Description of uterine prolapse in old age. Treatment options for uterine prolapse in older women

Dear readers! Today we are talking about such a delicate problem as uterine prolapse. This, indeed, becomes a problem for many women, which only gets worse over the years. So, according to statistics, such a pathology is diagnosed in every tenth out of a hundred women who have been diagnosed with such a diagnosis. At the age of up to 40 years, it is already diagnosed in 40% of cases, and at an older age, a similar problem is noted in half of women. 15% of all operations on the genitals are performed for prolapse or prolapse of the uterus. In this article I will tell you why uterine prolapse occurs, methods of treatment and whether it is possible to correct the situation at home.

Prolapse of the uterus - causes and consequences

Prolapse of the uterus, or as doctors also call this pathology, uterine prolapse is a pathological condition in which there is a failure of the ligaments and muscles in the pelvis. Under the weight and pressure of the internal organs on the uterus, the pelvic organs move downward. First of all, the uterus is subject to displacement, and then the vagina. In addition, the bladder and rectum are affected. If this process is not stopped in time, then the uterus can move outside the genital gap, that is, it will fall out.

The uterus itself also has its own tone. Its normal position is to be in limbo in the middle of the small pelvis at an equal distance from its walls between the bladder and the rectum.

If the muscles and ligaments are not able to support the uterus in a suspended state, it begins to move downward. The reasons for this bias may be the following factors:

• Heavy physical work associated with lifting weights;
• Heavy or multiple births;
• Surgical interventions in the pelvis and perineum, in which the integrity of the pelvic muscles is violated;
• Deficiency of the hormone estrogen in the blood, which occurs during menopause;
• Obesity, overweight;
• Heredity and genetic predisposition, congenital anomalies, inflammatory diseases and tumors in the pelvis;
• Chronic constipation, hernia;
• Sedentary lifestyle,
• Advanced age.

There are 4 degrees of uterine prolapse. If at the first degree there is a slight omission, while straining the uterus does not leave the gaping genital slit, then at the fourth degree it is already outside, outside the genital slit. At this degree, adjacent organs are involved: the wall of the vagina, the bladder and the anterior wall of the rectum prolapse.

The process of weakening the muscles of the pelvic floor occurs gradually, therefore, when the first symptoms appear that indicate this pathology, it is necessary to immediately pay attention and start treatment.

And the first symptoms may be the following signs:

• a feeling of fullness and the presence of a foreign body in the lower abdomen;
• pain radiating to the lumbar or sacral region;
• frequent urination and constipation;
• the likelihood of bleeding from the vagina;
• violation of the menstrual cycle, painful, prolonged or heavy periods;
• discomfort during sexual intercourse.

As the process progresses, the clinical manifestations worsen, and as the condition progresses, the pain becomes more intense, urinary incontinence develops, which occurs even with a slight sneeze or cough. There is incontinence of the stool and gases. Infection and inflammation of the urethra, bladder, development of pyelonephritis occur.

In the last stage, there is a feeling of prolapse of the uterus in the perineum. The prolapsed uterus becomes infected, inflammation occurs, trophic ulcers form, and atrophy of the mucosa. When walking, the prolapsed uterus is even more injured, bleeding from cracks, bedsores, and severe pain appear. The surrounding tissues become cyanotic and edematous, blood stasis and varicose veins of the small pelvis and lower extremities appear. All this chains a woman to bed, she becomes an invalid.

The most formidable complications include infringement of the uterus or part of the intestine, which can lead to necrosis of these organs. And only an urgent operation can save a life.

Of course, I repeat, the problem is too delicate and many women are afraid to see a doctor. Although, by starting treatment in the early stages, the progression of the disease and complications can be avoided.

Prolapse of the uterus - treatment without surgery

In modern gynecology, uterine prolapse is not considered a terrible diagnosis. Of course, the outcome of treatment primarily depends on the degree of the disease. Currently, there are modern technologies for the treatment of uterine prolapse, which are very effective at all stages.

In the early stages, conservative treatment is recommended, in the later stages, surgery is indispensable. An important point at all stages of uterine prolapse is treatment with folk remedies, as well as the use of special gymnastics, but more on that later.

