Prolapse of the cervix is a disease in which the cervix shifts below the prescribed level.
This pathology is one of the most common options for the incorrect location of the internal genital organs of a woman.
In women, prolapse of the cervix can occur at any age, but people 40 to 55 years old are at risk.
In this article, we will look at the dangers of prolapse of the uterus and how it can be cured.
The essence of pathology and its causes
Or prolapse is a pathological condition characterized by a downward displacement of the organ relative to the normal location of the uterus. In a neglected state, it is possible for the uterus to fall outward, while the cervix remains in place.
Prolapse of the uterus is a progressive pathology that should not be taken lightly. At the initial stage of the disease, some anatomical changes in the uterus are invisible, but due to the influence of some negative factors, the organ can begin to rapidly descend.
Negative factors can include heavy lifting or frequent constipation.
Exists , capable of provoking the onset of such a pathology as cervical prolapse:
- arising from improper location of the fetus. In addition, perineal ruptures can provoke prolapse of the uterus if the fetus is too large;
- congenital and acquired pathologies of the pelvic organs;
- trauma to the pelvic muscles, ruptures of the genitals, which can be not only external, but also internal;
- the age category of women from 45 years old - often excessive physical activity does not affect health at a young age, but after a time when a woman is already in old or pre-mature age, all these loads make themselves felt;
- overweight.
Associated symptoms
The prolapse of the cervix has , due to which the disease in most cases can be determined at the initial stage:
- constipation, diarrhea, urinary incontinence, increased gas production. Even with frequent urination, a woman may feel not completely emptied Bladder... Urinary incontinence is characteristic of a disease that occurs at a later stage;
- pain in the lower abdomen during and after;
- vaginal discharge, which can be either pure white or bloody. Too abundant and not passing for a long time discharge is a direct sign of the presence of pathology in the body, and a signal that it is necessary to immediately consult a doctor;
- violation of the menstrual cycle;
- the tissues of the perineum are almost always in an edematous state, pressure sores begin to form on the walls of the vagina. The perineal tissue swells precisely because of the prolapse of the uterus, which makes it difficult for a woman to take a sitting position. Pressure ulcers occur due to impaired blood circulation, which develops against the background of necrosis of the squeezed tissues;
- in women suffering from varicose veins, the disease is greatly exacerbated;
- often, with the prolapse of the uterus, colitis can be observed, as well as infringement of the intestinal loops.
Pain in the lower abdomen are the most characteristic and first signs of prolapse of the uterus. Often such pains can radiate to the perineum and lower back. Painful sensations at an early stage are usually dull, pulling in nature. At a later stage of the disease, the pain intensifies and becomes more severe.
Menstrual irregularities can be of two types - hyperpolymenorrhea and algodismenorrhea.
With hyperpolymenorrhea, the number of menstruation is very abundant, which can lead to such a consequence as anemia, and, as a consequence, signs characteristic of this condition:
- constant weakness;
- dizziness;
- frequent headaches;
- fast fatiguability.
With algodismenorrhea during menstruation, a woman experiences severe pain, similar to cramping, sensations. Sometimes the pain can be aching in nature and is localized in most cases in the lower abdomen.
Why is the disease dangerous?
One of the most serious complications of prolapse of the uterus is infringement of the organ, which, if untimely access to a doctor or improper treatment, can lead to tissue necrosis, which can only be eliminated by an operable way, often during such an operation, the uterus is completely removed.
NOTE!
No less dangerous is the prolapse of the cervix and the fact that during its development, an inflammatory process begins, which can affect the entire genital area of a woman. Without proper treatment, inflammation can lead to infertility.
So, summing up, we can say with confidence about what threatens the prolapse of the uterus in a neglected state:
- impossibility of conception;
- difficulties associated with pain during sexual intercourse;
- miscarriages and premature birth;
- problems with delivery;
- inflammation and infection of the internal genital organs, rectum, bladder;
- trauma and bedsores of the uterus and vaginal walls;
- infringement of the uterus or rectum.
Degrees of omission
There are several degrees of development of such a pathology as prolapse of the cervix:
For diseases, prolapse of the uterus is negligible. With this course of pathology, a woman begins to have a menstrual irregularity; during sexual intercourse, pain and slight discomfort may be experienced.
With a disease, the uterus descends almost to the genital slit. At the same time, the woman experiences severe pain, a foreign body in the vagina, sexual intercourse becomes almost impossible.
