Prolapse of the anterior abdominal wall. Causes and treatment of uterine prolapse, is it possible to do without surgery? Prevention of uterine prolapse - physical therapy

It’s a “they don’t talk about it out loud” problem, which worries many, but is voiced by few. Prolapse of the posterior wall of the uterus (as well as the anterior one) is familiar to women firsthand. What it is? What should you do if this difficult diagnosis is written on the card?

Read more about changing the position of the uterine wall

It is no secret that the birth of a child, like pregnancy itself, requires a woman to make impressive sacrifices on the part of her health. Often after the baby is born, the new mother cannot do anything about stretch marks, varicose veins, and diastasis (separation of the abdominal muscles). And, in fact, prolapse of the uterus.

Uterine prolapse or prolapse (also called prolapse) is a diagnosis in which the muscle groups of the pelvic floor have become so weak and the ligaments have become so stretched that they are no longer able to support the uterus as required. Which, in turn, causes it to slide down and begin to protrude from the vagina.

There are two options for the scale of action:

• the uterine cervix was “at the entrance” - partial prolapse;
• when the uterus falls out completely, the prolapse is naturally called total.

A similar misfortune can theoretically happen to anyone, but more often than others, uterine prolapse or prolapse occurs in women who have given birth during the postmenopausal period.

Causes of prolapse of the uterine walls

Before we talk about what to do when the uterine wall prolapses, it is worth knowing why this happened.

The pelvic muscles can weaken for several reasons:

• if there was an injury during pregnancy and childbirth;
• too much big baby or pregnancy with twins;
• violations hormonal levels(too low estrogen - the most important female hormone);
• age-related changes (than older woman, the higher the chances of “getting” prolapse);
• weak muscles, “office” lifestyle before pregnancy and the birth of a child;
• excess body weight (difference from normal – more than ten kilos);
• lifestyle associated with lifting too heavy a weight (work, training);
• the presence of a hernia of the bladder and/or vaginal walls;
• gynecological diseases (we are talking about fibroids, cysts, fibroids, which put a lot of pressure on the ligament system and can lead to prolapse of the reproductive organ).

This unenviable opportunity can be moderate and not bother the woman in any way. However, other, much more tragic options are also quite likely.

A little about the symptoms of pathology

Traditionally, a gynecologist reports about prolapse of the uterus or its prolapse, but even before a woman visits a specialist, prolapse can be revealed by several eloquent points:

• a stable feeling of a full stomach and a pressing sensation in the pelvic area;
• pain in lower section back (lower back);
• feeling that something is coming out of the vagina;
• quite painful process of urination;
• it hurts to have sex;
• vaginal bleeding;
• frequent cases of unexpected need to go to the toilet “in a small way”;
• discomfort while walking;
• if the pathology is not treated, soon the patient herself will be able to see the uterus protruding beyond the edge of the vagina, which will inevitably be injured while walking.

There is a category of ladies for whom admitting to this or that discomfort is like execution. But, as they say, “don’t do that.” If there is a problem, it needs to be solved. This is what doctors get paid for. If you notice at least a couple of these symptoms, rush to see a doctor.

What are the dangers of prolapse of the uterine walls?

Prolapse of the posterior wall of the uterus - serious problem. It is better to know the consequences of the impending disaster so that the question “prolapse of the posterior wall of the uterus, what to do” does not arise. And, if eloquent symptoms appeared, the woman immediately consulted a doctor. The consequences of prolapse of the uterine walls are as follows:

• If the walls of the uterus begin to descend, along with them comes the prolapse of the rectum with all the resulting troubles. This is accompanied by constipation. Part of the intestine is compressed. Attempts are also added here, which will only aggravate what is happening. The apogee is the prolapse of part of the intestine, which, naturally, will not end well.
• WITH back wall The uterus and vaginal walls descend. If the disease is advanced, everything that happens is accompanied by wild pain, as well as a violation of the integrity of the organ. Erosion appears. capable of growing all the way to the cervix. Unfortunately, these associated problems can greatly complicate the treatment process.
• It is worth noting that what formerly a woman visit the doctor, so much the better. If the disease crosses (literally and figuratively) the entrance to the vagina, self-healing will be impossible. There are no other options other than surgery for such a patient. Unfortunately, the “fallen out” tissues are only cut off. The organ may lose its former sensitivity, which can lead to problems in sexual life. In addition, the tissues of the intimate area are restored very slowly and painfully.
• None of the uterine walls descend alone. These “unauthorized” shifts put pressure on the urinary tract, causing pain, symptoms of cystitis and other troubles.
• The consequences will also affect the lower pelvic organs. With prolapse of the uterus there is a threat of prolapse intestinal loops to the pelvic area. Which is logical, because there is more space. This is a signal to the body that there is somewhere to move.

Physical activity that will help improve the situation

Exercises for the prolapse of the anterior wall of the uterus are as necessary as air. But first, it’s worth knowing a few general recommendations that will make a woman’s life much easier.

After the diagnosis has been confirmed by a specialist, experienced trainers recommend making the following adjustments to your life:

• if a woman has recently given birth, if the birth was complicated, you should definitely visit a specialist to find out if there are any signs of uterine prolapse;
• heavy lifting should be avoided, such as Everyday life, and in training;
• before starting training, it is better to consult a gynecologist to find out what should be done when the anterior wall of the uterus prolapses (you may need to use a special uterine ring);
• if there are deposits of excess fat on the sides and other parts of the body, you need to reduce your weight to normal;
• training intimate muscles at home will strengthen the walls and pelvic floor, which will help correct the prolapse of the anterior wall of the uterus;
• it is necessary to increase the amount of foods that increase the production of female sex hormone (eating legumes, more carrots, cauliflower, tomatoes, brown rice, whole grain bread, red meat and dairy products);
• try to eat more pure fiber. You can buy it at any pharmacy (this will make it possible to forget about problems with stool and the need to push, exposing yourself to additional risk). By the way, constipation is not only an aggravating factor, but also potential cause development of uterine prolapse and prolapse.

Kegel exercises

These intimate workouts can work wonders. And put the “lost” organ in place. Before you begin Kegel exercises, you need to learn how to “breathe with your belly.” This practice will be needed to work exclusively the pelvic muscles, without including the abs or hips. The vaginal muscles should work in isolation.

How to breathe correctly? We lie on our backs, relax and begin to inhale and exhale deeply. One palm is placed on the chest, the other on the stomach. You should try to breathe in such a way that only your abdominal muscles rise and fall. Keep the chest motionless.

