Diet after surgery for uterine prolapse. Prolapse and prolapse of the uterus. Reasons for the development of vaginal prolapse after removal of the uterus and why a “healthy” but prolapsed uterus does not need to be removed

The uterus is the main reproductive organ of a woman, the normal functioning of which makes it possible to conceive and bear a child without problems. Therefore, upon learning that the uterus has undergone prolapse or displacement, all patients immediately have many questions. How is the pathology treated? What to do if the doctor prescribes surgery? What types of surgery are there, and which one is less traumatic?

In general, there are quite a lot of questions and, therefore, in order to understand them in as much detail as possible, we decided to ask them to an obstetrician-gynecologist of the highest category, a doctor with more than 10 years of experience, Elena Sergeevna Avramenko.

Elena Sergeevna, please tell me how to understand that you really can’t do without the help of a surgeon? Maybe there is a way to deal with the pathology in a less safe way?

It is indeed possible to treat uterine prolapse without the use of surgery. If at the time of contacting the clinic the anatomical changes in the organ are very minor, you can return the organ to its place with the help of strengthening exercises, hormone therapy, yoga, as well as by wearing a vaginal ring and a special bandage.

But, if upon examination it turns out that the pathology has a more advanced stage, which is characterized by the descent of the uterus into the vaginal canal or its partial prolapse, then surgery for uterine prolapse of this degree is the only correct solution.

The clinics offer several types of surgeries. Which one to choose?

There are quite a few methods in gynecology. However, modern medicine today uses only a few of them. The following types of surgery are considered the most effective and less traumatic:

Lightweight laparoscopic promontofixation.
Mesh sacrovaginopexy.
Plication of the uterosacral ligaments.

The choice of a specific type of operation depends on many indicators. Which surgical method to resort to is determined based on:

neglect of the pathological process;
the presence of symptoms that appear in a woman against the background of the disease;
the general well-being of the patient and her state of health;
individual characteristics of the placement of the pelvic organs;
existing contraindications that may cause complications during surgery;
the surgeon's experience in performing a particular operation.

It is very important that the surgeon who is to perform the manipulations masters all available operating methods. This way, you can choose for a woman exactly the intervention option that will be most effective for a particular case of prolapse.

Correction of uterine pathology should only be carried out by an experienced surgeon who knows all the nuances and complexities of the procedure, and also bears personal responsibility for the health and life of his patient.

What are the features of facilitated laparoscopic promontofixation? Is she dangerous?

This type of surgery is the safest and is most often used for patients of reproductive age. Laparoscopic promontofixation was developed back in 1997 and is still considered the most effective method of treating uterine prolapse.

To carry it out, a special device is used that does not require large surgical incisions, as happens with other operating methods. The procedure is carried out through small holes (from 1 to 1.5 mm), after which most often there are no scars left.

Methods for treating uterine prolapse using folk remedies: baths or herbal decoctions are described.

To carry out promontofixation, a special bioinert mesh is used, which is introduced into the vagina and fixed above its dome using the laparoscopic method. A similar implant is installed in order to strengthen the weakened ligamentous apparatus of the uterus.

The advantage of this method is that during lightweight promontofixation, several procedures can be performed at once. For example, if, due to prolapse of the uterus, displacement of the pelvic organs has occurred, then through simultaneous surgery this pathological change can be corrected.

In addition, the method allows for the implantation of urethral slings, which is necessary to restore normal functioning of the urethra, because, as is known, uterine prolapse is a common cause of urinary incontinence. Also, during the operation, it is possible to eliminate the eversion of the cervical canal (if any), for which they resort to special plastic surgery. Such plastic surgery of the cervix during prolapse is necessary to prevent further prolapse of the organ.

Elena Sergeevna, in your experience, what are the contraindications for mesh sacrovaginopexy?

This type of surgery is performed by fixing the vaginal dome, walls (if necessary), uterus and cervix to the convex area of the sacrum in the pelvic region. This kind of suturing stops further descent of the organ, which helps stop the progression of the disease.

A special endoprosthesis made of polyvinyl chloride mesh is used as a fixing implant. It allows you to reliably hook the uterus to the sacral promontory in the desired anatomical position. Thanks to such manipulation, the likelihood of uterine prolapse remains minimal.

However, after such treatment of uterine pathology, the patient needs long-term rehabilitation, so there is a risk of bedsores. In addition, mesh sacrovaginopexy has a number of contraindications, in the presence of which it is strictly prohibited to perform it, among them we most often encountered:

blood clotting disorders;
diseases of systems and organs that are in the stage of decompensation;
acute inflammation of the genital organs;
oncology of the genitourinary system;
venereal diseases.

Also, the use of this procedure is not advisable if a woman has infectious processes.

Tell me, is it worth performing fusion of the uterosacral ligaments?

Yes, but only if the prolapse of the uterus occurred due to a weak supporting apparatus of the vaginal vault.

This surgical procedure is performed by shortening and tightening the uterosacral ligaments, as well as their further fixation in the area of the cervical stump and vaginal dome.

A special aponeurotic flap is used to secure the ligaments. This kind of manipulation is performed regardless of the patient’s age. The use of this technique is allowed in combination with other types of surgical elimination of uterine prolapse.

Pleation of the uterosacral ligaments allows partial correction of the anatomical position of the vagina and uterus. In addition, the procedure restores reproductive function.

How long will it take a woman to recover after surgery and what should be taken into account? After all, it is usually the severity of recovery that is the most common reason for refusing surgical intervention.

The duration of the rehabilitation period most often depends on the woman herself. I usually observed that it goes away quite quickly and, as a rule, without complications.