Most women in the second stage of prolapse of the uterus experience frequent urge to urinate.
On the the walls of the vagina descend beyond the entrance to the vaginal canal, and the uterus is completely in the vagina. Discharge appears, often with blood impurities.
The woman experiences severe excruciating pain while walking and in a sitting position. Urinary incontinence begins. Sometimes, at the third stage of prolapse of the uterus, in addition to other signs, infectious inflammatory processes of the genital organs can be observed.
For diseases, the uterus, together with the walls of the vagina, completely falls out. The woman experiences excruciating pain while walking, she cannot sit. Inflammatory processes at this stage of the disease almost always lead to the formation of pressure sores and abscesses.
Effects on pregnancy
Such a pathology as prolapse of the uterus is very dangerous. This is due to the fact that during pregnancy, with the prolapse of the uterus, all negative conditions experienced by a woman (pain in the lower abdomen, heaviness) increase several times.
The danger of prolapse of the uterus during pregnancy also lies in the fact that pathology can provoke premature birth or miscarriage.
Often, due to the fact that the uterus is lowered too low under the influence of pathology and fetal growth, the organ begins to become very inflamed. In this connection, a decision may be made to carry out an operative intervention with the subsequent removal of the organ.
Possible consequences
Often, when the uterus prolapses, a woman begins hormonal disorders, as a result of which the adrenal glands malfunction. Such a failure leads to menstrual irregularities and infertility. Even if there is a chance of conceiving a child, it is very small.
To cure infertility for a woman who wants to become a mother in the next few years, it is necessary to take all the necessary measures in order to get rid of the prolapse of the uterus as soon as possible and restore the menstrual cycle.
General treatment regimen
At an early stage, prolapse of the uterus can be treated conservatively at home. Therapy consists of exercises aimed at strengthening the ligaments and muscles of the pelvic floor.
Such exercises help to completely restore the previous position of the genitals and prevent their further displacement. Kegel exercises are especially effective in this case.
Often, at the initial stage of the disease, the doctor recommends women. This is especially true for women who have recently become a mother - the bandage, in addition to holding the stomach, supports internal organs and does not allow them to shift.
If conservative treatment did not give the desired result and the disease continues to progress, then the doctor decides to perform surgery.
There are several types used for prolapse of the uterus:
- perineoplasty... The purpose of this procedure is to perform an aesthetic and functional correction of the perineum. During the operation, a special mesothread is used, which eventually disintegrates and is replaced by collagen fibers, thereby forming an organic framework inside the tissues and supporting the perineum;
- colpoperineolevatoroplasty... During the procedure, the walls of the vagina are sutured and a synthetic mesh frame is used to support the pelvic tissue;
- colporrhaphy... This procedure involves suturing the anterior or posterior walls of the vagina, thereby adjusting its size and eliminating prolapse; Vkontakte
Sometimes a woman feels an incomprehensible heaviness in the pubic area, pain in the vagina. The gynecologist, after examination, determines that the cause of the malaise is weakening muscle tone, as a result of which there was a prolapse of the uterus. The pathology can be minor, but it can also have unpleasant consequences. Prolapse occurs more often in older women; in young women, this condition is also possible. Because of it, serious complications and consequences arise, therefore, treatment is necessary.
Content:
Prolapse of the uterus, its stages
The uterus is held in the pelvic cavity by the pelvic floor muscles (a muscle group in the perineum) and own ligaments... Normally, it is located in the center of the pelvic cavity between the rectum and bladder... The cervix is tilted slightly back, so that an angle of about 100 ° is formed between the body of the uterus and the cervix.
If the muscle tone weakens, and the ligaments stretch (the so-called prolapse of the genitals occurs), then the normal position of the uterus is disturbed, it descends: the upper part, from which the tubes extend (the bottom of the uterus), goes down, and the cervix moves closer to the inlet of the vagina. Prolapse of the uterus can occur when the cervix protrudes outward. Disorders in the ligamentous apparatus cause prolapse of the vagina, as well as the rectum, bladder, and kidneys.
Prolapse occurs more often in women over 55 years old, but this condition is often found in young people. There are several degrees of development of the disease.
1 degree. There is a prolapse of the body of the uterus, while its cervix approaches the inlet of the vagina, but does not go beyond it, even if the woman is pushing.
2nd degree. The uterus descends so much that its cervix is shown outward, if a woman pushes, coughs, picks up a heavy object. This condition is called prolapse and incomplete prolapse of the uterus.