Complex for correction of uterine prolapse:

• Lie on your back, relax, bend your legs, shoulder-width apart. Hands are pressed to the sides. The main task is to squeeze the intimate muscles for one to two seconds, then relax. The press should be absolutely relaxed, breathing should be calm. We continue to do this for five minutes, increasing the speed and strength of the compressions. After five minutes, add push-outs: squeeze, push a little and relax.
• In turn, for one to two seconds you need to retract the muscles of the vagina and anus. The main task is to isolate sensations: you need to learn to distinguish between the sensations of compression and relaxation of these muscle groups. The abdominal muscles should be as relaxed as possible during the exercise. This type of training is called "blinking".

Treatment for prolapse of the posterior wall of the uterus medium degree impossible without these exercises. They are the kind that can be done anywhere, anytime. In the car, watching your favorite TV series, standing in line at the grocery store, etc. They perfectly correct prolapse of the uterine walls and help avoid a visit to the surgeon.

How is uterine wall prolapse treated?

Treatment for prolapse of the uterine walls depends on how advanced the disease is. If you manage to “catch” the pathology in time, then it is quite capable of putting the organ in its place. physiotherapy, uterine massage (done by an experienced gynecologist) and wearing a special bandage.

If the prolapse of the uterine walls is out of control, you will need to solve the problem surgically. Fortunately, this is not the case now abdominal surgery, but a completely gentle laparoscopy method that doesn’t even leave scars. Repeated “force majeure” is excluded in such a situation.

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Vaginal prolapse or vaginal prolapse is an abnormal condition in the female reproductive system, which mainly occurs in women who have given birth after the age of fifty due to a weakening of the pelvic floor, but it can also occur in women aged 30 to 45 years (forty cases out of a hundred) , as well as up to thirty years (ten cases out of a hundred). Vaginal prolapse is not always associated with the birth process; in three percent of cases, the abnormal condition develops in young and nulliparous girls.

Causes or mechanism of vaginal prolapse.
Prolapse of the vaginal walls (prolapse) is expressed in a change in the anatomical location of the pelvic organs against the background of muscle weakening abdominal area and pelvic floor. Why is this happening? Due to increased pressure inside the abdominal region, the elasticity of the ligaments is gradually lost, which is why they are unable to preserve the internal organs (in particular bladder, uterus, rectum) in the required physiological position. Hence, the increase in organ pressure gradually leads to loss of muscle tone of the perineum and prolapse of vaginal tissue.

Promote development similar condition can be caused by many factors, including:

• Congenital anomaly of connective tissue development.
• Increased intra-abdominal pressure (constipation in chronic form, frequent ARVI, accompanied by cough).
• Development of complications during childbirth (long labor, perineal trauma, large fetus, use of obstetric forceps during childbirth).
• Sudden weight loss due to obesity.
• Tumor changes in the genital organs.
• Hard physical labor.
• An operation to remove the uterus when the vaginal dome was not fixed.
• Changes in the body that occur with age (loss of tissue elasticity (after 60 years)).
• Number of births (after the birth of the second child, the risk of prolapse of the vaginal walls increases significantly).

During the development of the disease, either the anterior or posterior wall of the vagina can undergo prolapse, or both at the same time. IN clinical practice Most often, prolapse of the anterior wall occurs, which is inevitably accompanied by prolapse of the bladder and urethra. When the posterior vaginal wall prolapses, there is a high risk of rectal prolapse or rectal prolapse.

• The first degree is prolapse of the posterior, anterior or both walls of the vagina, while the vulva itself does not extend beyond the boundaries of the entrance.
• The second degree is partial prolapse of the anterior wall of the vagina with part of the bladder (cystocele) or the posterior wall with part of the rectum (rectocele), accompanied by bulging of the walls outward.
• The third degree is complete prolapse of the vaginal walls, mainly accompanied by uterine prolapse.

Prolapse of the anterior vaginal wall most often manifests itself in the form of the development of chronic cystitis against the background of stagnation of urine, and the posterior wall - in the form of constipation and a feeling of the presence of a foreign object in the vulva.

A complication of prolapse of any of the vaginal walls is often prolapse and then prolapse of the uterus, which manifests itself in the form of excessive sanguineous or bloody discharge.

Diagnosis of prolapse and prolapse of the vaginal walls.
Detection of the disease is not difficult; when examined in a gynecological chair, the walls of the vagina and cervix protruding from the genital tract are noticeable. The doctor adjusts them and then assesses the condition of the pelvic floor muscles. IN in this case An additional consultation with a urologist and proctologist is required.

Prolapse of the vaginal walls and pregnancy.
Pregnancy with this state possible, but the degree of development of the disease should be taken into account. The first degree of the disease allows you to give birth without prior surgery. In this case, exercises to strengthen the pelvic muscles and abs will help. In case of progressive disease, it is necessary surgery, recovery, only then can you get pregnant. IN otherwise prolapse of the vagina is fraught with prolapse of the uterus.

And one more nuance, after the operation you will no longer be able to give birth on your own; a caesarean section is indicated.

Treatment of prolapse of the vaginal walls.
Prolapse of the vaginal walls, if diagnosed early, can be eliminated conservatively; in more advanced and complicated cases, surgical intervention is performed. Timely treatment significantly reduces the risk of complications.

Conservative therapy.
Therapy is indicated for minor prolapse of the vaginal walls and is expressed in the use of a set of exercises, the purpose of which is to increase the muscle tone of the pelvic floor, including Kegel exercises (squeezing and relaxing the muscles of the perineum), and physical therapy exercises. At the same time, therapy is prescribed for general strengthening the body, while nutrition is not the least important (no heavy foods that can cause constipation and complicate the problem).

During menopause, women are prescribed hormone replacement therapy to improve blood circulation and strengthen the muscles and ligaments of the pelvic organs.

If surgery is contraindicated for a woman for any reason, to prevent complete prolapse of the uterus, the patient is fitted with uterine rings (pessaries) - a device for supporting internal organs is inserted into the vulva. The pessary is selected for each patient individually, after which regular monitoring by a gynecologist is indicated to exclude the development serious complications(purulent and ulcerative processes, irritation and swelling of the mucous membrane, ingrowth of the pessary into the cervix or vulva). To prevent these phenomena, the doctor prescribes douching and washing the vagina. If weakness of the vaginal muscles does not allow insertion of a pessary, then a hysterophore is used - a device that holds the uterus by means of a pessary connected to a bandage attached to the waist.

Gymnastics (set of exercises) for prolapse of the vaginal walls at an early stage (can be used as a preventive measure for the disease).

• While inhaling, we raise the straightened right hand And left leg, while exhaling, lower it. Do six repetitions. Then do the same thing, only with the left hand and right foot.
• As we inhale, we lower our head and draw in the muscles of the perineum; on the way out, we relax, raise our head and bend in the lower back. Do ten repetitions.
• Bend your elbows and alternately raise your right and left legs. Do twelve repetitions with each leg.