If all the instructions of the surgeon and attending physician are followed, patients return to their normal lives within a week. In another five days we are discharged home.

If sacrofixation was performed to eliminate prolapse, in which the uterus is fixed to the walls of the pelvis, then rehabilitation lasts about two weeks. During this period, the woman is prescribed mandatory antibiotics in order to reduce the risk of infection, and a special diet is recommended. The diet should consist of liquid dishes, which is necessary to prevent constipation. Any kind of load is prohibited.

Is it possible to have sex when the uterus prolapses and will sex life worsen prolapse - read.

There have been cases in my practice where repeated prolapse of the uterus occurred after surgery, which was caused by non-compliance with the ban on physical activity. This, of course, significantly extended the recovery period, since it was necessary to resort to repeating the surgical procedure.

After any kind of surgery for prolapse, you can return to intimate life no earlier than after 6 weeks.

How much does the surgery cost and do prices vary depending on the degree of uterine prolapse?

The specific amount of any surgical intervention can be announced only after a full diagnosis and consultation. The cost of surgery for uterine prolapse depends on the chosen procedure method, its duration, the condition of the woman’s body tissues and the characteristics of the development of the disease.

It is also necessary to take into account that the price will usually include all pre- and post-operative treatment costs.

It consists of exercises that strengthen the vaginal muscles, as well as therapeutic exercises to restore muscle tone. A great contribution to solving this problem was made by the American specialist Arnold Kegel, who developed a series of exercises to strengthen the intimate muscles and restore the correct position of the uterus. Sometimes the use of such exercises can avoid the need for surgical treatment. Kegel exercises for uterine prolapse:

Exercise I: while in the toilet, try to hold back the urination process that has begun for a couple of seconds, squeezing the urinary sphincter with your internal muscles. Then continue urinating, trying to tense your muscles in such a way as to squeeze everything out of the bladder without a trace.
Exercise II: lie on your back, hands at your sides. Raise your legs at ∟45° and imitate a bicycle race.
Exercise III: sit on a stool, while inhaling, use your muscles to bring your buttocks closer to one another. Hold this way for a couple of seconds and, exhaling, relax. Repeat this several times.
IV exercise: squat down. Your task is to lift your pelvis up from this position and fix the position for a few seconds, then return to the starting position.
Exercise V: get on your knees, placing them slightly wider than shoulder width. Try to tilt your body forward, touching your forehead to the floor surface. At this time, your hands rest on the floor. Hold the position for a few minutes.
Exercise VI: perform a series of controlled contractions of the muscles of the perineum and anus, alternately tensing and relaxing the muscles.

Gymnastics for uterine prolapse should be carried out regularly, at least 4-5 times a day. Such exercises are hardly noticeable to the eyes of others, so they can be performed almost anywhere. The key to successful treatment will be your discipline and regularity of classes. Depending on the degree of pathology, treatment with exercises can last for months or even years, so you will also need a lot of patience, which will undoubtedly lead to recovery.

Exercises during uterine prolapse can be supplemented with a number of generally accepted strengthening activities:

lying on your back, place a pillow under the buttock area. Raise the straight leg to ∟90° and lower it. Raise the other leg. Repeat up to 10 times.
raise straight legs at the same time.
perform scissor movements for a minute.
perform “bicycle” movements.
We alternately move our legs to the sides at ∟45°.
We try, sitting on the floor with straight legs, to touch our toes with our fingers.
perform the “birch tree” exercise for a minute.
perform the “swallow” exercise, fixing the position as much as possible.

It is better to do classes on an empty stomach. It is better to start with a small number of movements, gradually increasing the load. The effectiveness of such activities usually appears after 1-10 months.

Gynecological massage for uterine prolapse

Massage for uterine prolapse is aimed at eliminating pain, improving blood circulation in the pelvic organs, increasing muscle tone and eliminating the pathological position of the uterus.

From practice, when treating prolapse, vaginal, vibration and segmental reflex types of massage are used.

Massage is not recommended for inflammatory diseases of the reproductive organs, for tumors of the uterus and appendages, for tuberculous lesions of the genital area and peritoneum, for purulent processes in the pelvic organs, for cervical erosion, urethritis and trichomonas colpitis.

Massage should be performed by an experienced specialist or a specially trained nurse using sterile rubber gloves. The procedure is performed in a gynecological chair or on a high couch.

The massage therapist inserts the index and middle finger of the dominant hand into the posterior fornix of the patient’s vagina. With the same fingers, the specialist lifts the body of the uterus and supports it. The other hand is placed on the stomach: it massages the anterior abdominal wall, with a gradual deepening to the pelvic organs, to the ligamentous apparatus of the uterus and its surrounding tissues.

The uterus is displaced up to 6 times per procedure every 10-15 seconds. The duration of the first three massage sessions should be no more than 4 minutes, all subsequent sessions up to seven minutes. Treatment includes 12-15 sessions, every day or every other day.

Surgery for uterine prolapse

The most effective radical method in the treatment of prolapse is considered to be surgical intervention. The indication for it is the lack of effectiveness of conservative treatment and a pronounced degree of disruption of the location of the uterus.