3 degree. Incomplete prolapse occurs: the cervix and part of the uterus protrude outside the vagina.
4 degree. The body and the fundus of the uterus go beyond the genital slit, and its so-called complete prolapse occurs.
Such a pathology does not pose a fatal threat, but as it progresses, more and more unpleasant symptoms of prolapse of the uterus and disorders of its functioning appear, which makes a woman disabled.
Reasons for prolapse of organs
The reasons for the weakening of the muscles and ligaments that hold the uterus and other organs of the small pelvis are:
- ruptures of the muscles of the perineum that occur during childbirth: during the extraction of the child with the help of obstetric forceps, the use of vacuum extraction, as well as during breech presentation of the fetus;
- damage to ligaments and muscles during operations on the genitals;
- injuries causing perineal rupture;
- violation of the sensitivity of nerve endings located in the organs of the genitourinary system, the impossibility of normal regulation of muscle contractility by the central nervous system;
- congenital disorders of the structure of organs, muscles and ligaments located in the small pelvis;
- hereditary pathology of the development of connective tissue (genetic disorder of collagen production) - connective tissue dysplasia.
- a decrease in the elasticity of muscles and ligaments as a result of age-related changes in hormonal levels, a decrease in the content of estrogen (in the menopausal period).
The risk of developing pathology is increased in women involved in weightlifting who are forced to do hard physical work. Often, prolapse and prolapse of the uterus occurs in women who have given birth many times, as well as in those suffering from constipation.
Development is facilitated by the formation of tumors in abdominal cavity... Increased intra-abdominal pressure, leading to organ prolapse, occurs in women with chronic diseases causing a severe cough. It can also occur with obesity.
Video: Causes and consequences of prolapse of the uterus
Symptoms and Potential Complications
Pathology may not bother a woman for many years. Symptoms of prolapse of the uterus begin to appear more and more as it progresses. A woman has a sensation of the presence of a foreign body in the vagina or in the perineum, pulling pains in this area, aggravated by walking or sitting. Disturbed by pain in the sacrum and lower back.
Painful sensations, discomfort appear during intercourse. In the last stages of prolapse, sexual intercourse becomes impossible.
When the uterus descends, it puts pressure on the bladder, so urination becomes frequent, difficult and painful, and urinary incontinence may occur. Stagnation of urine causes cystitis, kidney inflammation, urolithiasis.
The prolapse of the uterus entails a prolapse of the intestines, as a result of which the woman develops constipation and flatulence. Fecal incontinence sometimes occurs.
Increased leucorrhoea, the appearance of bloody vaginal discharge... Menses become profuse and lingering. With a strong prolapse or prolapse of the uterus, a woman cannot become pregnant.
The prolapsed part of the uterus is constantly injured when walking, so bleeding ulcers form on it and inflammation occurs. Blood circulation in the small pelvis is impaired, varicose veins of the lower extremities occur, edema of the tissues and mucous membrane of the uterus appears.
With prolapse and prolapse of the uterus, complications such as pressure sores in the vagina, infringement of the prolapsed uterus and bowel loops may appear.
Diagnosis of prolapse of the uterus
The doctor can detect prolapse and even more prolapse of the uterus during an external examination of the genitals. The degree of manifestation is checked at rest of the woman and when trying to strain. To determine the stage of development of the pathology and diagnose concomitant diseases, an examination is carried out, according to the results of which the doctor determines what treatment is required, whether it is necessary to carry out surgery.
The following diagnostic methods are used:
- Colposcopy of the uterus. Allows you to study the state of the cervix and uterine cavity, detect folds, areas of inflammation, examine the state of the endometrium and mucous membranes of the cervix.
- Hysterosalpingoscopy - ultrasound examination of the patency of the fallopian tubes.
- Ultrasound of the uterus and other organs of the small pelvis.
- PAP test. Cytological examination of a smear from the vagina and cervix to detect abnormal cells.
- Microscopic examination of the smear to determine the composition of the microflora, as well as sowing the contents of the smear to determine the type of bacteria present in it.
- Culture of urine. It is carried out to establish the presence of infection in the urinary organs.
- MRI or CT of the pelvic organs. These methods make it possible to diagnose precisely the prolapse or prolapse of the uterus, which by outward signs may be similar to such pathologies as the "birth" of the myomatous node, eversion of the uterus, vaginal cyst.
A proctologist and urologist are consulted to identify pathologies of the intestines and urinary organs.