• Arms along the body, legs straightened and joined together. Slowly, while exhaling, we raise our legs, while inhaling, we spread them apart, while we exhale, we close them, and while inhaling, we return to the starting position. Do eight repetitions.
• Hands under your head, feet together. Raise the pelvis while simultaneously drawing in the muscles anus. Do ten repetitions slowly.
• At an average pace we make a “bicycle” of twenty revolutions.
• Raise straight legs one by one. Do eight times with each leg.
• We lift our legs off the floor, put them behind our heads, and stretch our toes to the floor. Do six approaches at a slow pace.
• Raise your straight legs (together) at an angle of 45° to the floor and return back. Perform slowly eight times.
• Bend your knees (foot on the floor, arms under your head) and spread them slightly. Raise your pelvis from the floor, spread your knees wide and pull the anus muscles inward. Do ten approaches.

• We strain the pelvic muscles in steps, from low effort to maximum, each position should be fixed for several seconds. We relax in the same way.
• Hold urination for 10-20 seconds.
• Moderate straining (as during childbirth).

• Colporrhaphy - removal of “excess” tissue from the vaginal walls and stitching them together during prolapse and prolapse; the operation is aimed at restoring the anatomical location of the organs by strengthening the pelvic floor muscles. Can be front or back.
• Colpoperineorrhaphy is a reduction of the posterior wall of the vagina (against the background of overstretching after childbirth) by suturing it and tightening the perineal muscles.

• During the first five days, treat the perineum with an antiseptic.
• Take antibiotics prescribed by your doctor.
• For two weeks, to avoid overstraining the operated muscles, sitting is prohibited.
• In the first week, it is recommended to eat liquid or semi-liquid foods to prevent the development of constipation.
• Eliminate physical activity, including sports, for at least a month.
• It is recommended to resume sexual activity no earlier than five weeks after surgery.

• Correct suturing of ruptures or cuts of the perineum during childbirth.
• Mandatory physical education before, during and after childbirth.
• Do exercises to strengthen the pelvic floor muscles during pregnancy and after childbirth.
• Learn to urinate in portions, squeezing the stream several times during one urination.
• Protect yourself from carrying heavy objects.
• Balanced nutrition, including during pregnancy.
• Gentle conservative management of childbirth and prevention of maternal injuries.
• Learn to pull your vulva up while walking.

Quince can be brewed and drunk as tea; it gives tone to the muscles of the uterus. Brew 100 g of dried fruits and a liter of water using a water bath.

An alcoholic tincture of astragalus root is also considered effective means traditional medicine vs of this disease. Take nine parts of vodka for some of the chopped roots. Keep the mixture for two weeks in a cool, dark place. Then strain. Take three times before the main meal (breakfast, lunch, dinner), with plenty of water. Treatment course includes thirty days, if necessary, the course can be repeated after two weeks.

Mix 50 g of linden blossom and lemon balm, add 70 g of white damask and 10 g of alder root. Grind the mixture. Take two tablespoons, brew 200 ml of boiling water and leave until completely cool. Take half a glass three times a day before meals. The course of treatment is twenty-one days; after a two-week break, the course can be repeated.

Datura is effective as a remedy for sitz baths in cases of partial prolapse. Pour 20 g of herb into seven liters of boiling water and keep in a water bath for fifteen minutes. After this, the infusion should be cooled to 38 degrees. Use for a sitz bath, lasting no more than ten minutes.

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Discomfortable sensations in the vagina due to tension or contraction of the anterior wall of the abdominal cavity force a woman to consult a gynecologist. Sometimes this can occur at rest, as well as during sexual intercourse.

Similar unpleasant symptoms can be caused by prolapse of the vaginal walls (vaginal prolapse). This is a serious disease that requires careful diagnosis and comprehensive treatment.

Causes of prolapse of the anterior (posterior) vaginal wall

There are many factors that can contribute to the occurrence of this pathology, and these include:

• prolapse of the posterior (anterior) vaginal wall after difficult childbirth, or as a result of injuries received during birth process ruptures and other injuries;
• pathology of microcirculation processes of lymph and blood in the pelvic area;
• dysplasia (systemic deficiency) of connective tissue;
• systematic lifting of significant weights by a woman;
• obesity;
• physical inactivity, insufficiently active lifestyle;
• disturbance or decrease in estrogen production;
• bronchial asthma, bronchitis or constipation - these diseases contribute to increased intra-abdominal pressure.

Degree of development of pathology

Experts divide vaginal prolapse into three degrees, which differ in the severity of the pathology:

• first degree - moderate drooping of the walls (both or one), caused by the pressure of organs that have shifted downwards;
• with grade 2 prolapse of the vaginal walls, the pressure on them from the uterus or other internal organs increases several times. This is often accompanied by the presence of the body of the uterus in the vagina, and the pharynx of the cervix almost in the vestibule;
• third degree of prolapse, the most severe - eversion of the vaginal walls outward and even prolapse of the uterus.

In addition, vaginal prolapse can be caused by displacement of specific pelvic organs. So, they divide:

• cystocele - prolapse of the anterior wall of the vagina, under the pressure of a pathologically displaced bladder. It occurs due to weakened muscles or stretched ligaments that hold it in place;
• rectocele - prolapse of the posterior wall of the vagina, experiencing intestinal pressure.

Symptoms of vaginal prolapse

The prolapse of the vaginal walls does not occur on its own - it is a symptom of a general change in the location of other internal organs in this area - they create pressure on the vaginal walls.

The woman herself feels some of the symptoms of this pathology, but accurate diagnosis determined by a specialist doctor during a detailed examination.

This is often accompanied by uterine hypertrophy, cervical canal polyps, and pseudo-erosions. As a result of this, dryness of the vaginal mucosa, its thickening or thinning, appears.

When examining, it often turns out that microcirculation is impaired due to sclerotic changes in the lymphatic and blood vessels.

Already in the first stages of the disease, women feel painful impulses in the lower back and lower abdomen. experience difficulties with active movements, her ability to work is noticeably reduced.

Tissue irritation, itching, and severe dryness of the mucous membrane appear. This often leads to the appearance of erosions (ulcers) in the vaginal area. Sex during vaginal prolapse brings pain.

Organ prolapse provokes frequent urination, urinary incontinence, and sometimes a reverse reaction occurs - urinary retention.

Almost always, vaginal prolapse is accompanied by intestinal dysfunction - constipation occurs, uncontrolled gas secretion, and hemorrhoids, cases of fecal incontinence have been reported.

Treatment

When treating prolapse of the vaginal walls, the following can be used: surgical methods, and conservative.

Conservative methods

These include the installation of a pessary. This internal organ support device, made of silicone or plastic, is inserted into the vagina. This procedure is used infrequently, only when absolutely necessary.