Modern specialist gynecological surgeons offer various types of operations that can correct and secure the correct location of the organ:

plastic surgery involves strengthening the muscles and ligaments of the pelvic area. Such operations include colpoperineolevatoroplasty and plastic surgery of the anterior vaginal wall. These methods can be used as the main or accompanying types of surgical intervention;
an operation to shorten and strengthen the retaining ligaments and fix them to the walls of the organ. This operation has not proven itself sufficiently in surgery due to the high percentage of recurrence;
surgery to sew ligaments together. Such operations do not always make it possible to have children in the future;
an operation in which displaced organs are fixed to the bones and ligaments of the pelvic area;
surgery using alloplasty to strengthen the ligament system and securely fix the uterus. Such an operation also does not guarantee further recurrence of the disease, as well as rejection of the materials used;
Laparoscopy for uterine prolapse is perhaps the most common gentle operation, allowing the intervention to be performed with minimal tissue trauma. During laparoscopy, suturing of the ligaments that support the uterus is used, and artificial materials are also used to stabilize the position of the organ. The operation lasts about 2 hours, under general anesthesia. After a week, the doctor removes the stitches and recommends further conservative treatment. Since laparoscopy surgery is minimally invasive, the patient can be discharged home within a few days;
removal of the uterus during prolapse (extirpation) is carried out when a woman does not need to preserve reproductive function. Often, a laparoscopic apparatus is also used to perform such an operation. This makes the postoperative period more comfortable and shorter. Extirpation can be performed while preserving the cervix, which is more welcomed by women themselves.

If surgical treatment is performed correctly and the doctor’s recommendations are followed in the postoperative period, uterine prolapse does not recur. As a rule, after surgery you should lead a gentle lifestyle for 7-10 days. Sitting during this period is not recommended, but walking and simple physical exercises will be welcome. After organ-conserving surgery, it is recommended to practice the exercises outlined above to strengthen the muscular system of the pelvic region. They activate blood flow, improve tissue trophism and speed up recovery.

To ensure that the period after surgery proceeds faster and does not cause complications, experts advise adhering to the following recommendations:

during the first week after surgery, treat the perineal area with an antiseptic solution;
You may need to undergo a course of prophylactic antibiotic therapy;
for two weeks it is forbidden to sit in a sitting position so as not to strain the operated muscles;
during the week, food should be exclusively liquid or semi-liquid food to avoid constipation;
active sports can be carried out no earlier than in a month;
Sexual life after surgery is possible only after 5 weeks.

The cost of surgery for uterine prolapse can depend on many factors and ranges from $1,000 to $3,000.

Possible consequences after uterine prolapse surgery that you need to be prepared for:

development of bleeding (damage to vascular bundles);
perforated injuries of the pelvic organs;
the late postoperative period may be complicated by erosion of the vaginal mucosa and infection.

Difficulties most often occur in patients who began to practice sexual intercourse in the postoperative period.

Almost all complications may require additional operations and a complex treatment regimen.

Yoga for uterine prolapse

The poses presented in yoga help strengthen the ligamentous-muscular system of the pelvic area. This can be an excellent prevention and treatment for uterine prolapse. Yoga adherents recommend the use of the following poses:

Namaste position, in a vertical position, the feet are pulled towards each other and relaxed, we tilt our head slightly forward, and we also move the pelvis with the lower part forward. Let's breathe deeply;
We put the lower limb as far as possible to the side (for women - to the left, for men - to the right), place the feet parallel, knees - straight. We spread the upper limbs to the sides at shoulder level (for men - with palms down, for women - up) and stretch them out. We hold our breath as we inhale and relax;
On a full exhalation, bend your knees and, squatting slightly, spread your lower limbs as wide as possible. Keep your back upright, keep your pelvis straight. We also bend our arms, placing our palms on the sides of the hips below the waist. We keep our fingers together and point them forward;
being in the same position, while inhaling, we move the extended limbs upward from the sides, connecting our palms. We hold our breath, stretch our arms up and relax;
Without changing posture, we straighten our knees and tilt our straight back and outstretched arms (palms together) forward parallel to the floor surface. The head may be slightly raised, looking forward. We relax in this position;
in the same position, as you exhale, bend forward and take your feet with your palms. Knees straight, feet parallel, head free.

It is recommended to practice yoga under the supervision of a specialist, especially for beginners. To achieve a therapeutic effect, exercises must be performed correctly, and this is difficult to achieve on your own. Moreover, a yoga specialist will not only point out your mistakes, but will also demonstrate a number of additional effective positions.

Bandage for uterine prolapse

One of the most comfortable methods of rehabilitation for uterine prolapse is the use of a bandage. The bandage system will help keep the uterus in its natural position. This method is certainly effective, and in addition, its use will not require unnecessary effort from the patient. The only note: you cannot use the bandage permanently, this is only a temporary measure.

The bandage serves as a passive option designed to temporarily maintain the normal anatomical position of the uterus.

The bandage grips the thighs and perineum, holding the uterine organ from almost all sides. It is attached with adhesive clips, which allows you to quickly remove the structure when performing natural needs.
The bandage system is used no more than 10-12 hours a day due to its direct pressure on the internal organs. After removing the bandage, you need to lie down to consolidate the effect of its impact.
Modern designs of bandages allow you to safely put on outerwear without revealing the presence of the system.

However, do not rush to buy and use a bandage yourself when the uterus prolapses. Consult your doctor; only he can determine the effectiveness of such treatment in your particular case.

Underwear for uterine prolapse

The use of special underwear can have an effect in the early stages of the pathology, or in the pre- and postoperative period. When the uterus prolapses, compression panties should be worn as often as possible in order to consolidate the results of gymnastic exercises or yoga.

Special panties are a fairly durable product with a high waist, made of thin and elastic synthetic fabric, tested for safety for the human body.

The design features of the underwear do not at all resemble a bandage system: they take into account all the anatomical characteristics of the woman’s body. The underwear is worn directly on the body; it can be no more noticeable under clothing than ordinary everyday underwear. When wearing such underwear, possible discomfort is minimized: the size and shape are selected individually.