Modern gynecology does not consider uterine prolapse to be a terrible diagnosis, since the disease is very successfully treated at all stages. Although in some cases serious complications of the disease are possible and surgery is indispensable. But at any stage of pathology, treatment must always be approached individually. And no matter what method of treatment you choose, you must first consult with a gynecologist. And now we will consider in more detail about the treatment of uterine prolapse without surgery.

Prolapse of the uterus - treatment at home

In the initial stages, doctors prescribe home treatment. I found a lot of positive reviews on the Internet, when at home women coped with a similar problem on their own, meaning without surgical intervention. To do this, they used preparations from medicinal plants in combination with special gymnastics. And so we will analyze these two types of treatment in more detail.

Despite the fact that when the uterus is lowered, it is not recommended to engage in heavy physical work, and even more so, sports, but with this problem, this is simply necessary! The fact is that when the uterus is lowered, it is necessary to do special Kegel exercises or gymnastics according to Yunusov. What is this gymnastics?

Kegel exercises for uterine prolapse

Kegel gymnastics is the tension of the muscles of the perineum. By straining these muscles, the former tone of the muscles of the pelvic organs returns. As a result, the uterus returns to its normal position. There are no contraindications for this exercise.

The positive thing is that you can do these exercises anywhere and anytime, it all depends on your desire. A huge plus of these exercises: when performing these exercises, no one who is next to you sees that you are doing them. For example, you can do these exercises at home, while doing any household chores, or while sitting at the computer, or when you go to bed. You can perform these exercises in transport, at work, on a walk, but anywhere!

Do not worry if in the first days you do not succeed, the fact is that the muscles are weak and they will not immediately want to obey your will. A positive result can be noted after a week of their regular implementation. You need to do gymnastics every day, you can work out well once, or you can do several approaches in a day.

And another important point. Feeling the result, do not stop doing these exercises. Remember that with age, the muscles of the small pelvis weaken? So do these exercises all the time. In addition to restoring the elasticity of the muscles of the perineum and pelvis, you can get rid of the weakness of the bladder and urinary incontinence.

Therapeutic exercises for uterine prolapse - video

Gymnastics with uterine prolapse

Gymnastics according to Yunusov is also effective. Its essence lies in the contraction of the muscles that are involved in urination. To perform it is necessary to strain the muscles of the perineum, simulating urinary retention. This exercise can be done when, where and as much as you like. But I must say that Kegel exercises are more effective and more muscles of the perineum and small pelvis are involved there.

With a similar problem, it is recommended to practice yoga. I already wrote about how to start doing yoga at home, read by clicking on the link. Yoga has no contraindications for this pathology. And this video will help you.

Exercises to strengthen the abdominal muscles are welcome: “scissors”, “bike”, “birch”, slow raising and lowering straight legs, etc. When performing these exercises, not only the abdominal press is strengthened, but also the muscles of the small pelvis.

Omission of the uterus - treatment with folk remedies

Herbal treatment of uterine prolapse has been used since ancient times, the problem of uterine prolapse was with our grandmothers and great-grandmothers. You understand how much hard work they had to do: this was work in wartime in factories, and in the fields, and at home they had to work on an equal basis with men. And numerous births also contributed to the development of this disease. They hardly knew about gymnastics then, but they were treated with herbs.

Now herbal treatment along with gymnastics is widely used and brings tangible results. But you need to know that herbal treatment is long-term, you need to drink regularly, without missing the intake of tinctures and decoctions.

What does traditional medicine offer us?

Plantain syrup. Pour 50 grams of dried plantain leaves with a liter of boiling water and then simmer on low heat for another half an hour, then add a tablespoon of crushed fragrant celery seeds to the broth, Let the broth brew for another 40 minutes and filter through a sieve, Add 500 grams of honey to the cooled broth, mix. Take ¼ cup before meals for a month. If necessary, the course can be repeated.

Infusion with dill seeds. Take dill seeds, St. John's wort, chicory and medicinal chamomile equally. Pour 1 teaspoon of the collection into a thermos and pour a glass of boiling water and leave overnight. Filter in the morning. Drink the resulting decoction throughout the day in small portions. In the evening, make the infusion again. They take the infusion for 3 weeks, then a break for 2 weeks, the course of treatment is 3 months.

Melissa infusion. Brew in a thermos 2 tablespoons of lemon balm leaves (fresh or dried) with 2 cups of boiling water, leave for several hours to infuse. Take a quarter cup an hour before meals.