The device is selected individually for each patient. Women who have it installed are under constant control specialist, since complications are possible:

• irritation and swelling of the vaginal mucosa;
• ulcerative and purulent processes;
• ingrowth of an installed pessary into the tissue of the cervix or vagina.

To prevent these phenomena, the doctor prescribes douching, rinsing, and it is possible to change the device model.

This treatment is only allowed if moderate prolapse vaginal walls. If this is not possible due to weakness of the vaginal muscles, a hysterophore is used. This device helps hold the uterus in place using a pessary connected to a band that is attached to the waist.

Such methods are a typical palliative, which almost never entails full recovery. Therefore, surgical intervention is most often the most effective, except in cases where it is clearly contraindicated.

Surgical methods

The method of surgical intervention is chosen by a specialist depending on the degree of development of the pathology, the age of the patient and the individual characteristics of her body.

• colpoperineorrhaphy - this operation is performed on the back wall of the vagina, when the rectum prolapses into the vagina. It is sutured and levatoroplasty is performed, which ensures retention of organs in the pelvic cavity;
• an operation is performed on the anterior wall of the vagina to raise and secure the bladder during its descent, and to relieve the vagina from its excess pressure;
• Median colporrhaphy is performed for vaginal prolapse. A similar operation is recommended for women who have left reproductive age when the use of other radical methods is not recommended. The operation is quite easy to tolerate and in most cases has favorable results;
• Colpoperineocleisis (incomplete closure of the vagina) is also performed on elderly patients. The operation narrows the vaginal cavity, forming a dense septum that absorbs excess pressure from the abdominal cavity;
• The method of vaginal-vesical interposition is used for combined prolapse of the anterior wall of the vagina, uterus and bladder. During the operation, the round ligaments are shortened and fixed, which will create support for the organs fixed in their normal position. After this operation, pregnancy is excluded. In general, the technique gives good results without complications;
• if vaginal prolapse is directly related to the displacement of the uterus, then, depending on the indications, operations are performed to secure this organ in the abdominal cavity (ventrosuspension or ventrofixation), partial resection followed by plastic surgery (“Manchester” operation) or even complete amputation.

Gymnastics or Kegel exercises for vaginal prolapse

Gymnastic exercises have a good effect on vaginal prolapse. When performing them, you must be sure to monitor your breathing.

Perform the exercises while lying on your back or standing on all fours.

Exercises while lying on your back

• the familiar “bicycle” exercise is done slowly 15-20 times;
• put your hands behind your head, keep your legs together and slowly lift them 10-12 times, while squeezing the muscles of the anus;
• lift straight legs in turn 12 times each;
• Stretch your arms along your torso, keep both legs together. You need to raise your legs as you exhale, as you inhale they spread apart, as you exhale they move, and as you inhale they lower to the floor. The exercise is performed slowly 6 - 8 times;
• bend your knees and spread them apart, placing your feet on the floor. Place your hands behind your head. The pelvis is lifted off the floor, spreading the knees as far as possible and squeezing the anus muscles. This exercise is repeated ten times.

Exercises while standing on all fours

• As you inhale, you need to lower your head, stretch your right arm up, and lift your left leg and stretch it back, lower your leg and arm as you exhale. The same is done with the right leg and left arm. Repeat the exercise 6 times;
• the head is lowered down while inhaling while simultaneously contracting the muscles of the perineum. Next, relax the muscles as you exhale, raise your head and bend your spine. You need to do this exercise 10 times;
• lean on your elbows, take turns raising your left and right leg up. The exercise is repeated 12-14 times.

Kegel exercises

There is a well-known set of Kegel exercises that allows you to strengthen the muscle walls of the pelvic area. They are simple and accessible to every woman at any time of the day:

• the so-called Kegel lift. The pelvic muscles are tensed in stages, from small efforts to maximum, making sure to fix each position for several seconds. Relaxation is carried out in the same order;
• delaying urination for 10–20 seconds – this will not cause harm, but will help strengthen muscles and ligaments;
• moderate straining - as during labor;
• Regular performance of such exercises will become a reliable assistant for a woman in counteracting the extremely unpleasant syndrome of prolapse of the vaginal walls.

It is therapeutic exercises that become the main means of helping to completely get rid of such pathology without resorting to surgical intervention.

After giving birth I used vaginal cones. There was urinary incontinence. After two weeks the problem was practically resolved. Thanks to the doctor for recommending such an excellent remedy.

I was given a pessary during pregnancy. It helped a lot to carry the baby.

I had the same problem during pregnancy. After childbirth, terrible urinary incontinence. In general, I had to undergo surgery. Now, I heard there are vaginal cones that are designed for training the pelvic floor muscles. My friend uses them to keep herself in good shape. They say this helps bring the baby to term and makes the birth process easier. Only pregnant women cannot do exercises; they need to do it before giving birth.

I was given a pessary during pregnancy. It helped a lot to carry the baby.

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– incorrect position of the uterus, displacement of the fundus and cervix below the anatomical and physiological boundary due to weakening of the pelvic floor muscles and uterine ligaments. In most patients, uterine prolapse is usually accompanied by downward displacement of the vagina. Prolapse of the uterus is manifested by a feeling of pressure, discomfort, nagging pain in the lower abdomen and vagina, urinary disorder (difficulty, increased frequency of urination, urinary incontinence), pathological discharge from the vagina. May be complicated by partial or complete prolapse of the uterus. Uterine prolapse is diagnosed during a gynecological examination. Depending on the degree of uterine prolapse therapeutic tactics may be conservative or surgical.

General information

– incorrect position of the uterus, displacement of the fundus and cervix below the anatomical and physiological boundary due to weakening of the pelvic floor muscles and uterine ligaments. It manifests itself as a feeling of pressure, discomfort, nagging pain in the lower abdomen and vagina, urination disorder (difficulty, increased frequency of urination, urinary incontinence), pathological discharge from the vagina. May be complicated by partial or complete prolapse of the uterus.

Most frequent options Incorrect location of a woman’s internal genital organs results in uterine prolapse and prolapse (uterocele). When the uterus prolapses, its cervix and fundus shift below the anatomical border, but the cervix does not appear from the genital slit even with straining. Extension of the uterus beyond the genital slit is regarded as prolapse. Downward displacement of the uterus precedes its partial or complete prolapse. In most patients, uterine prolapse is usually accompanied by downward displacement of the vagina.

Uterine prolapse is quite common pathology, which occurs in women of all ages: it is diagnosed in 10% of women under 30 years of age, at the age of 30-40 years it is detected in 40% of women, and after the age of 50 it occurs in half. 15% of all genital surgeries are performed for prolapse or prolapse of the uterus.

