Severe uterine prolapse what to do. Uterine prolapse: causes, signs, conservative and radical treatment. Uterine prolapse - symptoms and treatment. Gymnastics

A change in the position of the uterus is called prolapse or prolapse. In the initial period, the disease is hidden and asymptomatic, but in the future it can cause serious consequences. What are the symptoms and treatment of uterine prolapse, how dangerous is this disease.

Causes of physiological displacement

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

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

When the pathology occurs in the initial stages, the patient complains of a feeling of pressure, discomfort, and nagging pain in the lower third of the abdominal cavity. As the disease progresses, problems with urination begin; the woman discovers a large amount of pathological vaginal discharge mixed with blood. A displaced and prolapsed organ can cause a serious complication - partial or complete prolapse.

When the organ continues to descend and the disease progresses, the woman experiences physical and mental suffering. Complete loss of performance is possible.

Degrees of displacement

With complete or incomplete prolapse, nearby pelvic organs are involved in the pathological process. If the anterior wall of the vagina is involved in the process along with the uterus, it is called a cystocele, if the posterior wall is called a rectocele.

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

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

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

Reasons for displacement

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

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

Reasons for omission:

Surgical interventions.
Hormonal imbalance in combination with connective tissue dysplasia, excessive physical activity during menopause.
Excess body weight.
Intestinal motility disorders (frequent constipation).
Chronic cough.
Abortion.
Hormonal deficiency.
Numerous and long labors.
Birth injuries
Neoplasms of malignant and benign nature of the pelvic organs.
Neurological diseases in which the innervation of the genitourinary diaphragm is impaired.

Basically, a single cause is not enough for a disease to develop. Typically, prolapse with organ prolapse is the result of several unfavorable factors.

Uterine prolapse after childbirth as a complication is equally common both after natural delivery and after cesarean section.

Symptoms of the initial stage

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

The following are one of the menstrual disorders:

Hyperpolymenorrhea - heavy menstruation with preserved frequency.
Algodysmenorrhea - menstruation with constant pain and accompanied by disturbances in bowel function and psycho-emotional disorders.

Between menstruation, profuse leucorrhoea appears, sometimes streaked with blood.

In the initial stage, the patient begins to experience discomfort during movements.

Pregnancy with uterine prolapse is usually impossible.

Cervical prolapse is a serious obstacle to healthy conception and pregnancy. The probability of fading and intrauterine fetal death reaches 95%.

Symptoms of a developed disease

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

At the second and third stages of the disease, overstretching of the ureters and expansion of the renal-pelvic system are observed. A lowered cervix is susceptible to injury, and the risk of developing cancer in a woman increases.

Of the proctological complications that occur in 30% of cases of the disease, women are concerned about constipation and colitis. Possible incontinence of feces and gases.

What does a prolapsed uterus look like: shiny or matte, with cracks or abrasions. From trauma while walking and sitting, ulcerations and bedsores form on the bulging surface. Wound mucosal surfaces bleed and quickly become infected.

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

Sex during uterine prolapse is usually impossible: discomfort, pain, unpleasant sensations. During sexual contact, vaginal inversion can occur, which can cause severe psychological trauma for a woman.

Physiological prolapse

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

Physiological cervical prolapse in late pregnancy can be identified by the following symptoms:

The contours of the abdomen change.
Digestive discomfort goes away.
The pressure on the diaphragm is relieved. The shortness of breath goes away and the woman breathes easier.
Frequent urge to urinate.
Difficulty walking.
Sleep disorders.

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

If pathology is detected before 36 weeks, then to prevent the threat of miscarriage, the pregnant woman is hospitalized for conservation.

Diagnostic measures

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

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

To determine the causes of uterine prolapse, the following are additionally prescribed:

Colposcopic examination.
Hysterosalpingoscopic examination.
Ultrasound examination, computed tomography.
Bacterial culture of vaginal flora.
Urine culture for bacterial flora.
Excretory urographic study.

The gynecologist prescribes consultations with related specialists: proctologist, urologist, endocrinologist.

A woman with a confirmed diagnosis is registered with a dispensary.

Therapeutic measures

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

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

Based on the aggregate data, the choice of therapeutic tactics is determined: surgical or conservative.

Conservative therapy

If the pathology does not cause disturbances in the functioning of adjacent organs, the body of the uterus is located above the genital slit, conservative therapy is indicated. Treatment without surgery for uterine prolapse includes: gymnastics, massage, use of special tampons, pessaries. In conservative therapy, the doctor may include special replacement therapy, vaginal medications with metabolites and estrogens.