Melissa can be brewed with other herbs: lemon balm -75 g, oregano - 75 g, coltsfoot 100 g. Mix the mixture and brew in the same way as with one lemon balm. Take a quarter cup an hour before meals.

Tincture with eggshell. Take the shells of 5 eggs, dry and grind in a coffee grinder. Grind 9 lemons and mix them together with the shell, leave for 4 days, then add 0.5 liters of vodka to the mixture and insist for 3 days. Then filter the tincture. Take ¼ cup morning and evening until you have drunk all the tincture. Repeat the course in a month, there should be 3 courses in total.

Bath with a decoction of pine nuts. Pour 1 cup of pine nuts with 2 liters of boiling water, cook in an enamel pan with a closed lid over low heat for an hour, turn off the fire and leave to brew for half an hour. Pour the resulting broth into a bath and soak in water at a temperature of 38º for 15 minutes.

Alternative methods of treatment of uterine prolapse - reviews

I found these reviews in a healthy lifestyle magazine, there is such a magazine. Knowing that I write about folk methods of treatment, my grandmother-neighbor brought me several files of this magazine. And here are some reviews - I found the results of the treatment of uterine prolapse.

fist massage

In the morning, waking up, lie on your back, stretch your legs, put the fist of your left hand on your stomach, cover the fist from above with your right palm and squeeze. Get a reinforced double fist. Drive this fist along the soft tissues of the abdomen with force pressing, first clockwise, then counterclockwise. Start with 2-3 ring movements, increasing the number of movements every morning. After 20 days, you need to do 20 movements in each direction. A woman does such exercises every morning 20 times in each direction. Her uterus fell into place, her stool improved, hemorrhoids disappeared. Against the prolapse of the uterus, it is useful to do other exercises: raise and lower the legs, make scissors, raise the knee to the chin, first with one, then with the other leg (2001, No. 10, p. 20)

Bank treatment

A simple remedy will help to cure prolapse and prolapse of the uterus. You need to take a half-liter jar and lie on it so that the navel is in the center of the neck. It will hurt, but you have to be patient and lie down for 3-5 minutes, as much as you can bear. Then, without rising, turn on your right side and lie down for another 10-15 minutes. Then lie on your back and tie up your lower abdomen with a handkerchief or elastic bandage, and only then get on your feet. A sign that the uterus has fallen into place will be the absence of pain in the supine position on the jar. This folk recipe has been passed down in the same family from generation to generation. (2004, No. 9, p. 24).

belly massage

In the evening, before going to bed, lie on your back, relax, bend your knees. With your fingers, you need to walk along the lower abdomen 3-5 times, slightly lifting it. It will hurt a little for the first few days, but then the pain will go away. (HLS 2011, No. 21, p. 31-32).

And one more useful exercise. Waking up in the morning, without getting out of bed, roll over onto your stomach and stand in a knee-elbow position, lower your stomach as low as possible, and raise your hips as high as possible, stay in this position for 15 minutes. Then roll over on your stomach and rest a little without getting out of bed. Do these exercises for at least 20 days, but for the best effect, you can do them longer. By performing this exercise, the uterus will not only return to its normal position, but constipation will also stop, menstruation will normalize, and such an exercise will be useful for conception.

1. Wear a special bandage in the form of panties, you can buy it at the pharmacy. The bandage prevents prolapse of the uterus and internal organs of the small pelvis. It is worn on the naked body in a prone position so that the abdominal muscles are completely relaxed. Remove it, too, in a prone position. It is recommended to wear it no more than 10-11 hours a day, then it must be removed.
2. It is very useful, both for prevention and for existing uterine prolapse, cycling 2-3 times a week for 30-60 minutes.
3. Do not lift weights greater than 3 kilograms.
4. During sexual intercourse, use the “woman on top” position, in this position the pelvic muscles will be in good shape as a result of constant contraction and relaxation of the muscles.

Dear readers, the topic of uterine prolapse, as you probably already understood, is a fairly common problem in women. And I have consecrated far from all the subtleties of solving this pathology. To be continued.

The prolapse of the uterus is a change in the position of the organ and its partial exit to the outside, which occurs under the influence of abdominal pressure. This pathology can also occur in young women who have experienced difficult childbirth, but most often it is diagnosed in older people: 50-60 years old.