Uterine prolapse is most often associated with weakening of the ligamentous apparatus of the uterus, as well as the muscles and fascia of the pelvic floor and often lead to displacement of the rectum (rectocele) and bladder (cystocele), accompanied by dysfunction of these organs. Often, uterine prolapse begins to develop as early as childbearing age and always has a progressive course. As the uterus prolapses, the accompanying symptoms become more pronounced. functional disorders, which brings physical and moral suffering to a woman and often leads to partial or complete loss of ability to work.

The normal position of the uterus is considered to be its location in the pelvis, at an equal distance from its walls, between the rectum and the bladder. The uterus has an anterior tilt of the body, forming an obtuse angle between the cervix and the body. The cervix is ​​deviated posteriorly, forms an angle of 70-100° relative to the vagina, its external os is adjacent to the posterior wall of the vagina. The uterus has sufficient physiological mobility and can change its position depending on the filling of the rectum and bladder.

The typical, normal location of the uterus in the pelvic cavity is facilitated by its own tone, relationship with adjacent organs, and the ligamentous and muscular apparatus of the uterus and pelvic floor. Any violation of the architectonics of the uterine apparatus contributes to prolapse of the uterus or its prolapse.

Classification of uterine prolapse and prolapse

Distinguish next stages prolapse and prolapse of the uterus:

• prolapse of the body and cervix - the cervix is ​​determined above the level of the entrance to the vagina, but does not protrude beyond the genital slit;
• partial uterine prolapse - the cervix appears from the genital slit when straining, physical stress, sneezing, coughing, lifting weights;
• incomplete prolapse of the body and fundus of the uterus - the cervix and part of the body of the uterus protrude from the genital slit;
• complete prolapse of the body and fundus of the uterus - exit of the uterus beyond the genital slit.

Causes of uterine prolapse and prolapse

Anatomical defects of the pelvic floor that develop as a result of:

• damage to the pelvic floor muscles;
• birth injuries - when applying obstetric forceps, vacuum extraction of the fetus or removing the fetus by the buttocks;
• previous surgical operations on the genital organs (radical vulvectomy);
• deep perineal lacerations;
• disturbances of the innervation of the genitourinary diaphragm;
• congenital malformations of the pelvic area;
• estrogen deficiency developing during menopause;

Risk factors for the development of uterine prolapse and its subsequent prolapse include multiple births in history, heavy physical labor and heavy lifting, advanced and senile age, heredity, increased intra-abdominal pressure caused by obesity, abdominal tumors, chronic constipation, cough.

Often, the interaction of a number of factors plays a role in the development of uterine prolapse, under the influence of which the ligamentous-muscular apparatus of the internal organs and the pelvic floor weakens. With an increase in intra-abdominal pressure, the uterus is forced out of the pelvic floor. Prolapse of the uterus entails displacement of anatomically closely related organs - the vagina, rectum (rectocele) and bladder (cystocele). Rectocele and cystocele enlarge due to internal pressure in the rectum and bladder, which causes further prolapse of the uterus.

Symptoms of prolapse and uterine prolapse

If left untreated, uterine prolapse is characterized by gradual progression of displacement of the pelvic organs. In the initial stages, uterine prolapse manifests itself nagging pain and pressure in the lower abdomen, sacrum, lower back, sensation foreign body in the vagina, dyspareunia (painful intercourse), the appearance of leucorrhoea or bloody discharge from the vagina. A characteristic manifestation of uterine prolapse is changes in menstrual function such as hyperpolymenorrhea and algomenorrhea. Often, when the uterus prolapses, infertility is noted, although pregnancy cannot be ruled out.

Subsequently, the symptoms of uterine prolapse are joined by urological disorders, which are observed in 50% of patients: difficulty or frequent urination, development of the symptom of residual urine, congestion in the urinary organs and subsequently infection of the lower and then upper parts of the urinary tract - cystitis, pyelonephritis develop , urolithiasis disease . Long-term progression of uterine prolapse leads to overstretching of the ureters and kidneys (hydronephrosis). Often, downward displacement of the uterus is accompanied by urinary incontinence.

Proctological complications with prolapse and uterine prolapse occur in every third case. These include constipation, colitis, fecal and gas incontinence. Often it is the painful urological and proctological manifestations of uterine prolapse that force patients to turn to related specialists - a urologist and proctologist. With the progression of uterine prolapse, the leading symptom becomes a formation independently detected by the woman, protruding from the genital slit.

The protruding part of the uterus has the appearance of a shiny, matte, cracked, raw surface. Subsequently, as a result of constant trauma when walking, the protruding surface often ulcerates with the formation of deep bedsores, which can bleed and become infected. When the uterus prolapses, a circulatory disorder develops in the pelvis, the occurrence of stagnation, cyanosis of the uterine mucosa and swelling of adjacent tissues.

Often, when the uterus is displaced below physiological boundaries, it becomes impossible sex life. Patients with uterine prolapse often develop varicose veins, mainly lower limbs, due to impaired venous outflow. Complications of uterine prolapse and prolapse can also include strangulation of the prolapsed uterus, bedsores of the vaginal walls, and strangulation of intestinal loops.

Diagnosis of uterine prolapse and prolapse

Uterine prolapse and prolapse can be diagnosed by consulting a gynecologist during a gynecological examination. To determine the degree of uterine prolapse, the doctor asks the patient to push, after which, during vaginal and rectal examination, he determines the displacement of the walls of the vagina, bladder and rectum. Women with displacement of the genital organs are registered at the dispensary. It is mandatory for patients with such uterine pathology to undergo colposcopy.

In cases of prolapse and prolapse of the uterus, requiring organ-preserving plastic surgery, and with concomitant diseases of the uterus, the diagnostic complex includes additional methods examinations:

• hysterosalpingoscopy and diagnostic curettage of the uterine cavity;
• ultrasound diagnostics of the pelvic organs;
• taking smears for flora, degree of vaginal cleanliness, bacterial culture, and also to determine atypical cells;
• urine culture to exclude urinary tract infections;
• excretory urography to exclude urinary tract obstruction;
• computed tomography to clarify the condition of the pelvic organs.

Patients with uterine prolapse are examined by a proctologist and urologist to determine the presence of rectocele and cystocele. They assess the condition of the sphincters of the rectum and bladder to identify gas and urinary incontinence under stress. Prolapse and prolapse of the uterus should be distinguished from uterine inversion, vaginal cyst, born myomatous node and carried out differential diagnosis.

Treatment of uterine prolapse and prolapse

When choosing treatment tactics, the following factors are taken into account:

1. The degree of prolapse or prolapse of the uterus.
2. The presence and nature of gynecological diseases accompanying uterine prolapse.
3. The need and possibility of restoring or maintaining menstrual and reproductive functions.
4. Patient's age.
5. The nature of dysfunction of the sphincters of the bladder, rectum, and colon.
6. Degree of anesthesiology and surgical risk in the presence of concomitant diseases.