Treatment
There are 2 ways to treat prolapse and prolapse of the uterus: conservative and surgical. When choosing the direction of therapy, the doctor takes into account the stage of development of the pathology and the symptoms of its manifestation.
Conservative treatment
It is used in the case when the first stage of prolapse is observed, the functioning of neighboring organs is not disturbed. Drug therapy is used with drugs that increase the level of estrogen in the blood. It helps to strengthen the ligaments and tone the muscles. Such drugs are also injected into the vagina in the form of ointments.
A gynecological massage of the uterus is prescribed to improve blood circulation and eliminate blood stagnation and edema. Elderly patients are prescribed the use of pessaries - special elastic rubber rings filled with air. The elastic ring supports the uterus, prevents it from sinking into the vagina. The disadvantage is that prolonged use of the pessary leads to pressure ulcers in the vagina. Therefore, they are used for 3-4 weeks, then taking a break for half a month. A mandatory procedure is daily douching with antiseptic solutions of furacilin, potassium permanganate or chamomile infusion.
Warning: Starting treatment, a woman should give up heavy physical exertion, switch to lighter work, follow a diet that will eliminate constipation.
Types of surgery
In the event that conservative therapy was ineffective, and the degree of displacement of organs is large, a surgical method of treatment is used. Elimination of pathology is possible using the following methods:
- Vaginoplasty. Suturing of the posterior wall of the vagina, as well as of the rectum, muscles of the anus and perineum is performed. In the presence of urinary incontinence, "anterior colporrhaphy" is performed (elimination of a hernia of the bladder resulting from its prolapse).
- Shortening of the uterine ligaments and fixing them in the anterior and posterior wall of the uterus. The method is not effective enough, as the ligaments stretch again over time.
- Sewing the ligaments together. After such an operation, a woman will not be able to give birth to a child, since the uterus is not able to stretch and contract normally.
- Fixation of the uterus to the bones and ligaments of the pelvic floor. Such an operation allows a woman to maintain fertility.
- Strengthening ligaments with plastic materials. Possible rejection of plastic, relapse of the disease, the appearance of fistulas in the pelvic organs.
- Narrowing of the vaginal lumen.
- Hysterectomy is the complete removal of the uterus. It is carried out in the event of prolapse of the uterus in women beyond childbearing age.
- Combined method: simultaneous fixation of the uterus, strengthening of the ligaments and suturing of the vagina.
Operations are performed through the vagina or using laparoscopy (through punctures in the abdominal wall). Sometimes you have to resort to open abdominal surgery.
After surgical treatment prolapse of the uterus, anti-inflammatory therapy and pain relievers are prescribed. If the uterus is preserved, if necessary, hormone replacement therapy with estrogen-containing drugs is performed.
Video: Surgical treatment of prolapse of internal organs
Prevention of prolapse of the uterus
The legislation provides for a restriction on the weight of objects that are allowed to be lifted and carried by a woman at work (no more than 20 kg). She must strictly adhere to the established norm. A girl from a young age needs to be introduced to the consequences of heavy physical exertion.
An important preventive measure is proper care behind the genitals, especially after childbirth. Such a measure is necessary to prevent inflammatory processes in the vagina. It is also important to timely treat diseases of the genital and other pelvic organs.
The correct management of childbirth, careful suturing of the tears is of great importance. After childbirth, doctors recommend doing exercises to restore the elasticity of the muscles and ligamentous apparatus of the uterus. In the presence of birth injuries, laser therapy or electrical stimulation of the pelvic muscles is prescribed.
You need to eat right to avoid constipation.
Exercises to strengthen the pelvic and vaginal muscles
A good way to prevent prolapse of the uterus and vagina are yoga classes using special poses. There is also a set of special exercises to help strengthen the muscles of the pelvic floor and vagina.
Some of them are performed in a sitting position: pulling in the muscles of the vagina and lower abdomen and then "pushing out" them, squeezing and relaxing the sphincter. Other exercises are performed in a standing or lying position, for example, walking in a circle with a ball clamped between the legs, crawling forward and backward.
An exercise that a woman should perform lying on her back with legs bent at the knees, with her feet pressed to the floor is also useful: it is necessary to spread the legs as much as possible, and then bring them together, squeezing the muscles of the vagina. With the same starting position, you can raise the pelvis by tightening the muscles. Exercises are performed 10 times. The effectiveness of such gymnastics is guaranteed.