The purpose of such underwear is to maintain the required level of intra-abdominal pressure. This, in turn, limits changes in the position of the organ and fixes its localization.

When using underwear, uncomfortable and painful sensations are reduced, and the effect of exercise therapy and gymnastics is enhanced. To prevent complications or relapses, it is recommended to wear underwear during the postoperative period.

Mesh for uterine prolapse

The installation of a lightweight polypropylene mesh endoprosthesis is used quite actively for reconstruction of the pelvic area. The mesh, according to reviews, copes excellently with the problems of prolapse, provided that the quality of the prosthesis itself is acceptable.

An endoprosthesis for uterine prolapse is installed during laparoscopic and abdominal surgical interventions. With its help, new muscle nodes are created to secure the uterus to the skeletal system. Thanks to the endoprosthesis, the uterus is fixed in its natural place: this protects the organ from even minor changes in position.

Contraindications to the use of mesh include infectious inflammatory processes in the abdominal cavity.

The mesh contains a combination of polypropylene and polyvinylidene fluoride monofilaments and is equipped with a special fixing suture material.

Ring for prolapse of the uterus

Pessaries are a polyvinyl chloride thermoplastic ring used for prolapse of the uterus. The ring is used both as a therapeutic measure for prolapse and prolapse, and as a prevention of miscarriage during pregnancy.

Rings are produced in various diameters from 5 to 11 cm. When the ring is installed in the body, the material from which it is made, under the influence of the temperature of the human body, acquires plasticity and follows the contours of the necessary organ.

Pessaries for uterine prolapse can only be installed by a doctor or a suitably qualified nurse. You cannot insert or remove pessaries yourself, so as not to provoke the development of ulcerative and inflammatory processes in the mucosa.

The ring can be used repeatedly, but a single course of wearing it should not exceed one month, after which a break is taken. The exact period of use, as well as the diameter of the pessary, is determined by the doctor.

Simultaneously with the use of the ring, other therapy options must be used to help strengthen the muscles of the pelvic region and uterine ligaments. The use of the pessary is stopped when the prolapse is no longer dangerous.

Herbs for uterine prolapse

The use of prescription methods in folk medicine for uterine prolapse is usually combined with gymnastic exercises or yoga classes. This comprehensive approach can effectively increase muscle tone and relieve pain.

The use of Datura is due to the content of tropane alkaloids in the plant: hyoscyamine, atropine and scopolamine. For 25 g of dry plant material, take up to 10 liters of clean water and boil for about ten minutes. The resulting decoction must be left for 45 minutes and filtered. The medicine is used for sitz baths, washing and douching. The bath can be taken for up to 15 minutes at temperatures up to 38°C. The course of baths or douching is 10 days, then, after a 7-day break, the treatment should be repeated.
The use of oak bark, known for its astringent, anti-inflammatory and anti-putrefactive properties, is practiced for douching. Take 35 g of dry bark and cook over low heat in 1 liter of water for up to 2 hours. Cool and syringe daily for a month. A full course of therapy includes the use of one and a half kilograms of bark.
The use of quince for the diagnosis of uterine prolapse is possible due to the enveloping and anti-inflammatory properties of the plant. Boil one part of crushed quince fruits and ten parts of water for about 20 minutes, cool and filter. This decoction is used as an enema procedure and douching.
The use of lemon balm can relieve inflammation and pain. Full 2 tbsp. spoons of raw materials are poured into a thermos and poured 0.5 liters of boiling water overnight. The infusion is consumed orally, half a cup, on an empty stomach before meals.
The use of alcohol tincture of elecampane must be done on an empty stomach in the morning, according to Art. spoon. To make the medicine, take the dried root of elecampane in the amount of one tbsp. spoons per bottle of vodka. Insist for 10 days in the dark.

When treating uterine prolapse, one should not limit oneself to the use of traditional methods. Consult a good specialist and carry out combined treatment for the disease.

Some people believe in the power of all kinds of conspiracies and whispers. What does traditional medicine say about this?

Spell for uterine prolapse

It is necessary to make a ten-minute decoction of nettle roots. And before the medicine is cooked, you should read the spell words over it:

Where on earth is your place?
Where the Lord God said!
Uterus, where is your place?
Where the Lord God gave!

After this, the sick woman drinks the medicine received in the evening before sunset (in no case in the morning or on a rainy day).

Drug treatment of uterine prolapse

One of the main causes of the disease during menopause is considered to be a deficiency of estrogen hormones in the body. In this case, drug treatment of uterine prolapse is used only in the initial stages of the disease. It involves the use of estrogen-containing (hormonal) drugs. Ointments or creams containing hormonal substances may also be prescribed. They are inserted into the vagina using tampons or other means.

Suppositories for uterine prolapse can replace the oral use of estrogen drugs. For example, quite often experts prescribe Ovestin vaginal suppositories.

Recently, Chinese Beautyful Life tampons have gained popularity. You can try using such tampons, however, as practice shows, their use is, rather, not therapeutic, but rather preventive.

Tampons for uterine prolapse

Tampons are made in Hong Kong and consist of several dozen natural ingredients from China. They do not include chemicals or toxic substances, therefore, as the manufacturer indicates, they are free of side effects.

Main properties of Beautyful Life tampons:

antibacterial, antimalignant;
hemostatic, analgesic;
strengthening, anti-inflammatory;
antipyretic, cleansing;
sedative, activating microcirculation;
antipruritic.

The manufacturer promises a visible effect after using only 3 tampons. Each tampon is inserted into the vagina for three days, after which it is removed. A day after its removal, the next tampon can be inserted.