Taking into account the combination of these factors, treatment tactics are determined, which can be either conservative or surgical.

Conservative treatment of uterine prolapse and prolapse

When the uterus prolapses, when it does not reach the genital slit and the functions of adjacent organs are not impaired, conservative treatment is used, which may include:

• physical therapy aimed at strengthening the pelvic floor muscles and abdominals(gymnastics according to Kegel, according to Yunusov);
• estrogen replacement therapy, which strengthens the ligamentous apparatus;
• local introduction into the vagina of ointments containing metabolites and estrogens;
• transferring a woman to lighter physical work.

If it is impossible to carry out surgical treatment for prolapse or prolapse of the uterus in elderly patients, the use of vaginal tampons and pessaries, which are thick rubber rings of various diameters, is indicated. The pessary contains air inside, which gives it elasticity and firmness. Once inserted into the vagina, the ring creates support for the displaced uterus. When inserted into the vagina, the ring rests against the vaginal vault and fixes the cervix in a special hole. The pessary should not be left in the vagina for a long time due to the risk of developing bedsores. When using pessaries to treat uterine prolapse, it is necessary to perform daily vaginal douching with chamomile decoction, solutions of furatsilin or potassium permanganate, and see a gynecologist twice a month. Pessaries can be left in the vagina for 3-4 weeks, followed by a break for 2 weeks.

Surgical treatment of uterine prolapse and prolapse

A more effective radical method of treating uterine prolapse or prolapse is surgery, the indications for which are ineffectiveness conservative therapy and a significant degree of organ displacement. Modern surgical gynecology for uterine prolapse offers many types of surgical operations that can be structured according to the leading feature - anatomical formation, which is used to correct and strengthen the position of organs.

The first group of surgical interventions includes vaginoplasty - plastic surgery aimed at strengthening the muscles and fascia of the vagina, bladder and pelvic floor (for example, colpoperineolevatoroplasty, anterior colporrhaphy). Since the muscles and fascia of the pelvic floor are always involved in the prolapse of the uterus, colpoperineolevatoroplasty is performed in all types of operations as a main or additional stage.

The second large group of operations involves shortening and strengthening the round ligaments supporting the uterus and fixing them to the anterior or posterior wall of the uterus. This group operations is not as effective and gives greatest number relapses. This is explained by the use of the round ligaments of the uterus, which have the ability to stretch, for fixation.

The third group of operations for uterine prolapse is used to strengthen the fixation of the uterus by suturing the ligaments together. Some operations in this group deprive patients of their ability to bear children in the future. The fourth group of surgical interventions consists of operations with fixation of displaced organs to the walls of the pelvic floor (sacral, pubic bone, pelvic ligaments, etc.).

The fifth group of operations includes interventions using alloplastic materials used to strengthen ligaments and fix the uterus. The disadvantages of this type of operation include a significant number of relapses of uterine prolapse, alloplast rejection, and the development of fistulas. The sixth group of operations for this pathology includes surgical interventions, leading to partial narrowing of the vaginal lumen. Last group operations include radical removal of the uterus - hysterectomy, in cases where there is no need to preserve reproductive function.

Preference for modern stage is given to combined surgical treatment, including simultaneously fixation of the uterus, vaginal plastic surgery, and strengthening of the ligamentous-muscular apparatus of the pelvic floor by one of the methods. All types of operations used in the treatment of uterine prolapse or prolapse are performed through vaginal access or through the anterior abdominal wall (abdominal or laparoscopic access). After the operation, a course of conservative measures is required: physical therapy, diet therapy to eliminate constipation, and avoidance of physical activity.

Prevention of uterine prolapse and prolapse

The most important preventive measures for uterine prolapse and uterine prolapse are compliance with rational regime, starting from the girl’s childhood. In the future, it is necessary to strictly comply with legislation in the field of women’s labor protection, to prevent severe physical work, lifting and carrying weights over 10 kg.

During pregnancy and childbirth, the risk of genital displacement increases. In the development of uterine prolapse, not only the number of births plays an important role, but also the correct management of pregnancy, childbirth and the postpartum period. Competently provided obstetric care, protection of the perineum, prevention protracted labor, choosing the right delivery method will help you avoid future troubles associated with uterine prolapse.

Important preventive measures in postpartum period are careful comparison and restoration of perineal tissue, prevention of septic complications. After childbirth, in order to prevent uterine prolapse, it is necessary to perform gymnastics that strengthens the muscles of the pelvic floor, abdominal muscles, and ligaments; in cases of traumatic labor, prescribe laser therapy and electrical stimulation of the pelvic floor muscles. In the early postpartum period, heavy physical activity is contraindicated. If women are prone to constipation, a diet aimed at preventing constipation is recommended, as well as special therapeutic exercises.

Particular attention should be paid to the prevention of uterine prolapse and prolapse during the premenopausal period: limit excessive physical activity, engage in therapeutic and preventive exercises and sports. In an effective way prevention of uterine prolapse during menopause is the appointment of hormone replacement therapy, which improves blood supply and strengthens the ligamentous apparatus pelvic organs.

Uterine prolapse 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 moves down to the entrance to the vagina or even falls outside 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 opening.

Doctors in describing this disease and its varieties use the concepts of “prolapse,” “prolapse,” “genital prolapse,” and “cystorectocele.” Prolapse of the anterior wall of the uterus, accompanied by a change in the position of the bladder, is called a “cystocele.” Prolapse of the posterior wall of the uterus involving the rectum is called “rectocele.”

Prevalence

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

How older woman, the higher the likelihood of such a disease. These conditions account for up to a third of all gynecological pathologies. Unfortunately, in Russia after the onset many patients long years They do not turn to a gynecologist, 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 common gynecological operations. Thus, in the USA, more than 100 thousand patients are operated on annually, spending 3% of the entire healthcare budget on this.

Classification

Normally, the vagina and cervix are tilted 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 anterior wall of the uterus, the posterior wall of the cervix and vagina is in contact with the rectum. Above the bladder top part The bodies of the uterus and the intestinal wall are covered with peritoneum.

The uterus is held in the pelvis by the force of its own ligamentous apparatus and the muscles that form the perineal area. When these formations become weak, they begin to sag or fall out.

There are 4 degrees of the disease.

1. The external uterine os descends to the middle of the vagina.
2. The cervix, together with the uterus, moves lower to the entrance to the vagina, but does not protrude from the genital slit.
3. The external os of the cervix moves outside the vagina, and the body of the uterus is located above, without coming out.
4. Complete prolapse of the uterus into the perineal area.

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

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

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

Causes and mechanism of development

The disease often begins at a woman’s fertile age, that is, before menopause. Its course is always progressive. As the disease develops, dysfunction of the vagina, uterus, and surrounding organs occurs.