If you do not pay attention to the resulting problem and do not start timely treatment, then serious consequences may develop. In this article we will talk about the causes of this phenomenon, its consequences, methods of diagnosis and treatment.

Types, stages and causes of pathology in the elderly

The uterus inside the female body is supported by the muscles of the small pelvis, with the weakening of the ligaments, it begins to sink down. Gynecologists distinguish the following types of this pathology:

If you do not start timely treatment, the uterus can completely leave the vagina. Gynecology defines several stages of this pathology:

• the initial stage is characterized by a displacement of the organ just below the level of the interspinal line, while the uterus does not enter the vagina;
• the second stage is characterized by partial omission, in which the main part of the organ is located on the line of the genital fissure, but the pelvic area is considered to be its location;
• The final stage represents a complete omission of the organ from the genital slit.

The main cause of this pathology in women over 50 years old, after the onset of menopause, is an insufficient amount of estrogens responsible for blood supply, nutrition, elasticity of the ligaments that hold the organ. In addition, this disease is provoked by the following factors:

Symptoms and methods of diagnosing the disease

The symptoms of this pathology vary according to the degree of the disease. At the initial stage, the following symptoms appear:

• lower abdominal pain;
• lower back pain;
• when moving, there is a feeling of heaviness.

If you do not contact a gynecologist and do not start treatment, then the symptoms worsen, there are:

If timely treatment is not started, then women over 50 years of age may develop chronic kidney disease, erosion, chronic bladder damage, uterine edema, urethritis, bleeding, varicose veins.

The prolapse of the uterus is determined on examination by a gynecologist. During the examination, the doctor determines the degree of pathology at rest and under tension, for this he asks the woman to push. After that, the organ should be put back into place to assess the state of the tone of the ligaments, appendages. The gynecologist also prescribes:

How to treat uterine prolapse in old age?

Treatment of pathology at an uncomplicated stage involves the use of special rings. They are made from biological material and prevent further deterioration of the condition. These rings or pessaries must be worn at all times, because at this age the muscles are rather relaxed and cannot be restored. When using them, it is necessary to observe personal hygiene, remove at night. To prevent the development of a sexual infection, these devices must be regularly processed.

Also, the initial stage involves wearing special underwear, which has a supporting structure. Sometimes it is recommended to wear a bandage worn over underwear in a prone position.

Tip: many gynecologists advise combining this underwear with pessaries, therapeutic exercises and hormonal therapy.

In addition to the supporting device, the following medicines help treat pathology:

• hormonal drugs can increase the level of female hormones;
• hormonal ointments injected into the vagina. They increase estrogen levels and have a beneficial effect on the condition of the ligaments.

conservative methods

With a slight omission, the following conservative therapy is indicated:

Surgical solution to the problem

Quite often, gynecologists recommend surgery for patients over 50 years of age who have crossed the line of childbearing age, who are not helped by conservative treatment. During surgery, the doctor can use the laparoscopic method, by punctures on the abdomen, and the vaginal, when the incision is made inside the vagina, access. Today, medicine offers to perform operations in different ways:

Treatment with traditional medicine

Traditional medicine helps to comprehensively treat this pathology. However, it must be remembered that it is only an addition to the main therapy and has the task of strengthening the vaginal muscles at home. The most used methods are listed below:

Prolapse of the uterus in women over 50 years old is a fairly common problem, in order to prevent complications and resolve the issue without surgery, you need to see a doctor as soon as possible and perform effective therapeutic exercises.

Age-related weakening of the pelvic floor muscles in postmenopausal women can be the basis for genital prolapse. Omission and prolapse of the uterus in old age is almost impossible to cure with the help of gymnastics: the main methods of therapy are the constant use of a special supporting pessary or surgical correction.

The tendency to prolapse of the internal genital organs in women is formed long before menopause. The most important factors contributing to the development of the disease are:

• complicated childbirth;
• any traumatic injury in the perineum;
• gynecological operations;
• severe obesity;
• heavy physical labor;
• permanent constipation.

In old age, a woman creates conditions for the progression of genital prolapse: against the background of a decrease in the elasticity of perineal tissues, the development of atrophic processes and muscle weakness, prerequisites are formed for a rapid deterioration of the disease.

Rice. Prolapse of the uterus

Manifestations of the disease

In older postmenopausal women, prolapse of the internal genital organs is much more difficult to treat, especially in the presence of severe pathology from the heart and blood vessels. Surgery is optimal, but if surgical treatment is not possible, a pessary or bandage must be worn to prevent complete uterine prolapse.

