the presence of contraindications to surgical treatment. Pessaries are rubber rings filled with air of various diameters. Sized individually. A pessary inserted into the vagina does not allow the uterus to move lower. The disadvantage of the pessary is the inability to enter it for a long time. A high probability of development and inflammation requires changing the uterine rings at least twice a month and doing regular douching with herbs and antibacterial agents.

Rubber rings can also be used in young women in a situation where they plan to give birth or have contraindications to surgical treatment.

– Special bandage for uterine prolapse for patients of any age. It is prescribed in the initial stages of the disease and is suitable for short-term use. A bandage has proven itself well for prolapse of the uterus in pregnant patients.

– Gynecological massage restores blood supply in the pelvic area, normalizes bowel function and eliminates inflammation and improves the tone of the vaginal muscles. It can be used as an independent method for minor changes in the position of the uterus or as part of complex therapy. Massage is carried out only in a medical institution by a trained specialist.

If conservative therapy could not stop the process of displacement of the genitals, you have to decide on surgical treatment. If the patient is diagnosed with a severe degree of prolapse or prolapse of the uterus, surgical treatment is started immediately.

Measures to prevent uterine prolapse are:

- Competent management of pregnancy and childbirth, as well as the restoration of normal muscle tone in the postpartum period.

- Therapeutic exercise for all women predisposed to uterine prolapse.

- Hormone replacement therapy (HRT) in menopause (only if indicated).

- Treatment of extragenital diseases that are background for the displacement of the genitals.

The best prevention of uterine prolapse is a timely visit to the doctor. Like any disease, uterine displacement detected in the initial stages is much easier to eliminate.

Surgery for uterine prolapse

Surgical treatment is an alternative for women who have already given birth and older patients with uterine prolapse. It is also acceptable for those women who do not want or cannot resort to other methods of treatment, have severe and / or complicated forms of genital prolapse.

Perhaps there is not a single gynecological pathology that has such a large number of surgical treatment methods as the omission (or prolapse) of the genitals. In the arsenal of modern surgery, there are several hundred (!) Treatment options for genital displacement, each of which has its own advantages and disadvantages. Unfortunately, none of the existing methods of surgical treatment excludes uterine prolapse after surgery, regardless of the qualifications of surgeons. Relapses of the disease in 30-35% of operated patients appear, as a rule, in the first three years after surgery.

When choosing a method of operation, many factors are taken into account:

- The degree of prolapse of the genitals. Severe forms (degrees) of the disease require more serious (radical) interventions.

- Age. In old age, it is not always possible to rely on conservative methods; refusal of surgical treatment may be justified by the presence of serious contraindications or the initial degree of displacement of the genitals. The volume of surgical intervention in older women, as a rule, is expanding.

- Extragenital pathology. Before any surgical manipulation, the patient should consult with doctors of related specialties and obtain their consent to the operation.

- The combination of uterine prolapse with concomitant cysto- and / or rectocele.

- The opinion of the patient. In some cases, women refuse one or another type of surgical intervention. This is especially true for the removal of the uterus.

With all the variety of treatment methods, they can be divided into several groups according to the main feature - due to what anatomical formation (muscles, ligaments, and so on) the abnormal location of the genitals is eliminated.

The first group consists of operations aimed at strengthening the muscles of the pelvic floor. In some cases, they have independent significance, and sometimes they are carried out as additional measures to other operations.

The second group of operations is performed to fix the uterus by shortening the uterine ligaments. For this, a round ligament of the uterus is used, it is shortened and sutured to the body of the uterus. Short ligaments prevent the uterus from moving downward and hold it in place.

The operations of the third group are more complex and volume. To strengthen the fixing apparatus of the uterus, all available ligaments are used, which are stitched together. This group includes the most popular and effective "Manchester operation", characterized by high trauma (deprives the patient of reproductive function).

Surgical methods of rigid fixation of the uterus to the pelvic bones belong to the fourth group of surgical treatment.

The fifth group of operations uses the methods of plastic surgery. Their essence is to replace ligaments and / or muscles with synthetic materials. This method is not widely used due to the large number of relapses of the disease and the presence of complications.

Operations to reduce the size of the vagina belong to the sixth group.

The seventh group of surgical interventions is formed by radical operations of removal of the uterus.

Combined surgical treatment using methods from different groups is considered the most appropriate.

All operations are associated with the risk of complications. Repeated prolapse of the uterus after surgery does not always indicate the shortcomings of the applied surgical method and may be associated with the poor health of the patient or her violation of the postoperative recommendations of the attending surgeon. The risk of developing other complications in the good health of the patient is low.

Successful surgery does not rule out a predisposition to uterine displacement. Therefore, it is necessary to comply with all preventive measures and not avoid visiting the doctor's office.

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.