Video: Exercises for the prevention of prolapse of the uterus
The 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 shifts down to the entrance to the vagina or even falls out of it. In modern practice, this disease is considered as a variant of a pelvic floor hernia, which develops in the area of the vaginal entrance.
Physicians in the description of this disease and its varieties use the concepts of "prolapse", "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 "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 during their lifetime, at least one in 10 women will undergo surgery for this condition. In women, after surgery, in more than a third of cases, there is a recurrence of genital prolapse.
The older a woman is, 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 most frequent gynecological operations. Thus, in the United States, more than 100 thousand patients are operated on annually, spending 3% of the total health care budget on this.
Classification
Normally, the vagina and neck are tilted backward, and the body of the organ itself is tilted forward, forming an angle with the axis of the vagina that is open forward. The bladder is adjacent to the front wall of the uterus, the back wall of the cervix and vagina is in contact with the rectum. Above the bladder, the upper part of the body of the uterus, the intestinal wall are covered with the peritoneum.
The uterus is held in the pelvis by the force of its own ligamentous apparatus and 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 pharynx descends to the middle of the vagina.
- The cervix, together with the uterus, moves below, to the entrance to the vagina, but does not protrude from the genital slit.
- The external os 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 perineal region.
This classification does not take into account the position of the uterus, it defines only the most prolapsed area, often the results of repeated measurements differ from each other, that is, there is poor reproducibility of the results. The modern classification of genital prolapse, adopted by most foreign experts, is devoid of these shortcomings.
Appropriate measurements are taken with the woman lying on her back while straining, using a measuring tape, uterine probe or forceps with a centimeter scale. Loss of points is assessed in relation to the plane of the hymen (outer edge of the vagina). The degree of prolapse of the vaginal wall and shortening of the vagina are measured. As a result, prolapse of the uterus is divided into 4 stages:
- Stage I: the most drop-out zone is more than 1 cm above the hymen;
- Stage II: this point is located within ± 1 cm from 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 of the length of the vagina by more than 2 cm.
Causes and mechanism of development
The disease often begins at a woman's fertile age, that is, before the onset of menopause. Its course is always progressive. As the disease progresses, dysfunctions of the vagina, uterus, and surrounding organs join.
A combination of two factors is necessary for the appearance of genital prolapse:
- increased pressure in the abdominal cavity;
- weakness of the ligaments and muscles.
Reasons for prolapse of the uterus:
- a decrease in the production of estrogen, which occurs during menopause and postmenopause;
- congenital weakness of the connective tissue;
- injury 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 (bowel disease with persistent constipation, respiratory diseases with prolonged strong cough, obesity, kidney, liver, intestine, stomach).
These factors, in various combinations, lead to weakness of the ligaments and muscles, and they become unable to keep the uterus in a normal position. The increased pressure in the abdominal cavity "squeezes" the organ down. Since the anterior wall is connected to the bladder, this organ also begins to stretch after it, forming a cystocele. The result is urological disorders in half of women with prolapse, for example, urinary incontinence when coughing, physical exertion. The posterior wall, when descending, "pulls" the rectum along with the formation of rectocele in one third of patients. Often there is a prolapse of the uterus after childbirth, especially if they were accompanied by deep muscle ruptures.
The risk of the disease is increased by multiple births, intense physical activity, and genetic predisposition.
Separately, it is worth mentioning the possibility of vaginal prolapse after amputation of the uterus for another reason. According to various 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 success in this case are much greater.
- a feeling that there is some kind of mass in the vagina or perineum;
- prolonged pain in the lower abdomen, in the lower back, tired of the patient;
- protrusion of a hernia in the perineum, which is easily injured and infected;
- painful and prolonged menstruation.
Additional signs of prolapse of the uterus arising from the pathology of neighboring organs:
- episodes of acute urinary retention, that is, 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 their quality of 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, varicose veins develop with edema of the legs, cramps and a feeling of heaviness in them, trophic disorders.
Diagnostics
How to recognize prolapse of the uterus? For this, the doctor collects anamnesis, examines the patient, and prescribes additional research methods.
A woman needs to tell the gynecologist about the number of births and their course, underwent operations, 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 dropped, finds defects in the muscles of the pelvic floor, conducts functional tests - a straining test (Valsalva test) and cough. A rectovaginal examination is also carried out to assess the condition of the rectum and the structural features of the pelvic floor.
To diagnose urinary incontinence, urologists use a combined urodynamic study, but when organs prolapse, the results are distorted. Therefore, such research is optional.