Treatment is not carried out for people prone to allergies, as well as a week before menstruation, during menstruation and within three days after the end of discharge.

Treatment duration is at least 1 package (6 pieces). You should not have sex while using tampons.

Exercise equipment for uterine prolapse

As you have already seen, there are many known methods for strengthening the muscles of the pelvic area. However, there is another fairly common way - using vaginal simulators. These are special designs to achieve maximum success in quickly strengthening the muscular corset of the uterus. Unfortunately, the use of such simulators is limited to degree I or II prolapse. In advanced stages, the use of devices may not only not help, but also aggravate the situation.

Exercise classes are held up to 3 times a week, the duration of a single lesson is 15 minutes.

The simulators have passed all the necessary tests, and their manufacturer is absolutely confident in the safety of their use and the positive dynamics of treatment. Exercise machines are available in the form of expanders, weight training machines or muscle stimulators. They not only strengthen the necessary muscles, but also increase the sensitivity of the genital area, improve blood supply to tissues, and relieve pain.

Due to the versatility of the effects of simulators, their use should be carried out only after consulting a doctor.

Content

The pelvic organs are held in a normal state by muscles, ligaments and fascia. But in some patients the supporting apparatus begins to weaken and the uterus descends. If its normal location is disturbed, problems arise with the functioning of the reproductive, urinary system and intestinal function.

Features of the pathology

Prolapse is most often encountered by women over 50 years of age, but according to statistics, about 10% of patients are under 40 years of age. Therefore, every woman needs to know what uterine prolapse is, how it manifests itself, and how to recognize it.

Gynecologists distinguish 4 stages of prolapse.

The entrance to the vagina opens slightly, its walls sag slightly. The cervix may move up to the middle of the vaginal canal.
The uterus descends almost to the genital slit; when straining, it may appear outward.
The walls of the vaginal canal and the uterus are partially lowered below the genital slit; the organ itself is located in the vagina.
The uterus falls out completely.

Depending on the identified stage, the choice of treatment tactics will be decided. The doctor may recommend the use of conservative therapy methods, suturing or removal of the main reproductive organ.

Characteristic symptoms

Even at the first stage of prolapse, women show signs. Ignoring them can lead to aggravation of the situation.

Symptoms:

pain, discomfort in the lower abdomen, lower back, sacrum, which intensifies after physical activity;
feeling of a foreign object in the vagina;
the appearance of profuse leucorrhoea, bloody discharge;
increased duration and abundance of menstruation, increased pain;
the appearance of urological disorders;
prolapse of the intestines, which causes constipation; over time, the woman cannot hold in gases and feces;
increased signs of varicose veins in the legs.

If you notice even some of the above symptoms, you should consult your doctor. Ignoring the signs will only worsen the condition. If at first it will be possible to cope with the help of conservative therapy methods, then as the prolapse progresses, surgery will be required.

Choice of treatment tactics

If unpleasant symptoms appear, you should not delay your visit to the doctor. Indeed, in the initial stages, suturing or removal of the uterus during prolapse is not necessary. You can normalize the position of the reproductive organ with the help of:

physical therapy;
hormone therapy;
using a pessary;
wearing a bandage.

If the anatomical changes are significant That is, then the situation can be corrected by suturing or removing the uterus. Surgery is necessary when this organ has already descended into the vaginal canal or has partially fallen out. The recovery method depends on the condition.

suturing the uterus to the symphysis pubis, sacrum, pelvic ligaments;
vaginal plastic surgery (colporrhaphy);
laparoscopic surgery, in which the uterus is sutured and fixed;
removal of the uterus (hysterectomy).

When the uterus prolapses, the gynecologist selects the treatment tactics.

Conservative methods

If you regularly visit a gynecologist, prolapse can be detected in the early stages during a routine gynecological examination. If necessary, doctors recommend lifestyle changes to patients with this diagnosis:

get rid of excess weight;
prevent constipation;
reduce the level of physical activity (if it is intense).

Patients who often suffer from respiratory diseases accompanied by coughing should spend more time preventing their occurrence. Indeed, in all the described conditions, intraperitoneal pressure increases. As it increases, the likelihood of damage to the ligaments that hold the uterus in its normal position increases.

Particular importance is given to gymnastics. When training the pelvic floor muscles, the tension of the ligaments increases. The likelihood of uterine prolapse is minimized.

With noticeable prolapse, not all women agree to have the uterus sutured or removed. If surgery is contraindicated for the patient, she may be offered to use pessaries, which are inserted into the vagina and hold the uterus in the desired position. Also, in advanced forms of prolapse, the use of bandages may be recommended. They fix the pelvic muscles so that the uterus cannot fall below the genital slit.

Surgical treatment

The doctor must decide how exactly the uterus will be sutured, because the woman is not able to assess the severity of the pathology and the effectiveness of various treatment methods.

Laparoscopy

The least traumatic and most effective is laparoscopic surgery, during which the uterus is sutured.

The doctor makes three punctures in the abdominal wall and pumps carbon dioxide into the cavity: thanks to this, the abdominal walls do not interfere with the view. Hemming is carried out under the control of a video camera, which is inserted into one of the punctures. The surgeon inserts instruments into the remaining 2 and shortens the stretched muscle ligaments. After suturing, the uterus immediately takes the desired position.

But in a few years the situation may repeat itself. There is a possibility that the stitched ligaments will stretch again. Relapse can be prevented by fixing the uterus in the desired position using a special mesh prosthesis. With its help, the descended organs are “tied” to the sacrum or abdominal wall. The mesh is made of hypoallergenic materials.