Physiotherapy

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

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

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

As a preventive measure, a gymnastic course is indicated for women with congenital weak muscles and ligaments, and those with excess body weight.

Gynecological massage course

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

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

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

Obstetric pessaries

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

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

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

But this treatment has its disadvantages:

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

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

A woman should visit a specialist twice a month.

Home treatment

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

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

Tincture of astragalus roots.
Herbal collection of white claret, linden flowers, alder roots, lemon balm.
Quince infusion.
Herbal mixture of St. John's wort, calendula, burnet.

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

Surgery

When the uterus prolapses, surgery is inevitable if conservative methods to cure the pathology are ineffective.

Possible surgical methods:

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

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

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

Avoid sexual intercourse completely.
Avoid physical activity and heavy lifting.
Avoid baths and use showers for hygiene procedures.
Don't use tampons.

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

Forecast

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

Uterine prolapse in women is a pathology characterized by displacement of an organ relative to its normal position. It can lead to changes in the location of other organs or complete prolapse of the uterus. Treatment is surgical, but in the initial stages it can be corrected with exercises at home. The effectiveness of gymnastics is quite high if performed regularly. Prevention includes an active lifestyle and giving up bad habits.

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Description

Prolapse refers to the displacement of the uterine fundus relative to its normal position. Prolapse leads to various consequences, the most unpleasant of which is complete loss of the organ. Pathology occurs mainly in the climatic period, but can develop earlier.

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

The main functions of the muscular frame are:

keeping organs in the abdominal cavity in a normal position;
fetal advancement during the pushing period of labor;
maintaining optimal intra-abdominal pressure.

The uterus in its normal position is also supported by the ligamentous apparatus, which consists of the round and broad ligaments. The reasons for organ descent are impaired muscle tone and weakening of ligaments. The uterus can be located at the entrance to the vagina or come out completely.

Causes

The following factors directly influence the displacement of the genitals:

Cause	Description
Birth injuries	Complications during childbirth arise due to incorrect actions of midwives, large fetuses, multiple pregnancies
Weight lifting	Pathology develops with regular lifting of a load weighing more than 10 kg
Chronic constipation	Constant straining causes microtrauma and weakening of the ligamentous apparatus
Tears in the perineal area	The main reason for their appearance is a difficult birth or episiotomy. Can also occur due to physical impact
Surgery	Any interventions on the pelvic organs increase the likelihood of developing adhesive disease and decreased muscle contractility. The most common of these is a caesarean section.
Nervous disorders	Caused by pathologies of the nerves that innervate the pelvic organs
Hormonal imbalances	The development of pathology is facilitated by a decrease in estrogen production during menopause
Connective tissue dysplasia	Varicose veins, hernias, joint dysplasia
Other reasons	Constant cough, developmental abnormalities of the reproductive organs, obesity, hereditary predisposition, the presence of tumors in the uterine walls

Prolapse after childbirth

Pathology does not always occur in women during menopause. Although rare, prolapse also occurs in young patients (postpartum form of the disease).

The reasons are considered:

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

Stages and symptoms

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

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

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

Degrees of uterine prolapse

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

The symptoms of the disease are difficult to diagnose in a timely manner. Prolapse may not cause pain for a long time.

The most striking symptoms:

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

There are 4 degrees of uterine prolapse:

1. The distant point of the uterus is located above the vulvar ring.
2. Becomes flush with the vulva.
3. Drops 1 cm lower.
4. Complete loss of the organ is observed.

There is a Malinowski classification, according to which there are threedegrees of omission:

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

Diagnostics

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

To confirm the diagnosis, the following studies are performed:

cytology;
microbiological examination of a smear;
hormonal tests.

Also assigned:

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

Treatment

Various techniques are used in the treatment of the disease. Their choice depends on the following factors:

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

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

Exercise therapy - increases the tone of the pelvic muscles;
Kegel exercises;
therapeutic gynecological massage;
hormonal therapy with estrogen (helps improve muscle tone);
limiting physical activity.

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

Installation of a pessary

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

Diet

Nutritional adjustments are extremely important in the treatment of prolapse. Its goal is to increase muscle tone. To do this, the following requirements must be met:

minimizing fatty foods;
eating more proteins;
the predominance of vitamin-rich vegetables and fruits in the menu;
consumption of dairy and fermented milk products.