If necessary, endoscopic diagnostics are prescribed: (examination of the uterus), cystoscopy (examination of the bladder), sigmoidoscopy (examination of the inner surface of the rectum). Usually, such studies are necessary if cystitis, proctitis, hyperplasia, or cancer are suspected. Often, after the operation, a woman is sent to a urologist or proctologist for conservative treatment of identified inflammatory processes.
Treatment
Conservative treatment
Treatment of prolapse of the uterus should achieve the following goals:
- restoration of the integrity of the muscles that form the pelvic floor, and their strengthening;
- normalization of the functions of neighboring organs.
Uterine prolapse of the 1st degree is treated conservatively on an outpatient basis. The same tactics are chosen for uncomplicated genital prolapse of the 2nd degree. What to do with prolapse of the uterus in mild cases of the disease:
- strengthen the pelvic floor muscles with therapeutic exercises;
- give up heavy physical activity;
- get rid of constipation and other problems that increase intra-abdominal pressure.
Is it possible to swing the press when the uterus is lowered? When the body is lifted from the supine position, intra-abdominal pressure increases, which contributes to further pushing the organ out. So physiotherapy includes bends, squats, leg swings, but without straining. It is carried out in a sitting and standing position (according to Atarbekov).
At home
Home treatment includes a diet rich in plant fiber and reduced in fat. The use of vaginal applicators is possible. These small devices electrically stimulate the muscles in the perineum, strengthening them. There are developments in SCENAR-therapy aimed at improving metabolic processes and strengthening ligaments. You can do it.
Massage
Gynecological massage is often used. It helps to restore the normal position of organs, improve their blood supply, and eliminate discomfort. Usually, 10 to 15 massage sessions are performed, during which the doctor or nurse, with one hand inserted into the vagina, lifts the uterus, and with the other hand, circular massage movements are performed 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 hinder the function of neighboring organs, does not cause the patient troubles associated with an inadequate sexual life, is not accompanied by inflammatory and other complications.
Surgical intervention
How to treat III-IV degree prolapse of the uterus? If, despite all conservative treatment methods or due to the late treatment of the patient for medical help the uterus has gone beyond the vagina, the most effective method of treatment is prescribed - a surgical one. The purpose of the operation is to restore the normal structure of the genitals and correct the impaired functions of neighboring organs - urination, defecation.
The foundation surgical treatment- vaginopexy, that is, fixing the walls of the vagina. In case of urinary incontinence, the walls of the urethra are strengthened at the same time (urethropexy). If there is a weakness of the muscles of the perineum, they are plasticized (restored) with the strengthening of the neck, peritoneum, supporting muscles - colpoperineolevatoroplasty, in other words, suturing of the uterus during prolapse.
Depending on the required volume, the operation can be performed using a transvaginal access (through the vagina). This is, for example, the removal of the uterus, suturing of the vaginal walls (colporrhaphy), loop operations, sacrospinal fixation of the vagina or uterus, strengthening of the vagina with the help of special mesh implants.
With laparotomy (incision of the anterior abdominal wall), the operation for lowering 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 adhesions in the pelvis. Application may be limited due to lack of required equipment or qualified personnel.
Vaginal colpopexy (strengthening of the cervix by access through the vagina) can be performed under conduction, epidural, intravenous or endotracheal anesthesia, which expands its use in the elderly. This surgery uses a mesh-shaped 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 complication in the long-term period 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. Early activation of the patient is required in the field of surgery. Discharge is carried out 3-4 days after the intervention, outpatient rehabilitation lasts up to 6 weeks.
For 6 weeks after the operation, a woman should not lift weights more than 5 kg, she needs sexual rest. For 2 weeks after the intervention, physical rest is also necessary, then it is already possible to do light housework. The average period of temporary incapacity for work is 27 to 40 days.
What to do in the long term after the operation:
- do not lift weights more than 10 kg;
- normalize stools, avoid constipation;
- treat diseases in time respiratory tract accompanied by a cough;
- long-term use of suppositories with estrogens (Ovestin) as prescribed by a doctor;
- do not engage in some sports: cycling, rowing, weightlifting.
Features of the treatment of pathology in old age
Gynecological ring (pessary)
Treatment of prolapse of the uterus in old age is often difficult due to concomitant diseases. In addition, this disease is often present in an advanced stage. Therefore, doctors face significant difficulties. To improve the results of treatment, at the very first signs of pathology, a woman should consult a gynecologist at any age.