For genital prolapse to occur, a combination of two factors is necessary:

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

Causes of uterine prolapse:

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

These factors in various combinations lead to weakness of the ligaments and muscles, and they become unable to hold the uterus in its normal position. Increased pressure in the abdominal cavity “squeezes” the organ down. Since the anterior wall is connected to the bladder, this organ also begins to follow it, forming a cystocele. The result is urological disorders in half of women with prolapse, for example, urinary incontinence when coughing or physical exertion. When the posterior wall subsides, it “pulls” the rectum with it, forming a rectocele in a third of patients. Uterine prolapse often occurs after childbirth, especially if it was accompanied by deep muscle tears.

Multiple births, intensive births increase the risk of illness exercise stress, 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 mainly 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 treatment success in this case are much greater.

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

Additional signs of uterine prolapse arising from pathology neighboring organs:

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

More than a third of patients experience pain during sexual intercourse. This worsens 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 dysynergia.

Varicose veins often develop with swelling of the legs, cramps and a feeling of heaviness in them, and trophic disorders.

Diagnostics

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

The woman needs to tell the gynecologist about the number of births and their course, previous 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 descended, finds defects in the pelvic floor muscles, and conducts functional tests - a straining test (Valsalva test) and a cough test. A rectovaginal examination is also performed 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 in case of organ prolapse, the results are distorted. Therefore, such a study 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). Typically, such studies are necessary if cystitis, proctitis, hyperplasia or cancer is suspected. Often, after surgery, a woman is referred to a urologist or proctologist for conservative treatment of identified inflammatory processes.

Treatment

Conservative treatment

Treatment of uterine prolapse should achieve the following goals:

• restoration of the integrity of the muscles that form the pelvic floor and their strengthening;
• normalization of the functions of neighboring organs.

Stage 1 uterine prolapse is treated conservatively on an outpatient basis. The same tactics are chosen for uncomplicated genital prolapse of the 2nd degree. What to do in case of uterine prolapse in mild cases of the disease:

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

Is it possible to pump up the abs when the uterus prolapses? When lifting the body from a lying position, intra-abdominal pressure increases, which further pushes the organ out. Therefore, therapeutic exercises include bending over, squats, and swinging legs, but without straining. It is performed in a sitting and standing position (according to Atarbekov).

At home

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

Massage

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

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

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

Surgery

How to treat grade III–IV uterine prolapse? If, despite all conservative treatment methods or due to the patient’s late request for medical help, the uterus has moved beyond the vagina, the most effective method treatment – ​​surgical. The purpose of the operation is to restore normal structure genital organs and correction of impaired functions of neighboring organs - urination, defecation.

The basis surgical treatment– vaginopexy, that is, securing the vaginal walls. In case of urinary incontinence, strengthening of the urethral walls (urethropexy) is simultaneously performed. If there is weakness of the perineal muscles, they undergo plastic surgery (restoration) with strengthening of the cervix, peritoneum, and supporting muscles - colpoperineolevatoroplasty, in other words, suturing the uterus during prolapse.

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

During laparotomy (incision in the anterior abdominal wall) surgery for uterine prolapse involves fixing the vagina and cervix own tissues(ligaments, aponeurosis).

Sometimes laparoscopic access is used - a low-traumatic intervention, during which the vaginal walls can be strengthened and defects in the surrounding tissue can be sutured.

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

Vaginal colpopexy (strengthening the cervix through the vagina) can be performed under conduction, epidural anesthesia, intravenous or endotracheal anesthesia, which expands its use in older people. This surgery uses a mesh implant to strengthen the pelvic floor. The duration of the operation is about 1.5 hours, 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 long term– erosion of the vaginal wall.

Laparoscopic surgery is performed under endotracheal anesthesia. During it, a mesh prosthesis is also used. Sometimes amputation or hysterectomy is performed. The surgical field requires early activation of the patient. Discharge takes place 3-4 days after the intervention, outpatient rehabilitation lasts up to 6 weeks.

For 6 weeks after surgery, a woman should not lift weights exceeding 5 kg; sexual rest is required. Physical rest is also necessary for 2 weeks after the intervention, after which you can do light housework. Average term temporary disability ranges from 27 to 40 days.

What to do in the long term after surgery:

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

Features of treatment of pathology in old age

Gynecological ring (pessary)

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

Therefore, a bandage will provide significant assistance to a woman with uterine prolapse. 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 pain in the lower abdomen. Pick up good bandage It’s not easy, a gynecologist should help with this.

A woman must perform therapeutic exercises.

In case of significant loss, carry out surgery, often this is removal of the uterus through vaginal access.

Consequences

If the disease is diagnosed in a woman of fertile age, she often has the question of whether it is possible to become pregnant if the walls of the uterus prolapse. Yes, there are no special obstacles early stages to conception does not occur if the disease is asymptomatic. If the prolapse is significant, then before a planned pregnancy it is better to undergo surgery 1-2 years before conception.

Maintaining pregnancy with proven uterine prolapse is difficult . Is it possible to carry a child to term with this disease? Of course, yes, although the risk of pregnancy pathology, miscarriage, premature and rapid labor, and bleeding in the postpartum period increases significantly. In order for the pregnancy to develop successfully, you need to be constantly monitored by a gynecologist, wear a bandage, use a pessary if necessary, do physical therapy, take medications prescribed by a doctor.

What are the dangers of uterine prolapse besides possible problems with pregnancy:

• cystitis, pyelonephritis – urinary system infections;
• vesicocele - a saccular expansion of the bladder in which urine remains, causing the sensation of incomplete emptying;
• urinary incontinence with perineal skin irritation;
• rectocele - expansion and prolapse of the rectal ampulla, accompanied by constipation and pain during bowel movements;
• infringement of the intestinal loops, as well as the uterus itself;
• uterine inversion followed by necrosis;
• deterioration in the quality of sexual life;
• decrease in overall quality of life: a woman is embarrassed to go out public place, because she is constantly forced to run to the toilet, change incontinence pads, it exhausts her constant pain and discomfort when walking, she does not feel healthy.

Prevention

Prolapse of the uterine walls can be prevented in this way:

• minimize prolonged traumatic labor, if necessary, by eliminating the period of pushing or performing a caesarean section;
• promptly identify and treat diseases accompanied by increased pressure in the abdominal cavity, including chronic constipation;
• if ruptures or cuts in the perineum occur during childbirth, carefully restore the integrity of all layers of the perineum;
• recommend that women with estrogen deficiency take replacement therapy hormone therapy, in particular, during menopause;
• prescribe special exercises to strengthen the muscles that form the pelvic floor for patients at risk of genital prolapse.