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Zhumanova Ekaterina Nikolaevna has certificates of an obstetrician-gynecologist, a doctor of functional diagnostics, a doctor of ultrasound diagnostics, a certificate of a specialist in the field of laser medicine and in the field of intimate contouring. Under her leadership, the Department of Laser Gynecology performs about 3,000 operations per year. Author of more than 50 publications, including guidelines for doctors.

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Uterine prolapse is a change in the position of the uterus in the vaginal canal, which appears due to the depletion of the muscles of the small pelvis. Signs are in the lower abdomen, as well as copious discharge. Often the disease is accompanied by pain during urination.

Diagnosis of uterine prolapse in older women is often by chance during examination by a gynecologist. Uterine prolapse has no age restrictions; absolutely any representative of the fair sex can face such a diagnosis. Most often, the diagnosis of prolapse of the uterus in women after 55 years of age who gave birth to two or more children in a natural way and / or are in a post-menopausal state. Old age brings with it not only external, but also internal changes. Muscles slowly begin to deplete and lower the organs of the pelvis. Which method of treatment is required surgical or conservative will show a complete history, it will also determine the stage of the disease.

Where does it appear from?

In addition to depletion of the muscles of the small pelvis, there may be other reasons:

• congenital pathology of the small pelvis;
• heredity;
• previously performed surgical interventions of the genitourinary system;
• systematic heavy physical activity;
• the presence of various types of tumors;
• repetition of labor activity;
• perineal injury;
• heavy physical work;
• the problem of excess weight;
• hormonal changes;
• birth trauma;
• mature age and old age;
• disorders of the muscles of the pelvic floor;
• neurological diseases.

At the initial stages, there are practically no symptoms, and only if the prolapse of the uterus in older women progresses, they begin to appear and cause discomfort.

IMPORTANT: without proper therapy, the disease develops, and over time, the displacement of the pelvic organs worsens.

A symptom of heaviness in the pelvic region is characteristic, as well as:

• drawing pains in the lower abdomen;
• discomfort when walking;
• sensation of a foreign body in the vagina;
• incomplete emptying of the urinary system;
• pain during intercourse;
• lower back pain;
• frequent urinary tract infections (cystitis, pyelonephritis);
• discomfort when urinating;
• excessive discharge;
• impossibility of sexual life.

If the symptoms of the disease are ignored, there is a risk of urological disorders: stagnation in the urinary organs, frequent urination, residual urine syndrome. If you do not treat these diseases, ignore the symptoms, there is a high risk of severe complications:

• infection in the lower and upper parts of the genitourinary system;
• urolithiasis disease;
• urinary incontinence;
• cystitis;
• constipation, encopresis.

As a result of constant injury, the protruding organ is often covered with ulcers. Also, prolapse (location of the uterus) is worsened by pinched organs and intestinal loops.

Stages of development of uterine prolapse

There are four stages of uterine prolapse in patients in old age:

1. Stage one. Slight displacement of the uterus.
2. Stage two. The cervix, descending lower, is outside the vulvar ring.
3. Stage three. The cervix has noticeably drooped outside the vagina.
4. Stage four. The organ fell out of the genital slit.

Diagnosis of the disease often occurs by chance at a gynecologist's appointment. To determine the stage of prolapse, the doctor asks the woman to push. Thus, the displacement of the rectum, the walls of the vagina and the bladder is checked. Also appointed:

• colposcopy (examination of the walls of the vagina, cervix, vaginal entrance with a special device - a colposcope);
• hysterosalpingoscopy (method of studying the uterine cavity and the patency of its tubes);
• conducting an ultrasound examination;
• swab sampling for flora (sowing tank);
• urine culture tank;
• excretory urography;
• CT scan.

Based on the results of a comprehensive examination, a qualified specialist decides on the method of treatment. There is surgical and conservative therapy.

The second is prescribed if the performance of adjacent organs is in order and the uterine prolapse has not reached the genital gap. The doctor prescribes gynecological massage and special exercises to strengthen the muscles of the small pelvis. In addition, doctors recommend the use of ointments and suppositories with estrogens for insertion into the vagina, it is possible to take estrogens as a replacement conservative therapy that will improve tissue trophism, restore blood flow and, to some extent, the elasticity of the mucosa, thereby contributing to the retention and strengthening of the musculoskeletal apparatus of internal organs. . The concept of “trophic” means the nutrition of organs, which depends on the volume of the muscles and their ability to generate force.