Therefore, a bandage will provide significant assistance to a woman in the prolapse of the uterus. It can also be used by younger patients. These are special supportive panties that tightly cover the abdominal area. They prevent uterine prolapse, support other pelvic organs, and reduce the severity of involuntary urination and lower abdominal pain. Finding a good bandage is not easy; a gynecologist should help with this.
A woman must definitely perform remedial gymnastics.
With significant prolapse, a surgical operation is performed, often this is the removal of the uterus through the vaginal access.
Consequences
If the disease is diagnosed in a woman of fertile age, she often has a question whether it is possible to become pregnant when the walls of the uterus descend. Yes, there are no special obstacles to conception in the early stages if the disease is asymptomatic. If the prolapse is significant, then before the planned pregnancy it is better to operate 1-2 years before conception.
Maintaining pregnancy with proven prolapse of the uterus is fraught with difficulties . Is it possible to carry 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 pregnancy to develop successfully, you need to constantly be monitored by a gynecologist, wear a bandage, use a pessary if necessary, engage in physiotherapy exercises, take medications prescribed by a doctor.
What threatens the prolapse of the uterus, in addition to possible problems with bearing a pregnancy:
- cystitis, pyelonephritis - infections of the urinary system;
- vesicocele - saccular expansion 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 rectal ampulla, 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 to a public place, because she is constantly forced to run to the toilet, change pads during incontinence, she is exhausted by constant pain and discomfort when walking, she does not feel healthy.
Prophylaxis
The prolapse of the walls of the uterus can be prevented in this way:
- to minimize long-term traumatic childbirth, if necessary, excluding the tiring period or performing a cesarean section;
- timely identify and treat diseases accompanied by increased pressure in the abdominal cavity, including chronic constipation;
- in the event of tears or dissection of the perineum during childbirth, carefully restore the integrity of all layers of the perineum;
- recommend to women with estrogen deficiency substitution hormone therapy, in particular, with menopause;
- prescribe special exercises for patients at risk of genital prolapse to strengthen the muscles that form the pelvic floor.
Prolapse of the uterus is a diagnosis that will not leave indifferent any woman. A very common disease among women in the age group from 35 to 60 years old, usually detected at later stages.
The main reason for 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, together with the vagina, falls out of the abdominal cavity, accompanied by minor discomfort.
Uterine prolapse can also occur in young nulliparous women who, while actively playing sports, abruptly stop exercising. There is a chronic weakening of connective tissue, ligaments, muscles, which leads to organ prolapse.
What it is?
Uterine prolapse is an incorrect position of the uterus, a displacement of its bottom, as well as a 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.
The pathology is accompanied by a number of characteristic symptoms: a feeling of pressure, a feeling of discomfort, the patients are worried about 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 organ prolapse.
Reasons for development
Weakness of the musculo-ligamentous apparatus of the uterus can be caused by a number of factors.
Some of the reasons leading to prolapse of the uterus include:
- surgical interventions on the organs of the reproductive system;
- age-related muscle weakening;
- disorders of the innervation of the pelvic floor muscles;
- 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;
- childbirth injuries;
- hormonal imbalance during menopause;
- neoplasms (cysts, fibroids, fibroids).
During childbirth, significant perineal tears (in particular, with breech presentation of the fetus) in some cases lead to serious muscle damage. Injuries can also be sustained 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 prolapse of the uterus. One of the predisposing factors may be a severe chronic cough, in which the muscles of the diaphragm are constantly tense.
Usually, a combination of two or more factors takes place in the development of the disease.
Symptoms
Among women of different ages prolapse of the uterus has quite noticeable symptoms:
- pulling pains, which often radiate to the lower back;
- squeezing in the pelvic area;
- constipation;
- frequent urge to urinate;
- a feeling of a foreign object in the vagina;
- Availability a large number mucus or blood. With large blood loss, anemia may develop;
- pathology of the menstrual cycle (soreness, violation of the frequency);
- the inability to live a sexual life due to pain during intercourse or the impossibility of their commission (in the later stages).
If the prolapse of the uterus is not diagnosed in time and treated, then the woman will experience an increase in dysuric pathologies, which will manifest itself as urinary incontinence or, conversely, difficulty in urinating. In turn, this will contribute to the risk of the appearance of infectious diseases of the urinary system, which include pyelonephritis, urethritis.