Carrying out laparoscopic surgery sewing and fixing the uterus to prevent its prolapse is allowed even to those women who plan to give birth in the future.

Colporrhaphy

You can normalize the position of the uterus and strengthen the pelvic floor and vaginal walls with the help of intimate plastic surgery.

Depending on the clinical picture, anterior, posterior or median suturing of the vagina is performed.

During anterior colporrhaphy, the anterior vaginal wall is removed, excess tissue is secured with clamps and cut off. Through the formed hole, cutting the subcutaneous tissue, the doctor gains access to the ligaments of the internal organs of the small pelvis and performs suturing of the uterus. After the operation is completed, sutures are placed on the vaginal mucosa.

Posterior colporrhaphy is performed according to a similar scheme. Only the surgeon cuts out a diamond-shaped piece of tissue from the back wall, determines the optimal location of the uterus and stitches it up.

With median colporrhaphy (Lefort-Neugebauer operation), an incision is made from both the anterior and posterior wall of the vagina, and the remaining areas are fastened together. The uterus is not sutured separately; it is held together by the walls attached to each other. Anterior and posterior suturing allows you to maintain the possibility of sexual activity in the future; with median colporrhaphy, intimate relationships become prohibited.

Hysterectomy

In some situations, complete removal of the uterus is recommended. But the absence of this organ in the pelvic region provokes displacement of the bladder, intestines and further genital prolapse, so hystrectomy (removal) is resorted to in rare cases.

Removal of the uterus is performed transvaginally or abdominally. But when using the first method, the postoperative period is easier.

To remove the uterus, an oval cut is made on the anterior wall of the vaginal canal. The uterus is removed through it, the vessels, ligaments that support it, pipes and ligaments connecting it to the ovaries are crossed. During removal, special attention is paid to fixing the vaginal stump, plasticizing its walls and creating a high perineum. The part of the vagina remaining after removal of the uterus is attached to the sacrum using a special mesh.

But in case of uterine prolapse, a hysterectomy is not performed; reduction and suturing are performed. Indeed, in this condition, the location of the pelvic floor organs changes and after removal, the likelihood of prolapse of other organs increases.

Rehabilitation

After the operation to suture or remove the organ, the rehabilitation period begins. It lasts for at least 1 month, although a woman can be discharged after 3 days.

The first 7-10 days after hemming, removal, a gentle lifestyle is recommended. Women are prohibited from sitting, but moderate physical activity is encouraged.

To prevent complications it is necessary:

treat the perineal area with antibacterial agents;
take antibiotics as recommended by a gynecologist;
review your diet, eat semi-liquid foods to prevent the development of constipation;
give up training in the gym and at home for a month;
avoid intimacy for at least 5-6 weeks in a row.

You can avoid relapses of prolapse if you follow the recommendations of gynecologists. They advise not to lift anything weighing more than 5 kg for 6 months after surgery. At other times, the maximum permissible load is 10 kg. Also, after suturing, on the doctor’s recommendation, it is necessary to do exercises that strengthen the pelvic floor muscles and perineum.

The specialists at the Frau Klinik Aesthetic Gynecology Department offer patients a full range of both non-surgical and surgical methods for treating pathologies.

Non-invasive methods include:

As part of surgical treatment, patients undergo:

Uterine prolapse - what is it?

The disease occurs when the tone of the muscular structures of the pelvic floor decreases. The essence of the problem is the gradual displacement of the body of the uterus towards the vagina, while its cervix is in its previous position. In severe cases of pathology, even complete prolapse of the organ can occur.

Gynecologists distinguish three categories of disease:

The location of the uterus is slightly changed, it is shifted closer to the vagina, and there is a slight deformation of the cervix.
The position of the uterus is significantly changed, it sags inside the vagina, as a result of which it changes shape.
Extreme stage: the uterus does not have a fixed position, it can move outside the vaginal cavity partially or completely.

Causes and factors contributing to prolapse of the uterus and vagina

Reduced amount of collagen in connective tissue

A slowdown in the rate of production of collagen fibers in the body entails a gradual stretching of the ligaments, and, as a result, leads to prolapse of the pelvic organs.

Decreased muscle tone

The disease occurs when the tone of the muscular structures of the pelvic floor decreases. The process may be due to both physiological changes in the pregnant woman’s body and overload on the pelvic muscles during childbirth, as well as neglect of the doctor’s recommendations regarding the nutrition and physical activity of the young mother. The correct (healthy) location of the uterus is between the rectum and the bladder. If tone is lost, the muscles can no longer prevent the uterus from moving towards the vagina.

Mechanical damage and birth injuries

The position of the uterus is also affected by injuries to the perineum received by a woman during childbirth or for some other reason. In the case of a difficult birth and long-term stress, the abdominal muscles may also suffer.

Age-related changes

As a woman ages, the production of estrogen decreases, which leads to a gradual loss of muscle tone. During menopause, symptoms of uterine prolapse bother women much more often.

Excess weight and gastrointestinal problems

In some cases, uterine prolapse can be provoked by: excess body weight, which creates a constant additional load on all internal organs, as well as chronic pathologies of the digestive system (constipation, etc.).

Symptoms of uterine prolapse

At an early stage, the disease practically does not manifest itself at all, so it is most often recognized during an examination by a gynecologist or using an ultrasound.

In some cases, the process of descent is uneven: for example, only the back or front wall can change location. Therefore, the choice of treatment must be made taking into account all the features of the course of the disease.

With significant prolapse of the uterus, the pain becomes more intense, sharp pain occurs even when trying to sit down.

Diagnostics

If the problem is detected in a timely manner, there is a high chance of preventing the appearance of painful symptoms and surgical intervention.