Surgical intervention

There are several surgical techniques:

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

Alloplasty

Traditional methods

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

The most effective folk remedies are:

Quince. Improves muscle tone of the uterus and rectum. Used in the form of compote for daily use. Water and dry fruits are mixed in a ratio of 10:1 and boiled over low heat.
Datura. Take 20 g of herb per 7 liters of water, steam and infuse for 30 minutes. The decoction is added to the bath.
Melissa. Steam the leaves of the plant in a thermos overnight. Take half a glass daily.
Elecampane. 1 tbsp. l. the herbs are poured with half a liter of vodka and infused for 10 days in a cool place. Take 1 tsp. in the morning, on an empty stomach.

Physical exercise

Exercises help eliminate pathology at an early stage of development. The main condition is regular daily implementation.

The most effective:

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

Abdominal exercises help treat prolapse:

For the lower one: raising the legs from a lying position.
For the top: raising the body.
Exercises “Scissors”, “Bicycle” and “Birch”.

Kegel gymnastics is considered the most popular and effective. The main essence of this set of exercises is to tense the muscles of the perineum. There are no contraindications to the procedure; they can be performed at any time. The effect occurs only with regular exercise. Every day you need to do several approaches.

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

Consequences and prevention

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

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

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

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

Update: October 2018

The list of gynecological diseases is very wide and not the last place in it is occupied by such a pathology as uterine prolapse. In principle, this formulation is incorrect, since it does not reflect the full depth of the disease.

The scientific name for uterine prolapse is genital prolapse. It affects women not only of menopausal age (see), but also quite young ones. The incidence of pathology increases as the number of years lived increases:

up to 30 years of age, genital prolapse occurs in 10%
at the age of 30 – 45 years, prolapse is registered in 40%
at 50 years of age and older, the pathology is detected in every second woman

Genital prolapse – what is it?

A strong frame consisting of muscles and connective tissue prevents the uterus, bladder, small intestine and rectum from extending beyond the abdominal cavity. The pelvic floor or pelvic diaphragm is represented by three layers of muscles, which not only support the genital and other muscles within the small pelvis, but also ensure the closure of the genital fissure, narrow the lumen of the rectum, participate in maintaining intra-abdominal pressure and play an important role in the process of childbirth. In addition to the pelvic floor, the uterus is supported by the ligamentous apparatus (various ligaments of the uterus itself).

Uterine prolapse is said to occur when it and its cervix are displaced and are below the anatomical and physiological boundaries, as a result of which the genitals descend to the entrance to the vagina or fall beyond its limits. Thus, genital prolapse is caused not only by the failure of the muscular layer of the pelvic floor, but also by stretching and/or damage to the ligaments supporting the uterus.

What causes uterine prolapse?

From the above, it becomes clear that genital prolapse is caused by a disorder due to weakening or injury to the pelvic floor muscles and ligaments that support the uterus. Prolapse of the uterine walls is caused by many reasons, which can be divided into 4 groups:

traumatic injury to the pelvic floor;
so-called “systemic” underdevelopment of connective tissue (presence of hernias of various locations, joint dysplasia, etc.);
impaired production of steroid hormones;
extragenital diseases (metabolic disorders, microcirculation).

Childbirth

The main factor that leads to genital prolapse is the birth process. The more births a woman has in her history, the more likely the development of the described pathology is. But uterine prolapse can develop after the first birth. It all depends on how they proceeded. Prolonged labor, especially a long period of pushing, abnormal labor forces, delivery of the fetus in the breech presentation or the application of obstetric forceps or the use of vacuum extraction of the fetus leads to injuries to the pelvic floor muscles. Heavy physical activity, in particular constant lifting or carrying heavy objects, is also of great importance. Even healthy women are not recommended to lift anything heavier than 5 kg.

Woman's age

The age of a woman is also important, the older she gets, the less tone of the abdominal muscles, and of course, the pelvic floor, and in addition, in the pre- and menopausal period, the production of sex hormones decreases, which determine the tone of muscle tissue and the elasticity of connective tissue decreases ( cm. ).

Injuries and surgeries

Surgeries and injuries in the perineum and vagina can lead to damage to small arteries, veins and nerves, which disrupts the nutrition of the pelvic floor muscles, and therefore its supporting function. Gynecological operations, specifically the removal of the uterus, lead to disruption of the anatomical relationship of organs in the pelvis, which subsequently provokes genital prolapse.

Constipation

In addition, constant constipation and cough contribute to an increase in intra-abdominal pressure, as a result of which the organs located in the pelvis are squeezed out, that is, into the vagina.

Obesity, hormonal disorders

Obesity also plays a role in uterine prolapse, both due to hormonal imbalances and lack of muscle tone.

