Symptoms of uterine prolapse, treatment methods, typesoperations, diagnosis

Update: October 2018

The list of gynecological diseases is very wide and far from
The last place in it is occupied by such a pathology as the prolapse of the uterus.
In principle, this wording is incorrect because it does not
displays the full depth of the disease.

The scientific name of the uterus prolapse is prolapse of the genitals.
Women are affected not only by menopausal age (see menopause
in women), but also quite young. The frequency of occurrence of pathology
grows with the increase in the number of years lived:

  • under 30 years old, genital prolapse is observed in 10%
  • at the age of 30 – 45 years old, prolapse is registered in 40%
  • at the age of 50 and older, pathology is found in
    every second woman

Genital prolapse – what is it?

Prevents the uterus, bladder, thin
intestine and rectum outside the abdominal cavity strong frame,
composed of muscles and connective tissue. Pelvic floor
or the pelvic diaphragm is represented by three layers of muscles that are not
only support the genital and others within the small pelvis, but also
provide closure of the genital slit, narrow the lumen of the rectum,
participate in maintaining intra-abdominal pressure and play
important role in the process of childbirth. In addition to pelvic floor support
the uterus carries the ligamentous apparatus (various bundles of the actual
uterus).

A drop in the uterus is indicated when she and her cervix are displaced and
are below the anatomical and physiological limits due to
which the genitals descend to the entrance to the vagina or fall behind her
the limits. Thus, genital prolapse is not caused by
only by the failure of the muscular layer of the pelvic floor, but also
stretching and / or damage to the uterine ligament.

What causes uterine prolapse?

From the above, it becomes clear that to prolapse genital
organs leads to impairment due to weakening or injury
pelvic day muscles and ligaments supporting the uterus. The omission of the walls
The uterus is caused by a variety of reasons, which can be divided into 4
groups:

  • traumatic injury to the pelvic floor;
  • the so-called “systemic” underdevelopment of connective tissue
    (presence of hernias of various localization, varicose disease, dysplasia
    joints, etc.);
  • impaired steroid hormone production;
  • extragenital diseases (metabolic disorders,
    microcirculation).

Childbirth

The main factor that leads to genital prolapse,
is a generic process. The more births available in
history of women, the more likely the development of the described pathology. But
prolapse of the uterus may develop after the first birth. It all depends on
how they proceeded. Protracted labor, especially long
period, anomalies of labor forces, childbirth in pelvic presentation or
imposition of obstetric plugs or the use of fetal vacuum extraction
ведет к травмам мышц pelvic floor. Also of great importance
heavy physical exertion, in particular constant elevation or
carrying weights. Even healthy women are not recommended lifting
heavy over 5 kg.

Woman’s age

Also important is the age of the woman, the older she gets, the
less tonus of the abdominal muscles, and of course, the pelvic floor, and besides
Moreover, in the pre- and menopausal period, the production of sexual
hormones that cause muscle tone and decreases
elasticity of connective tissue (see how to get rid of hot flashes
with menopause).

Injuries and surgical interventions

Operations, injuries in the perineum and vagina can cause
damage to the small arteries, veins and nerves that interfere with nutrition
pelvic floor muscles, and hence its supporting function.
Gynecological surgery, specifically the removal of the uterus leads to
violation of the anatomical interposition of organs in the pelvis,
which provokes further prolapse of the genitals.

Constipation

Besides, постоянные запоры и кашель способствуют
increase intra-abdominal pressure, resulting in organs
are in the pelvis squeezed out, that is, in
vagina.

Obesity, hormonal disorders

Plays a role in uterine prolapse and obesity, both due to hormonal
disorders, and due to lack of muscle tone.

Genetic location

Genetic predisposition, that is, “systemic”
connective tissue underdevelopment, also takes place at this
pathology. So, in Spaniards and Asians or in women with burdened
heredity for connective tissue diseases
(astigmatism, mitral valve prolapse, etc.), omission
genitalia is much more common.

TOак правило, в развитии заболевания играет роль воздействие
several factors. TOогда нарушается состоятельность тазового дна,
and the supporting ligaments are stretched, the uterus by increasing
intra-abdominal pressure is pushed into the vagina, in parallel
there is a prolapse of the anterior vaginal wall along with urinary
the bubble, which is called the cystocele and the back wall along with
rectum (rectocele). Besides, наполнение мочевика и/или
ampoules rectum increases pressure in them that intensifies
prolapse of the vagina and uterus. Thus, a closed
a circle.