If surgical intervention is contraindicated, the doctor prescribes an elderly patient to use pessaries (special rubber rings inflated with air and having various sizes) and tampons. Support for the displaced organ is created using a pessary, but it is important to know that the vaginal ring should not be left for a long time. This can lead to pressure ulcers.

When using a pessary, women will have to douche daily (the procedure consists in washing the vagina). For this, a decoction of pharmaceutical chamomile or a solution of furacilin is perfect. You will also need to visit the gynecologist twice a month.

In advanced cases, surgery cannot be avoided. Sometimes these are operations using laparoscopic access and even special mesh implants that create artificial support for organs. With insufficient effectiveness of conservative therapy and a greater degree of mixing of the organ, the doctor resorts to surgical intervention. The operation is efficient and effective.

There are several types of operations that modern surgery can offer:

1. vahypoplasty - strengthening the muscles of the small pelvis;
2. strengthening and shortening of the uterine fibers (a large percentage of relapses, therefore it is used extremely rarely)
3. fixing the organ by stitching the ligaments together;
4. fixing the descending organ to the walls of the pelvic floor;
5. fixation of the uterus and strengthening of the ligaments with the help of a special mesh material;
6. partial narrowing of the lumen of the vagina;
7. removal of the descending organ.

At the moment, doctors combine several methods of therapy - vaginal plastic surgery with fixation of the uterus and strengthening the muscles of the small pelvis.

The danger of refusing the operation is manifested in the fact that sooner or later the quality of life will decrease so much that it will be difficult for the patient to move around even within the city and apartment.

The lower the degree of omission, the sooner the patient consults a doctor, the sooner the attending physician pays attention to this problem, the more effective and easier it is to correct the anatomical disorders that have arisen against the background of the disease.

The operation in the early stages of the development of the disease is not difficult and it is enough to perform plastic surgery of the vagina.

What treatment can be done at home? Do not get involved in folk ways. Trust the doctors. They will recommend Kegel exercises.

Arnold Kegel's exercises were created specifically for women with prolapsed uterus and received positive reviews around the world. The therapeutic effect is possible with the systematic performance of tasks. It is necessary to do exercises 3 times a day, gradually increasing to 300 exercises per day. It does not take much time, does not require any special equipment or space. It is an effective way to counter the disease.

First you need to determine which muscles you need to use. To do this, during urination, you need to stop the process and feel which muscles were involved in this. You can also stick your finger into the vagina and try to squeeze it.

These procedures do not need to be repeated, it will be enough once to understand which muscles are needed for the next exercise.

Before you start, you need to make sure that the bladder is empty.

The essence of gymnastics is to contract those same muscles and relax them. The first exercise: muscle contraction and delay in this state for 10 seconds, relax for 10 seconds and repeat. General performance 5 minutes per day.

The second exercise: muscle contraction and delay in this state for 5 seconds, then relax for 5 seconds and repeat. Total execution 1 minute per day.

Charging to strengthen intimate muscles

One of the main exercises for restoring the elasticity of the muscles of the pelvic floor.

1. Starting position: lie on your back, bend your legs, heels on the floor. One hand lies under the navel, the second - above it.
2. Exhale - contract the pelvic floor muscles then the transverse muscles.
3. Entrance - relax.
4. Repeat.

Prevention of uterine prolapse

In order to prevent such a disease as uterine prolapse in old age, prevention of the disease is required. Some tips:

• physical education (equestrian and cycling, as well as swimming);
• proper nutrition;
• limitation of heavy physical exertion;
• 2 times a year to meet with a gynecologist for an examination;
• childbirth in special institutions (perinatal centers and maternity hospitals);
• following the recommendations of a specialist after childbirth;
• lead an active life.

Video: Omission and prolapse of the uterus and vagina

Video: Uterine prolapse - Kegel exercise (a set of exercises for training the muscles of the pelvic floor)

Prolapse of the uterus is one of the forms of prolapse (displacement, prolapse) of the pelvic organs. It is characterized by a violation of the position of the uterus: the organ is shifted down to the entrance to the vagina or even falls out of it. In modern practice, this disease is considered as a variant of the hernia of the pelvic floor, which develops in the area of ​​the vaginal entrance.