The set of diagnostic procedures includes:

examination on a gynecological chair,
instrumental diagnostics,
lab tests.

If necessary, the doctor may additionally prescribe: urography, ultrasound of the pelvic organs, colposcopy, tomography, urinalysis. In some cases, the opinions of specialized specialists are required: a proctologist and a urologist.

Treatment of prolapse of the vaginal walls without surgery

Surgical treatment of uterine prolapse

The diagnosis of uterine prolapse does not always imply surgery. In most cases, it is possible to cope with the pathology using conservative methods.

Surgical treatment is indicated in cases of uterine prolapse. There are two options for solving the problem: hysterectomy (complete removal of the organ) or its fixation.

Young patients

Perineoplasty with thread- a minimally invasive procedure, the purpose of which is the aesthetic and functional correction of the female perineum. Solves problems such as genital gaping, genital prolapse. To perform perineoplasty, a bidirectional vaginal mesothread made of biodegradable material is used, which over time, disintegrating inside the tissue, is replaced by collagen fibers. Result: strengthening of the perineal area, formation of an organic frame inside the tissues. Depending on the indications, the vaginal thread is inserted into the muscle layer or directly under the skin.

The procedure lasts about 1 hour and is performed on an outpatient basis. The patient returns home the same day.

Colpoperineolevatoplasty- an operation that involves suturing the vaginal wall and muscles. It is performed in tandem using synthetic non-biodegradable meshes. Implants create a supporting and reinforcing effect on the pelvic tissues.

3 types of vaginal surgery:

the anterior wall is strengthened (if it and the bladder prolapse);
the posterior wall is corrected to strengthen the rectum;
The installation of both implants is performed in case of complete prolapse of the uterus, the organ is fixed with special ligaments.

Colporrhaphy- an operation aimed at correcting the size of the vagina. Depending on the situation, the doctor sutures its front or back wall.

At the first stage, the part of the mucous membrane to be corrected is selected. It is excised longitudinally, after which the tissues are stitched together in layers. The vagina becomes narrower. Using this method, it is possible to remove postpartum scars.

Older patients

Median colporrhaphy- the operation is performed on elderly women. This intervention excludes the possibility of sexual activity, as well as gynecological examination and cervical biopsy. Therefore, the presence of cervical cancer pathologies is a contraindication to the use of this method.

Radical method- used for severe forms of uterine prolapse, when the only option is removal of the organ. A hysterectomy is performed if there is no need to preserve the woman's fertility. The method involves a subsequent special course of treatment, exercise therapy, diet, and minimizing physical activity.

Surgical techniques

Operations for prolapse of the walls of the uterus and vagina

Why can’t we delay solving the problem?

Uterine prolapse is a serious pathology. Without treatment, patients experience many associated problems:

urinary incontinence;
bladder pinching;
chronic constipation;
rectal prolapse;
intestinal dysfunction;
vaginal inversion, etc.

Dear women! Please don't put off taking care of your health. Listen to your body. The earlier the disease is diagnosed, the faster and easier it will be to treat. Be healthy!

Gynecologists treating uterine prolapse at the Frau Klinik

About the clinic

Clinic Frau Clinic discovered by world famous plastic surgeons S.N. Blokhin And I.A. Wulf with extensive experience both in Russia and abroad.

Near 50% human body weight is the so-called " connective tissue". Its main function is to maintain a constant structure of the body and consolidate all other tissues together.

The pelvic floor, like a hammock, supports the abdominal organs
(translation of text from the illustration: “I’m not sure I can hold all this on myself forever”)

Ligaments and fascia are typical representatives of connective tissue. These dense fibrous structures (strands and films) fix soft tissues and human insides to the main supporting structures (bones, tendons), thereby ensuring a constant and orderly arrangement of organs.

In such a stable state, the cardiovascular, respiratory, digestive, genitourinary and other systems can fully perform their functions. Conversely, failure of connective tissue leads to structural changes that can greatly affect the functioning of the body.

The main supporting structure of the female pelvic floor is the ligaments and fascia. Their damage leads to the development of a condition that is commonly called prolapse (prolapse) of the pelvic organs: bladder, uterus, small intestine, rectum.

Sometimes the term “prolapse of the vaginal walls” is used (it is not scientific, because it does not characterize the essence of the process, but only indicates external manifestations). Bladder prolapse leads to frequent urination, a strong urge to go to the toilet (up to urinary incontinence), a feeling of incomplete emptying of the bladder, and in severe forms - the appearance of residual urine and impaired kidney function (the development of hydronephrosis).

Prolapse of the rectum is accompanied by constipation, difficulties during emptying, gas incontinence, etc. Prolapse of the uterus, as a rule, is combined with other types of prolapse and has mixed symptoms. If the ligaments that hold the female urethra (urethra) in the correct position are damaged, urinary incontinence develops under stress (when coughing, sneezing, laughing, running, etc.).

Connective tissue (dense fibrous tissue) is designed in such a way that it is unable to adequately recover from damage (tears). This means that if the ligaments and fascia have been seriously damaged, then the only reliable way to restore their structure is surgery.

Today, stress urinary incontinence and pelvic organ prolapse (prolapse) can only be cured surgically.

Unfortunately, neither pelvic floor muscle training, nor laser exposure, nor medications, nor reflexology can provide acceptable effectiveness. It is important to note that the pelvic floor muscles are not directly related to the development of pelvic organ prolapse; they are not even located in the areas where defects form.