TOлассификация опущения матки

It should be noted that the omission, and the following loss
the uterus always goes “hand in hand” with the omission of the vagina. Allot
following uterine prolapse rates:

  • the first degree is said when the cervix reaches the middle
    vagina or above;
  • second degree is characterized by cervical dislocation and
    vaginal walls to the threshold of the vagina;
  • in the third degree, the cervix and vaginal walls are located
    outside the vagina, and the uterus itself is localized in
    vagina;
  • if the uterus is located outside the vagina, talk about
    fourth degree or about complete prolapse of the uterus.

TOак проявляется пролапс гениталий?

It should be noted that the uterus prolapse is progressive.
disease, only in some cases it happens slowly, and in
others very quickly. Even the initial signs of genital prolapse
sooner or later lead to prolapse of the uterus, if not to do
treatment in a timely manner.

Discomfort, pain

The initial stages of genital prolapse are characterized by
the occurrence of discomfort and pulling pain in the lower abdomen,
smacking around the lower back and / or the sacrum that most
patients go unnoticed and regarded as signs
future menstruation. When the uterus is dropping, these symptoms increase
noted after physical work and lifting heavy, during
hiking Later, discomfort or even
pain in minutes of coitus, sex does not bring the same pleasure, but in
further becomes impossible at all.

Foreign body sensation

Besides, женщина может отмечать «что-то лишнее, мешающиеся во
vagina, such as a foreign body. Whites appear, also possible
bleeding caused by mechanical injury
vaginal walls, cervix and uterus. The patient can independently
palpate the cervix or even the uterus in the genital region
(at loss).

Menstrual disorders

There is a violation and menstrual function (see reasons
menstrual irregularities). Menstruation becomes profuse and
long, and sometimes develops algomenorrhea. Not исключается при
prolapse of the genitals development of infertility, although the pregnancy itself
also not excluded.

Urological disorders

When the anterior wall of the vagina and uterus descends, it often develops
cystocele. This pathology provokes the development of urological
disorders Marked by:

  • difficulty urinating
  • the bladder does not empty completely
  • urine stagnates in it, is patched by pathogens
    microorganisms, which leads to infection of the lower and upper
    urinary tract
  • long current prolapse of genitals contributes to the development
    ureteral stenosis, hydroureter and hydronephrosis
  • often when the uterus is omitted, a symptom such as
    stress urinary incontinence (i.e., coughing, sneezing
    or laugh, see urinary incontinence treatment in women).

Rectum prolapse

If the posterior wall of the vagina and uterus descends, then often
rectocele (prolapse of the rectum) develops. Arise
proctological problems: persistent constipation
the parties are the result of the disease and on the other hand
провоцируют прогрессирование omission of the genitals. Celebrated
inability to keep gases and feces, often develop colitis (see
symptoms of intestinal colitis).

Varicose veins of the lower extremities

As the disease progresses, manifestations increase
varicose veins of the lower extremities. First, it is due to
impaired venous outflow due to a change in the location of organs in
pelvis, on the other hand, due to failure
connective tissue.

Ulcers of the cervix and vagina

The mucosa of the uterus and vagina when prolapse becomes shiny,
cracks and bruises due to constant injury
and drying out. As a result, on the cervix or vaginal walls
ulcers are formed that bleed and become infected. Such
ulceration is very difficult to treat.

Пример из практики: У меня на учете в женской
Consultation consisted of a woman of very advanced age – 80 years.
The diagnosis was: Full prolapse of the uterus and vagina.
Notсостоятельность мышц pelvic floor. Notдержание мочи при
tension. In the patient, the uterus was constantly beyond the bounds.
sex gap, but she refused to wear pessaries, and by age and
the operation was contraindicated to her. Naturally, she periodically
It was treated in gynecology for cervical trophic ulcers.
She was prescribed ointment with levomekol, solkoserilom, Actovegin.
She was treated every time for a long time and was not even discharged with
recovery, and improvement. But, слава Богу, до отека и пролежней
it did not work. And so the woman suffered to the end of her life.
From the anamnesis it is known that there were 4 births, all my life I was engaged
hard work, plus the post-war time, when men were on weight
gold – all these factors could not lead to prolapse of the genitals.
Indeed, at a time when the patient was still quite young and healthy
woman given operations were rare and were considered
luxury.