Doctors in the description of this disease and its varieties use the concepts of "omission", "prolapse", "genital prolapse", "cystorectocele". The prolapse of the anterior wall of the uterus, accompanied by a change in the position of the bladder, is called a "cystocele". The prolapse of the posterior wall of the uterus with the capture of the rectum is called "rectocele".

Prevalence

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

The older the woman, the more likely she is to have this condition. These conditions occupy up to a third of all gynecological pathology. Unfortunately, in Russia, after the onset, many patients do not go to the gynecologist for many years, trying to cope with the problem on their own, although every second of them has this pathology.

Surgical treatment of the disease is one of the frequent gynecological operations. Thus, in the United States 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 back, and the body of the organ itself is tilted forward, forming an angle open to the front with the axis of the vagina. 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. From above the bladder, the upper part of the body of the uterus, the intestinal wall are covered with peritoneum.

The uterus is held in the pelvis by the force of its own ligamentous apparatus and by the muscles that form the perineal region. With the weakness of these formations, its omission or loss begins.

There are 4 degrees of the disease.

1. The external uterine os descends to the middle of the vagina.
2. The cervix, along with the uterus, moves down to the entrance to the vagina, but does not protrude from the genital gap.
3. The external pharynx of the cervix moves outside the vagina, and the body of the uterus is higher without going out.
4. Complete prolapse of the uterus into the perineum.

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. These shortcomings are deprived of the modern classification of genital prolapse, adopted by most foreign experts.

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

• Stage I: the most drop-down zone is more than 1 cm above the hymen;
• Stage II: this point is 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 the length of the vagina by more than 2 cm.

Causes and mechanism of development

The disease often begins at the woman's fertile age, that is, before the onset of menopause. Its course is always progressive. As the disease develops, there are dysfunctions of the vagina, uterus, and surrounding organs.

For the appearance of genital prolapse, a combination of two factors is necessary:

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

Causes of uterine prolapse:

• a decrease in estrogen production that occurs during menopause and postmenopause;
• congenital weakness of the connective tissue;
• trauma to the muscles of the perineum, in particular, during childbirth;
• chronic diseases accompanied by impaired blood circulation in the body and increased intra-abdominal pressure (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 a 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 the women with prolapse, for example, urinary incontinence when coughing, physical effort. The posterior wall, when lowered, "pulls" the rectum behind it with the formation of a rectocele in a third of patients. Often there is a prolapse of the uterus after childbirth, especially if they were accompanied by deep muscle ruptures.

Increase the risk of disease multiple births, intense physical activity, genetic predisposition.

Separately, it is worth mentioning the possibility of vaginal prolapse after amputation of the uterus for another reason. According to different authors, this complication occurs in 0.2-3% of operated patients with a removed uterus.

Clinical picture

Patients with pelvic organ prolapse are mostly elderly and senile women. Younger patients usually have early stages of the disease and are in no hurry to see a doctor, although the chances of successful treatment 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 the pathology of 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 the quality of their life, leads to tension in family relationships, negatively affects the woman's psyche and forms the so-called pelvic descent syndrome, or pelvic dysynergy.

Often develops varicose veins with swelling of the legs, cramps and a feeling of heaviness in them, trophic disorders.

Diagnostics

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

A woman needs to tell the gynecologist about the number of births and their course, surgeries, 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 sunk, finds defects in the muscles of the pelvic floor, performs functional tests - a test with straining (Valsalva test) and cough. A rectovaginal examination is also carried out to assess the condition of the rectum and structural features of the pelvic floor.

To diagnose urinary incontinence, urologists use a combined urodynamic study, but when organs are prolapsed, its results are distorted. Therefore, such a study is optional.

If necessary, endoscopic diagnostics is prescribed: (examination of the uterus), cystoscopy (examination of the bladder), sigmoidoscopy (study of the inner surface of the rectum). Typically, such studies are necessary if cystitis, proctitis, hyperplasia, or cancer are suspected. Often, after the operation, 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 bottom of the small pelvis, and their strengthening;
• normalization of the functions of neighboring organs.