Genetic disposition

Genetic predisposition, that is, “systemic” underdevelopment of connective tissue, also occurs with this pathology. Thus, in Spanish and Asian women or in women with a family history of connective tissue diseases (astigmatism, mitral valve prolapse, etc.), genital prolapse is much more common.

As a rule, several factors play a role in the development of the disease. When the consistency of the pelvic floor is disrupted and the supporting ligaments are stretched, the uterus is pushed into the vagina due to increased intra-abdominal pressure, and in parallel, the anterior vaginal wall prolapses along with the bladder, which is called a cystocele and the posterior wall along with the rectum (rectocele). In addition, filling the bladder and/or rectal ampoules increases the pressure in them, which increases prolapse of the vagina and uterus. Thus, a vicious circle is formed.

Classification of uterine prolapse

It should be noted that prolapse, and subsequent uterine prolapse, always goes “hand in hand” with vaginal prolapse. The following degrees of uterine prolapse are distinguished:

the first degree is said to be when the cervix reaches the middle of the vagina or is higher;
the second degree is characterized by displacement of the cervix and vaginal walls to the vestibule of the vagina;
in the third degree, the cervix and vaginal walls are located outside the vagina, and the uterus itself is localized in the vagina;
if the uterus is located outside the vagina, they speak of fourth degree or complete uterine prolapse.

How does genital prolapse manifest?

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

Discomfort, pain

The initial stages of genital prolapse are characterized by discomfort and nagging pain in the lower abdomen, stretching in the lower back and/or sacrum, which goes unnoticed by most patients and is regarded as signs of future menstruation. When the uterus prolapses, an increase in these symptoms is observed after physical work and heavy lifting, while walking. Later, unpleasant sensations or even pain appear during coitus, sex does not bring the same pleasure, and in the future it becomes impossible at all.

Foreign body sensation

In addition, a woman may notice “something extra, interfering with the vagina,” such as a foreign body. Leucorrhoea appears, and bloody discharge is also possible due to mechanical injury to the walls of the vagina, cervix and uterus. The patient can independently feel the cervix of the uterus or even the uterus itself (in case of prolapse) in the area of the genital slit.

Menstrual irregularities

There is also a disturbance in menstrual function (see). Menstruation becomes abundant and prolonged, and sometimes algomenorrhea develops. In case of genital prolapse, the development of infertility is not excluded, although pregnancy itself is also not excluded.

Urological disorders

When the anterior wall of the vagina and uterus prolapses, a cystocele often develops. This pathology provokes the development of urological disorders. Noted:

difficulty urinating
the bladder does not empty completely
urine stagnates in it, becomes contaminated with pathogenic microorganisms, which leads to infection of the lower and upper urinary tract
long-term genital prolapse contributes to the development of ureteral stenosis, hydroureter and hydronephrosis
Often, when the uterus prolapses, a symptom such as stress incontinence occurs (that is, when coughing, sneezing or laughing, see).

Rectal prolapse

If the back wall of the vagina and uterus prolapse, a rectocele (prolapse of the rectum) often develops. Proctological problems arise: constant constipation, which on the one hand is a consequence of the disease, and on the other hand provokes the progression of genital prolapse. There is an inability to retain gases and feces, and colitis often develops (see symptoms of intestinal colitis).

Varicose veins of the lower extremities

As the disease progresses, manifestations of varicose veins of the lower extremities increase. Firstly, this is due to impaired venous outflow due to changes in the location of organs in the pelvis, and on the other hand, it is due to insufficiency of connective tissue.

Ulcers of the cervix and vagina

During prolapse, the mucous membrane of the uterus and vagina becomes shiny, cracks and becomes covered with abrasions due to constant injury and drying out. As a result, ulcers form on the cervix or vaginal walls, which bleed and become infected. Such ulcerations are very difficult to treat.

Case study: I had a very old woman registered at the antenatal clinic - 80 years old. The diagnosis was: Complete prolapse of the uterus and vagina. Incompetence of the pelvic floor muscles. Stress incontinence. The patient’s uterus was constantly located outside the genital slit, but she refused to wear pessaries, and due to her age, surgery was contraindicated for her. Naturally, she was periodically treated in gynecology for a trophic ulcer of the cervix. She was prescribed ointments with levomekol, solcoseryl,... Each time she was treated for quite a long time and was discharged not even with recovery, but with improvement. But, thank God, it didn’t lead to swelling or bedsores. This is how the woman suffered for the rest of her life. From the anamnesis it is known that there were 4 births, she was engaged in hard work all her life, plus the post-war period, when men were worth their weight in gold - all these factors could not but lead to genital prolapse. Indeed, at a time when the patient was still quite a young and healthy woman, these operations were rarely performed and were considered a luxury.