Stages
Depending on the degree of loss, 4 degrees of the disease are distinguished:
- Grade 1 is characterized by slight drooping of the organ in the vagina;
- 2 degree - displacement of the organ to the entrance to the vagina;
- Grade 3 is diagnosed after the protrusion of the uterine body outside the vagina;
- Grade 4 - when the uterus completely falls out of the peritoneum.
The girl is able to determine the symptoms of prolapse of the uterus at stages 2, 3 and 4 herself - it is enough to touch the tissues of the organ protruding from the vagina. Signs of prolapse of the uterus are often characterized by a change in the position of the bladder or even the rectum. A prolapse of the uterus is diagnosed by a gynecologist after childbirth, who, according to the stage of pathology, can prescribe either conservative therapy (bandage for prolapse of the uterus) or surgery.
Diagnostics
To establish a diagnosis, they collect complaints, study anamnesis and conduct a gynecological examination. A rectovaginal examination is mandatory. During the examination, the degree of prolapse, the presence or absence of rectocele and cystocele is established.
Each patient undergoes colposcopy. In addition, the following tests are prescribed:
- smear on the vaginal microflora;
- smear for cytology;
- determination of hormonal status;
- general and bacteriological urine tests.
It is also mandatory to conduct a gynecological ultrasound scan 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, kidney ultrasound if indicated. If a pathology is detected on a gynecological ultrasound, hysteroscopy with diagnostic curettage of the uterus is prescribed.
How is uterine prolapse treated?
The specialist prescribes treatment, having determined the degree of prolapse of the uterus. It depends on the extent to which the uterus has descended, 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 descends, a special set of exercises is performed, as well as massage. If the operation cannot be performed (there are contraindications), the doctor prescribes pessaries for 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.
Nowadays it is also very common to wear a bandage to keep the genitals in the correct position. Wearing a bandage while carrying a baby will prevent the organs from dropping. If the completed course of treatment has not brought any result, they switch to surgical treatment.
Exercises for lowering the uterus
A decrease in the tone and elasticity of the pelvic floor muscles creates conditions for a possible displacement of the genitals. A specially developed gymnastics for this muscle group allows you to prevent unwanted processes of prolapse of the uterus and other genitals, and in patients with prolapse of the uterus, it is included in the composition of therapeutic measures.
Therapeutic gymnastics during prolapse of the uterus is 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 consists in training the muscles surrounding the vagina, rectum and urethra (urethra) by a maximum contraction of 3 seconds and subsequent relaxation. To fulfill these therapeutic exercises you do not need to visit the gym or the room of physiotherapy exercises, they are performed in any position, they can be repeated in the shower or before 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 "lift", on which she rises to the very top and descends back. The ascent begins from the “basement floor” (complete relaxation), gradually the woman slightly strains the pelvic muscles, rises to the “first floor” and lingers for a couple of seconds in this position (stopping the elevator), then continues upward, stopping at each impromptu “floor” ... The higher you go, the stronger the muscle tension. On the fifth "floor" it reaches its maximum. The downward movement is accompanied by gradual muscle relaxation.
- Each Kegel exercise is repeated many times during the day, carrying out a total of 50 - 100 contractions per day.
From the entire set of exercises for each specific patient, several of the most suitable 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 remedial gymnastics for prolapse of the uterus includes strengthening the muscles of the abdominal press (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 exercise therapy according to the Yunusov method. It includes voluntary contractions of the pelvic muscles during the act of urination until the cessation of urine flow. In women with a predisposition to prolapse of the uterus, therapeutic gymnastics acts as an effective prevention, and in the presence of an initial stage of the process, it can become the only therapeutic measure.
Regular swimming, cycling, and measured physical activity can replace a significant amount of exercise.
Operation
This problem is often solved with surgery. This method has been used for a long time. But earlier, doctors performed abdominal operations. Surgical intervention was performed if the woman wanted to maintain fertility. Nowadays, the operation is performed laparoscopically. Already on the third day after the intervention, the woman is discharged. The recovery period lasts about a month.
No scars remain after laparoscopy. This negates the likelihood of adhesions. The operation has no 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 technology and the materials make it possible to leave the mesh inside the body.
At the same time, nothing threatens the woman's health. The material is elastic. During pregnancy, the mesh is simply stretched. The operation allows you to achieve good results in the shortest possible time. The woman does not need to train her muscles or use other methods of conservative therapy.
Relapses are excluded here. During the operation, the surgeon, if necessary, corrects the position of the intestines, bladder and vagina.