Diagnostics

To establish the diagnosis produce a collection of complaints, study history
and conduct a gynecological examination. Without fail
rectovaginal examination is performed. During the inspection
establish the degree of prolapse, the presence or absence of rectocele
and cystocele. Colposcopy is performed for each patient. Besides,
The following tests are assigned:

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

It is also necessary to conduct a gynecological ultrasound with vaginal
sensor (in the presence of pathological changes of the pelvic organs
the question of their removal is being addressed). Excretory urography appointed
in the presence of cystocele, renal ultrasound according to indications. Upon detection
pathology on gynecological ultrasound is assigned to hysteroscopy with
diagnostic curettage of the uterus (on condition after
hysteroscopy).

Treatment

When the uterus is omitted, treatment can have 2 directions:
conservative and operational. To decide on treatment tactics
Genital prolapse The doctor assesses a number of factors:

  • age of the patient;
  • the degree of prolapse;
  • concomitant pathology;
  • degree of risk as anesthetic, and
    surgical;
  • is it necessary and possible to preserve the menstrual, reproductive
    functions;
  • the degree of dysfunction of the large intestine and
    sphincter of the rectum.

What to do with the omission of the uterus? Just want to make a reservation.
Uterus prolapse must be treated. Conservative treatments are not
very effective, and they are used only in the early stages
diseases (genital prolapse 1 – 2 degrees).

Physiotherapy

Physical therapy classes rather preventive measure
uterine prolapse than curative. And, nevertheless, in the initial stages
diseases appointed therapeutic exercises at Atarbekov and
Yunusov. Kegel exercises for lowering the uterus are also not lost.
its relevance and aimed at maintaining muscle tension
pelvic floor.

Bandage

Such a device as a bandage, with the omission of the uterus, too
used, only in the initial stages of the disease. Design
the brace is such that it “surrounds” the hips and crotch,
so that the uterus is in the right position, and the pain and
discomfort associated with prolapse of the genitals disappear. But also wearing
the bandage is only a palliative measure, not a medical one. Although his
wearing indispensable after giving birth to regain muscle elasticity
pelvic floor, as well as after surgical plasty about
omission of the genitals.

Use of pessaries

Vaginal pessaries are recommended for patients with a 3–4 degree
diseases that for some reason are contraindicated surgical
treatment. Wearing pessaries (polyvinyl chloride rings) can
for a long time, a single course is 1 month, after which
need a break. The ring is installed and removed only
to doctors. Once every 3 to 7 days, a pessary change from aseptic is necessary.
processing the latter. Vaginal rings are also not
medical measure, they only keep the uterus within the pelvis. TO
cons pessaries applies stretching the vagina, which exacerbates
omission

Surgical treatment

But a radical measure in the omission of the uterus is an operation. Not
there is an “ideal operation” in this pathology. Any
surgery has its pros and cons. All kinds
surgical intervention are divided into several groups:

  • operations that aim to strengthen the muscles of the pelvic floor –
    colpoperineolevatoroplasty (this is usually the vaginal stage
    two-stage operation);
  • surgery on the ligaments of the uterus (shortening and filing round
    ligaments to the anterior wall of the uterus);
  • surgical strengthening of uterine ligaments
    (cardinal, sacro-uterine) – the operation violates the genital
    patient function;
  • rigid fixation of the uterus and vagina to the pelvic walls (hemming to
    to the pubic joint, the sacral bone, and others);
  • surgeries using allo-implants (endoprostheses);
  • surgeries that partially constrict the vagina;
  • extirpation of the uterus (if there are additional indications).

Surgical intervention can be performed through the vaginal
access, by laparoscopy or laparoscopically, simultaneously or at
several stages. Remain high percentage of uterine prolapse
(reaches 30%). In the postoperative period, it is important to adhere to
doctor’s recommendations:

  • restriction of carrying weights (no more than 5 kg) for 1.5
    months;
  • sexual rest for 6 weeks;
  • ban on physical activity for 2 weeks, then
    slight exercise is permitted.

In the subsequent should monitor the work of the intestine, in time
empty the bladder, timely treat diseases
bronchopulmonary system, avoid carrying weights and engage
certain sports (cycling, rowing).

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