Diagnostics

To establish a diagnosis, complaints are collected, anamnesis is studied and a gynecological examination is performed. A rectovaginal examination is mandatory. During the examination, the degree of prolapse, the presence or absence of rectocele and cystocele are determined. Each patient undergoes colposcopy. In addition, the following tests are prescribed:

smear on vaginal microflora;
cytology smear;
determination of hormonal status;
general and bacteriological urine tests.

It is also necessary to conduct a gynecological ultrasound with a vaginal sensor (if there are pathological changes in the pelvic organs, the issue of their removal is decided). Excretory urography is prescribed in the presence of cystocele, ultrasound of the kidneys according to indications. If a pathology is detected on a gynecological ultrasound, hysteroscopy with diagnostic curettage of the uterus () is prescribed.

Treatment

When the uterus prolapses, treatment can have 2 directions: conservative and surgical. To decide on treatment tactics for genital prolapse, the doctor evaluates a number of factors:

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

What to do if the uterus prolapses? I would like to make a reservation right away. Uterine prolapse must be treated. Conservative treatment methods are not very effective, and they are used only in the early stages of the disease (genital prolapse of 1st - 2nd degree).

Physiotherapy

Exercise therapy is more of a preventive measure for uterine prolapse than a therapeutic one. And, nevertheless, in the initial stages of the disease, therapeutic exercises according to Atarbekov and Yunusov are prescribed. Kegel exercises for uterine prolapse have also not lost their relevance and are aimed at maintaining tension in the pelvic floor muscles.

Bandage

A device such as a bandage is also used for prolapse of the uterus, only in the initial stages of the disease. The design of the bandage is such that it “encircles” the hips, as well as the perineum, due to which the uterus is in the correct position, and pain and discomfort associated with genital prolapse disappear. But wearing a bandage is only a palliative measure, not a curative one. Although wearing it is indispensable after childbirth to restore the elasticity of the pelvic floor muscles, as well as after surgical plastic surgery for genital prolapse.

Use of pessaries

Vaginal pessaries are recommended for patients with grades 3–4 of the disease, for whom surgical treatment is for some reason contraindicated. Pessaries (polyvinyl chloride rings) can be worn for a long time; a single course lasts 1 month, after which a break is necessary. The ring is installed and removed only by doctors. Once every 3–7 days, it is necessary to change the pessary with aseptic treatment of the latter. Vaginal rings are also not a therapeutic measure; they only hold the uterus within the pelvis. The disadvantages of pessaries include stretching of the vagina, which aggravates prolapse.

Surgical treatment

But surgery remains a radical measure for uterine prolapse. There is no “ideal operation” for this pathology. Any surgical intervention has its pros and cons. All types of surgical intervention are divided into several groups:

operations that aim to strengthen the pelvic floor muscles - colpoperineolevatoplasty (this is usually the vaginal stage of a two-stage operation);
operations on the uterine ligaments (shortening and suturing of the round ligaments to the anterior wall of the uterus);
surgical strengthening of the ligaments that fix the uterus (cardinal, uterosacral) - the operation disrupts the patient’s reproductive function;
rigid fixation of the uterus and vagina to the pelvic walls (sewn to the pubic symphysis, sacral bone, and others);
operations using alloimplants (endoprostheses);
operations that partially narrow the vagina;
hysterectomy (if there are additional indications).

Surgical intervention can be performed through vaginal access, by transection or laparoscopically, simultaneously or in several stages. The percentage of recurrences of uterine prolapse remains high (reaches 30%). In the postoperative period, it is important to follow the doctor’s recommendations:

restriction of carrying heavy objects (no more than 5 kg) for 1.5 months;
sexual rest for 6 weeks;
a ban on physical activity for 2 weeks, then minor physical activity is allowed.

Subsequently, you should monitor your bowel function, empty your bladder on time, promptly treat diseases of the bronchopulmonary system, avoid carrying heavy objects and engage in certain sports (cycling, rowing).

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The uterus is the most important reproductive organ of a woman, located in the middle part of the pelvic cavity.

However, for a number of reasons, it can shift from its anatomical position, which causes a number of problems that not only complicate daily life, but also pose a threat to overall health.