Prolapse of the uterus of the 1st degree is treated conservatively on an outpatient basis. The same tactic is chosen for uncomplicated genital prolapse of the 2nd degree. What to do with the prolapse of the uterus in mild cases of the disease:

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

Is it possible to pump the press when the uterus is lowered? When lifting the body from a prone position, intra-abdominal pressure increases, which contributes to further pushing the organ out. Therefore, therapeutic exercises include tilts, squats, leg swings, but without straining. It is carried out in a sitting and standing position (according to Atarbekov).

At home

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

Massage

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

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

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

Surgery

How to treat uterine prolapse III-IV degree? If, despite all conservative methods of treatment or due to the patient's late request for medical help, the uterus has gone beyond the vagina, the most effective method of treatment is prescribed - surgical. The purpose of the operation is to restore the normal structure of the genital organs and correct the disturbed functions of neighboring organs - urination, defecation.

The basis of surgical treatment is vaginopexy, that is, fixing the walls of the vagina. With urinary incontinence, the strengthening of the walls of the urethra (urethropexy) is simultaneously performed. If there is weakness of the muscles of the perineum, they are plastic (recovered) with strengthening of the neck, peritoneum, supporting muscles - colpoperineolevathoroplasty, in other words, suturing of 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 the walls of the vagina (colporrhaphy), loop operations, sacrospinal fixation of the vagina or uterus, strengthening the vagina with the help of special mesh implants are performed.

With laparotomy (an incision of the anterior abdominal wall), the operation for prolapse of the uterus consists in fixing the vagina and cervix with its own tissues (ligaments, aponeurosis).

Sometimes laparoscopic access is also used - a low-traumatic intervention, during which it is possible to strengthen the walls of the vagina and suture defects in the surrounding tissues.

Laparotomy and vaginal access do not differ in long-term results. Vaginal is less traumatic, with less blood loss and 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 with access through the vagina) can be performed under conduction, epidural anesthesia, intravenous or endotracheal anesthesia, which expands its use in the elderly. This operation uses a mesh-like implant that strengthens the pelvic floor. The duration of the operation is about 1.5 hours, the blood loss is insignificant - up to 100 ml. Starting from the second day after the intervention, the woman can already sit down. The patient is discharged after 5 days, after which she undergoes treatment and rehabilitation in the clinic for another 1-1.5 months. The most common long-term complication is erosion of the vaginal wall.

Laparoscopic surgery is performed under endotracheal anesthesia. During it, a mesh prosthesis is also used. Sometimes amputation or extirpation of the uterus is performed. The field of operation requires early activation of the patient. An extract is carried out on the 3-4th day after the intervention, outpatient rehabilitation lasts up to 6 weeks.

Within 6 weeks after the operation, a woman should not lift weights of more than 5 kg, sexual rest is required. Within 2 weeks after the intervention, physical rest is also necessary, then you can already do light housework. The average period of temporary disability is from 27 to 40 days.

What to do in the long term after the operation:

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

Features of the treatment of pathology in the elderly

Gynecological ring (pessary)

Treatment of uterine prolapse in the elderly is often difficult due to comorbidities. In addition, often this disease is already in an advanced stage. Therefore, doctors face significant difficulties. To improve the results of treatment, 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 when the uterus is lowered. It can also be used by younger patients. These are special supportive panties that tightly cover the abdominal area. They prevent prolapse of the uterus, support other organs of the small pelvis, reduce the severity of involuntary urination and pain in the lower abdomen. Choosing a good bandage is not easy, a gynecologist should help with this.

A woman must perform therapeutic exercises.

With a significant prolapse, a surgical operation is performed, often this is the removal of the uterus through a 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 with the omission of the walls of the uterus. Yes, there are no special obstacles to conception in the early stages if the disease is asymptomatic. If the omission is significant, then before the planned pregnancy it is better to be operated on 1-2 years before conception.

Preservation of pregnancy with proven uterine prolapse is fraught with difficulties . Is it possible to bear a child with this disease? Of course, yes, although the risk of pathology of pregnancy, miscarriage, premature and rapid birth, bleeding in the postpartum period is significantly increased. In order for the pregnancy to develop successfully, you need to constantly be observed by a gynecologist, wear a bandage, use a pessary if necessary, engage in physiotherapy exercises, and take medications prescribed by a doctor.

What threatens the prolapse of the uterus in addition to possible problems with carrying a pregnancy:

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

Prevention

The prolapse of the walls of the uterus can be prevented in this way:

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