Displacement in the normal position of the uterus affects not only it. The fact is that, as the uterus moves, it naturally leads to prolapse of the vaginal walls, vaginal eversion, exit of the vagina and cervix beyond the genital slit, compression of the bladder, compression of the intestines. All this is a more or less complete set of troubles that the prolapse of the anterior wall of the uterus promises - effective treatment. This article is intended to discuss the problem of how to treat prolapse of the anterior wall of the uterus. Effective treatment is possible when the problem reaches the stage of severe uterine prolapse.

Prolapse of the anterior wall of the uterus - the essence of the problem

The main problem is that a woman with uterine prolapse almost completely loses the joy of sexual life. Violation of the position of the uterus primarily affects the vagina. The vaginal mucosa has a folded, elastic structure, a structure with a mass of nerve endings. Constant physical pressure leads to loss of sensitivity, disruption of the integrity of the integument in the flesh, until bloody discharge appears. And this is not all that the prolapse of the anterior wall of the uterus threatens for a woman.

What needs to be done to stop the disorder and effectively stop the prolapse of the anterior wall of the uterus in time.

Prolapse of the anterior wall of the uterus - effective treatment

When pulling, cutting, stabbing pains lower abdomen, consult a gynecologist. An examination will immediately allow you to diagnose the problem of prolapse of the uterine wall. With a doctor, you can find the optimal solution to the problem in a particular case.

Feel the vagina yourself. Index finger, try the vaginal wall facing the peritoneum. If you feel this painful sensation, and you observe edema and swelling, then the sign clearly indicates prolapse of the anterior wall of the uterus.

The drooping of the anterior wall may be noticeable from the outside. The genital fissure will swell, and the edge of the vagina will become visible from the outside. The painful effect is in most cases very strong. Therefore, it is impossible to ignore the problem.

The appearance of excessive discharge, ichor or bloody discharge may also indicate not a prolapse, but a prolapse of the uterus.

The prolapse of the anterior wall of the uterus causes a pain effect that can no longer be confused with pain during menstruation, cystitis or other bacterial diseases. Feeling foreign object in the vagina, discomfort, difficulty urinating, constipation, all this may indicate a growing problem.

Do not ignore pain, they most likely indicate that you should pay attention to your body and do it as quickly as possible. It is recommended that you fully obtain the doctor’s advice and the treatment he proposes for uterine prolapse.

Hello, dear readers! Prolapse of the uterus and vaginal walls is one of the most common pathologies in gynecology. According to some reports, more than a third of women after 45 years suffer from this disease. The high relevance of the problem requires a certain alertness and competence of ladies in these matters. What is the essence of the disease, why does it appear and how to recognize it in time - read about all this in the article.

The essence of pathology and terminology

Prolapse or prolapse is a disease characterized by the displacement of the internal genital organs outward. Genital prolapse develops due to incompetence of the muscles and ligaments of the pelvis and abdominal cavity. Final stage pathological process is genital prolapse.

Genital prolapse is classified depending on what kind of displacement of organs or their parts occurs. Thus, there is prolapse of the anterior or posterior vaginal wall, prolapse of the uterus, or vaginal vault. Sometimes listed violations combine. It is also worth considering that along with the anterior vaginal wall, the bladder and urethra, with the posterior wall there is often an outward displacement of the rectum. Regardless of the topography of the internal genital organs and, accordingly, the type of prolapse, these pathological changes have the same causes of development, similar manifestations, as well as the principle of treatment.

Causes

Women who have given birth are most susceptible to prolapse of the uterus and vaginal walls. As the uterus enlarges during pregnancy, additional stress is placed on the pelvic muscles. Mothers of twins or those who have given birth to a large child have a greater risk of getting sick. There is also a risk of prolapse in women who have suffered complications during childbirth.

Other factors leading to the development of the pathological process include the following:

• Genetic predisposition.
• Injuries and previous surgical interventions in the pelvis and abdominal cavity.
• Persistent cough, prolonged sneezing.
• Chronic constipation.
• Lifting weights.
• Obesity.

Experts note an increase in incidence with age. This negative trend is primarily associated with the aging of the body and hormonal changes. A significant risk of developing the disease begins after menopause, as the amount of estrogen decreases, which affects muscle tone throughout the body.

Symptoms

Symptoms of prolapse of the uterus and vaginal walls differ depending on the degree of development of the disease. Thus, in the early stages the pathology practically does not manifest itself. There may be periodic pain in the lower abdomen, which is not considered a manifestation of a serious illness. But it is possible to detect prolapse at this stage. To do this, it is enough to conduct a gynecological examination, during which a low location of the cervix and one or two walls of the vagina will be revealed.

Over time, symptoms of prolapse will begin to appear, and genital prolapse is characterized by their progression. Main manifestations of the disease:

• Pain syndrome of the pelvis and lower abdomen (women note its intensification after physical activity).
• Severe pain when trying to have sexual intercourse.
• Determined visually at gynecological examination downward displacement of the uterus and/or protrusion of the vaginal wall.
• Feeling of pressure on the vaginal wall.
• Problems with urination (inability to hold or retain urine).
• Problems with stool (fecal incontinence, constipation or intestinal obstruction).

If the disease is not treated in time, genital loss is inevitable. Manual repositioning of the organ does not solve the problem, since prolapse occurs immediately when the woman takes vertical position bodies. Injury to the uterus and vagina by rubbing them against underwear causes severe pain, there is a high probability of erosion and inflammation of the membranes, bleeding, etc.

Principles of treatment and prevention

In the treatment of genital prolapse, two main directions can be distinguished - conservative and surgical. The first method can only be used in the early stages of prolapse. It includes following methods: Kegel exercises, special genital massage, wearing uterine rings, orthopedic underwear, etc. The effectiveness of the procedures is relatively low - treatment takes a lot of time and requires patience.

Surgical treatment aims to strengthen the pelvic supporting apparatus artificially. IN modern clinics Operations with the installation of mesh prostheses are predominantly used. Other methods are used much less frequently and acquire historical significance.

Taking care of your health will help prevent the development of pathology. Try to normalize your weight, start exercising and eating right. In any case, on will benefit intimate gymnastics. But the main thing that is required from every woman is vigilance. If you notice the first signs of prolapse of the uterus or vaginal walls, consult a doctor as soon as possible. Go to the gynecologist annually for a medical examination, since the initial stages of not only prolapse, but also other gynecological diseases can be asymptomatic.

What to remember

1. Prolapse of the uterus and one or two vaginal walls can develop in isolation or a combination of these processes is observed.
2. Genital prolapse, regardless of which organ is affected, has common reasons development, similar manifestations and treatment tactics.
3. Diagnosis of uterine and vaginal prolapse is based on the symptoms of the pathology, but a gynecological examination is crucial.
4. Treatment of prolapse without surgery can only be performed in the early stages.

See you in the next article!