What it is? Uterine prolapse is the result of weakening of the pelvic muscles, which hold the internal organs in a certain position. Another name for the displacement of the uterus down to the inguinal canal is prolapse.

The pathology affects not only the reproductive organ itself, but also the cervix, fallopian tubes and ovaries, which also change their location.

Causes of prolapse

Lifting weights. Excessive tension can tear the internal muscles that hold the uterus in a certain position. Damage to the muscle fibers will significantly weaken the tone and the body of the uterus will gradually descend.
Difficult birth. Normally, the muscles located in the pelvic cavity should restore their elasticity within several weeks after childbirth. However, during a complicated birth process, ruptures can occur, which subsequently lead to atrophy of muscle fibers. As a result, the fundus of the uterus in the postpartum period cannot rise to the level at which it was before pregnancy.
Elderly age. The older a person gets, the weaker his muscle tone becomes. This is partly to blame for the decrease in estrogen levels in the blood that occurs with the onset of menopause.
Surgical operations that resulted in serious damage to the pelvic floor muscles.

General symptoms of uterine prolapse

At the very initial stages, the disease may not make itself felt. But if there is no treatment, then after a while the woman begins to notice the following symptoms:

Pressing sensations in the lower abdomen.
Aching pain in the pelvic area, which intensifies before menstruation and in its first hours.
Inconvenience and pain during sexual intercourse.
Long periods that are much heavier than before.
Sensation of a foreign body in the vagina.
Pain in the lower abdomen that begins immediately after lifting heavy objects.
Intermenstrual bleeding.
Constipation resulting from compression of the rectum by the displaced uterus.

If all the signs of uterine prolapse are ignored, and treatment has not been started, then it begins to fall out of the vagina, and this stage of the disease can no longer be corrected with exercises alone.

Gynecologists distinguish 4 degrees of prolapse, and each of them has its own symptoms and clinical picture upon palpation.

The uterus can be displaced either completely or partially. Therefore, doctors have developed an appropriate classification of the pathological condition of the main organ of the woman’s reproductive system:

Displacement of the anterior vaginal wall.
Displacement of the posterior vaginal wall.
Displacement of the uterine body (including prolapse of only the anterior or only the posterior wall of the uterus).
Displacement of the posterior vaginal vault.

Actions for prolapse depend on the degree of displacement; now I will talk about the symptoms and treatment of uterine prolapse depending on the degree.

First degree prolapse

The uterus is slightly displaced, the cervix has dropped into the vagina a few centimeters, but is not yet visible from the outside. When straining, the pharynx of the cervical canal can be felt at a distance of 1-2 centimeters from the vulva.

Symptoms: pulling sensations in the abdomen, minor stool disorders, discomfort during sexual intercourse. If there has been no change of sexual partner, then the woman may notice that discomfort is felt when the penis fully enters the vagina.

Treatment for first degree prolapse: In such cases, surgical intervention is not provided and correction of the position of the uterus is performed using special exercises.

Kegel exercises- every time a woman urinates, she should try to hold back the stream of urine. This trains not only the muscles of the urethra, but also the muscles of the vagina. Another one of the Kegel exercises is that the patient needs to do several series of tensions of the pelvic floor muscles throughout the day. To do this, they need to be squeezed and fixed in this position for 10 seconds, then relaxed for the same time and squeezed again. The number of approaches during the day during the first stage of prolapse can be any, but the main thing is to perform them regularly.
Leg exercises– “scissors” training effectively helps with uterine prolapse. To do this, you need to lie on your back, raise your outstretched legs up, lift your shoulder girdle off the floor and start swinging with straight legs. In one approach you need to perform 3-4 series of “scissors” exercises.

It should be taken into account that such training should be carried out over at least several months. If you practice only a few times, it will not bring any effect. And older women need to perform exercises from time to time after a course of exercise therapy to prevent relapse of prolapse.

Second degree prolapse

The uterus is significantly displaced, the cervical canal is located near the entrance to the vagina. When straining (often during bowel movements), the cervical os falls out. When the pushing stops, it moves back into the vagina on its own.

Symptoms: premenstrual pain, pulling sensations in the lower abdomen throughout the entire period of menstruation, cutting pain during sexual intercourse, short-term aching pain in the vagina during bowel movements.

Treatment for second degree prolapse: To correct the position of the uterus, complex therapy is required, which includes the following components:

Exercise therapy - for several months the patient is prescribed to perform special exercises for prolapse of the uterus - Kegel, “scissors” and “bicycle” exercises in a lying position.
An obstetric pessary is a ring that the gynecologist inserts into the vagina to prevent the body of the uterus and the cervix from descending even lower. The doctor will select the type of device based on the clinical picture of the disease. However, if severe intermenstrual bleeding is observed, then rings cannot be inserted with such complicated uterine prolapse.