Surgeries for urinary incontinence and pelvic organ prolapse can be divided into two types:

Restorative(when the surgeon determines the exact location of the fascia and ligament tears and “sutures” these defects). Some types of these operations: anterior and posterior colporrhaphy (“vaginoplasty”), paravaginal reconstruction, sacrospinal fixation, etc.
Prosthetics(when various devices are implanted into the tissue, replacing the function of destroyed ligaments and fascia). Most often, synthetic mesh endoprostheses ("mesh") are used for these purposes, which, after installation, grow with the patient's connective tissue and become artificial ligaments and fascia. Similar operations include: implantation of a suburethral sling (loop) - TVT Urosling etc., installation of shaped mesh prostheses ( Pelvix, Elevate, etc.).

The first group of operations is certainly more attractive from the point of view of relative physiology and, again, relative safety. However, it is not always possible to reliably close tissue defects without the use of additional plastic materials. If the degree of destruction of ligaments and fascia does not allow one to completely avoid the use of “synthetics,” then it may be advisable to install polymer implants in the most damaged areas and thereby ensure a reliable result. There are cases when the use of the patient’s own tissues is completely impossible due to their extremely low strength.

Surgical meshes are not a panacea. It is not always necessary to resort to implantation of synthetic materials. But when indicated, the use of endoprostheses in pelvic floor reconstruction provides an obvious and, one might say, dramatic improvement in treatment results in a huge number of patients with severe (!) forms of prolapse and stress urinary incontinence. Today, sling implantation can occur in a one-day hospital setting. Pelvic organ prolapse requires 2-3 days of hospitalization. At the same time, rehabilitation occurs an order of magnitude faster than was previously the case when using traditional approaches.

The effect of operations using mesh implants reaches 80-90%.

However, these technologies require a very high level of special knowledge and skills of the surgeon! Otherwise, the patient may face severe and extremely difficult to correct complications.

Appearance of the endoprosthesis - Gyneflex mesh

The fact is that correct implantation of surgical meshes during prolapse should be carried out in the deep structures of the pelvis in close proximity to the bladder, rectum, large vessels and nerves. Damage to these structures threatens not only the health, but also the life of the patient. This obliges the doctor to thoroughly master the topographic anatomy of this zone.

The classical education of gynecologists and urologists (both in the Russian Federation and in the world) often covers this area of knowledge rather superficially. In order not to take risks when working in the “dark forest”, many specialists attempt to implant mesh endoprostheses superficially (directly under the vaginal mucosa - in the “habitual area”) and thereby violate the technology. This causes the vaginal wall, deprived of adequate blood supply and innervation, to heal poorly. As a result, erosions of the mucous membrane are formed (when the mesh is exposed), scarring and shortening of the vagina develops, sexual dysfunction occurs (dyspareunia), and so on.

Implantation of a suburethral sling for urinary incontinence is, of course, a less complicated operation. But it also has a huge number of nuances that directly affect the result, among them: determining the indications for surgery (this is not always obvious), the technique of positioning/tensioning the loop, the choice of endoprosthesis, etc.

An important feature of pelvic floor surgery is the need to restore not only the anatomy, but also the impaired function of organs while maintaining the function of adjacent structures! Solving this problem without special training in the field of functional urology, neurourology and urodynamics is sometimes very difficult. Moreover, it is impossible to adequately cope with complications.

All of the above clearly indicates that effective and safe treatment of pelvic floor pathology is possible only in specialized clinics, where doctors have the necessary knowledge and skills, have completed numerous trainings and practical courses, perform similar operations on-line and have constant feedback with operated patients ( !).

An “amateur” approach to this problem, when specialists begin to perform operations after watching a DVD with an educational film, is categorically unacceptable. Objective international data indicate that the incidence of complications in the surgical treatment of pelvic floor pathology using mesh prostheses in different arms can vary from 1-3% to 30%. There was even a term: “surgeon-associated complications.”

The negative information field, which in the last few years has begun to accompany the technology for prosthetics of pelvic floor structures with synthetic implants, is a direct consequence of the uncontrolled use of this technology by a large number of insufficiently qualified specialists. Obviously, when faced with complications, the easiest way for a doctor to blame everything is on the mesh. Who wants to declare their incompetence (especially if the status of a doctor categorically does not allow this)?

Treatment at KVMT named after. N.I. Pirogov St. Petersburg State University

Northwestern Center for Pelvioperineology(SZTsPP), founded in 2011 on the basis of the Department of Urology of the Clinic of High Medical Technologies named after. N.I. Pirogov St. Petersburg State University, specializes in modern low-traumatic methods of treating pelvic organ prolapse (POP) and urinary incontinence using mesh endoprostheses, the head of the Center is Doctor of Medical Sciences, urologist Shkarupa Dmitry Dmitrievich .

Pelvic floor reconstructive surgery is a very specialized field that requires a thorough understanding of the anatomy and function of the pelvic organs, as well as proficiency in both “mesh” and “traditional” procedures. Knowledge makes the doctor free to choose a treatment method, and the patient happy with the results.

Every year our Center performs more than 600 surgeries for urinary incontinence in women and more 900 - with prolapse (prolapse) of the pelvic organs (also in combination with urinary incontinence).

We consider tracking long-term treatment results to be the most important element of our work. More than 80% of our patients are regularly examined by the Center’s specialists in the late postoperative period. This allows you to see a real picture of the effectiveness and safety of the treatment.

Cost of treatment for pelvic organ prolapse and urinary incontinence:

Most patients receive care free of charge as part of compulsory health insurance (compulsory medical insurance).

It is also possible to pay for treatment in cash. The price depends on the volume and complexity of the operation. On average: from 50,000 to 80,000 rubles. (The price includes: surgery, anesthesia, hospital stay, mesh implant and other expenses).