Third degree prolapse

The uterus is completely lowered into the vagina, the cervix partially falls out and does not move inward on its own. When straining, it falls out an additional few centimeters. Sexual life becomes impossible, fast walking and playing sports, too.

Symptoms: constant aching pain in the lower abdomen, constant sensation of a foreign body in the vagina. Menstruation is heavy, long, painful. STDs are getting worse, the main reason for this is the cervix, which is constantly in contact with the external environment. Urinary incontinence and constipation are noted.

Treatment for third degree prolapse: in this case, neither exercises nor an obstetric pessary will help. The patient is indicated for surgical intervention and a course of antibiotics, since the prolapsed cervical canal becomes vulnerable to various types of infections.

Surgical intervention is a plastic surgery of the pelvic floor muscles and forced repositioning of the cervix and uterine body to their original place. Surgical treatment can be performed using laparoscopy - this is the most preferred method. It involves small incisions in the abdominal cavity, through which the uterus is brought back to its previous position and secured to prevent relapses.
Antibacterial therapy - includes the use of potent antibiotics that can block the development of intravaginal infections and infections of the urethra. These include such products as Amoxiclav, Monural, Suprax.

Fourth degree prolapse

The uterus and cervical canal completely fall out of the vagina, leaving the patient unable to sit or walk without pain. In this case, the woman is advised to undergo strict bed rest and constant medical supervision. The mucous membrane of the cervix and uterine body becomes rough and cracks.

Symptoms: constant pain in the lower abdomen, urinary and fecal incontinence, intestinal displacement. The woman is severely limited in mobility, there is constant bleeding.

Treatment of fourth degree prolapse: Surgery is indicated. Only in this situation, laparoscopy is not suitable in all cases. Most often, doctors have to resort to mesh sacrovaginopexy, which involves fixing the reproductive organ to the sacrum.

As a rule, fourth degree uterine prolapse can occur after a difficult birth, but in this case the woman is under medical supervision and, if necessary, she will undergo surgery.

Consequences of uterine prolapse

If the correction of the displacement of the organs of the reproductive system was carried out on time, then the woman retains childbearing functions. True, most likely, at a later stage of pregnancy, she will be advised to install an obstetric pessary.

With the third and fourth degrees of uterine prolapse, the consequences are much more severe. If the treatment was not emergency and the woman put off visiting the doctor for a long time, then most likely her main problem in subsequent pregnancies will be chronic miscarriage.

In addition, complete prolapse of the uterine body threatens serious displacement of other internal organs, which will lead to various diseases in the future.

Prolapse of the cervix

A few words about the causes of pelvic organ prolapse, or why women should not lift weights

Unfortunately, medical statistics are extremely disappointing: cervical prolapse is diagnosed by gynecologists in every 4th woman under the age of 40. In older age groups, every third person faces this problem. The widespread prevalence of this disease and the lack of basic medical knowledge lead to late treatment of this pathology and the occurrence of complications, which will be discussed in detail below.

What is uterine prolapse called? This is a pathology that is characterized by displacement of the cervix relative to its normal anatomical position. Over time, complete loss of this organ may occur, as a result of which it emerges from the genital slit to the outside.

A few words about anatomy. The uterus is the organ in which the baby develops. Its narrowest part is the cervix, the outer part of which is visible during a gynecological examination. Normally, the uterus is strengthened by powerful ligaments and muscles, which prevents its displacement. Under pathological conditions, it can fall down, which entails a displacement of its neck.

Causes of downward displacement of the cervix

The following factors can lead to an abnormal position of this organ:

Reduced tone of the muscles that form the pelvic floor. With age, the structure of all muscle fibers changes: they become less elastic and strong. In some cases, this situation can also occur in young women who lead a predominantly sedentary lifestyle.
Perineal injuries received during childbirth. Quite often, the mother herself is to blame for them, who, contrary to the advice of doctors, does not synchronize efforts with the phases of breathing. Sometimes the culprits of injuries are a large fetus and/or unqualified actions of an obstetrician-gynecologist.
Hard physical work. By the way, improper exercise in the gym can also lead to prolapse of the pelvic organs. Therefore, if you are in doubt about the correct technique for performing any exercise, be sure to consult a trainer.
Genetic predisposition.
Connective tissue diseases.
Disturbed hormonal levels, the most striking manifestation of which is a deficiency of the female hormone estrogen in the blood. In most cases, this situation is typical for women in menopause.
Excess body weight.
Frequent constipation, especially if a woman strains hard to pass stool during bowel movements.
High intra-abdominal pressure, which can be caused by pregnancy, tumors or ascites (i.e. accumulation of fluid in the abdominal cavity).
Anomalies of the development of the genitourinary system.

Classification of downward displacement of the pelvic organs

There are such degrees of uterine prolapse:

1st degree: the walls of the vagina are somewhat lowered, the genital slit is gaping.

2nd degree: pronounced downward displacement of the vaginal walls, prolapse of the bladder and rectum.

3rd degree: The cervix is at the level of the vaginal opening.

4th degree: The cervix is below the level of the vaginal opening (so-called incomplete uterine prolapse).

5th degree: eversion of the vaginal walls and complete prolapse of the uterus.

Symptoms of pelvic organ prolapse

In most cases, a woman is bothered by the following symptoms:

sensation of a foreign body in the genital fissure;
discomfort during sexual intercourse or lack of orgasm;
difficulty urinating;
violation of the act of defecation, manifested by difficulty in passing feces;
menstruation becomes more abundant;
aching pain in the lower abdomen or a feeling of heaviness.

Diagnosis of pelvic organ prolapse

Displacement of the uterus or its cervix is easily detected during a routine gynecological examination in the speculum. In exceptional cases, ultrasound with a transabdominal probe may be required.

To diagnose concomitant diseases, a general urine test and a vaginal smear are performed. If an abdominal tumor is suspected, a CT or MRI is necessary. To exclude connective tissue pathology, it is recommended to perform rheumatic tests, biochemical blood tests and tests for inflammatory activity.

Treatment of downward displacement of the cervix

At the beginning of this section, it is worth making a reservation right away: with pronounced degrees of pelvic organ prolapse (above the second), treatment tactics can only be surgical. This is understandable: no conservative (medicinal or folk) methods will be able to return the organ to its original position.

Today, about 2 hundred different surgical interventions are known that make it possible to fix the pelvic organs in the correct anatomical position.

In some cases, in older women, complete removal of the uterus through the vagina is used. Sometimes such an operation can be performed through an incision in the abdomen (especially if the organ is greatly enlarged or there are tumor formations in it).

Modern specialists try, whenever possible, to choose organ-preserving treatment tactics. The following options for surgical interventions are possible, which are especially relevant for women planning to have children in the future:

Implantation of special frames made of biologically inert material with a mesh structure. This design is a kind of “prosthesis” that allows you to maintain the uterus in the correct position and prevent its downward displacement.
Shortening of the overstretched ligamentous apparatus of the genital organs.
Colporrhaphy – fixation and strengthening of the vaginal walls, which prevents cervical prolapse.
Surgical correction of the anatomical position of the uterus using special devices.
Colpoperineoplasty is the application of surgical sutures to the vagina, as well as the posterior wall of the uterus. Due to this, the pelvic organs become practically motionless, retain their original position and can perform a reproductive function.

Prevention and physical therapy

Prevention and treatment of displacement of the pelvic organs in the initial stages

In young women, a special set of therapeutic exercises can be used, which is aimed at strengthening the pelvic floor muscles. By regularly performing it, it is possible not only to prevent the disease described, but also to significantly reduce its manifestations (or even completely defeat it) in the early stages.

So, take a few minutes a day for therapeutic exercises and forget about cervical prolapse.

Lie on your back, lift your legs up (if possible, straighten them completely at the knee joints) and imitate the movements of scissors for 1 minute.
After this, do a “bicycle”, just don’t be lazy: try to bend your knees only in the extreme abductions.
Take a knee-elbow position. Next, arch your back down while moving your head up, then smoothly slouch, lowering your head down. Perform 7-8 such repetitions.
Stand in the “swallow” pose for 30-35 seconds. Make sure that the pelvis is level and the spine is in the middle position.
Do some smooth and slow squats. Carefully monitor your breathing so as not to increase intra-abdominal pressure. Remember, you need to exhale while lifting your torso.

It is very important that the described set of exercises be performed on an empty stomach, as well as after emptying the pelvic organs.

Yoga classes are quite useful for women suffering from cervical prolapse.

You can also practice the following exercise throughout the day: tighten, squeeze and hold your pelvic floor muscles in a tense state for as long as possible. This will not only strengthen the muscles and ligaments, but also narrow the vagina. The latter is important for women who have given birth.