Prolapse of the uterus
Uterine prolapse - displacement of the anatomical and physiological position of the cervix and fundus of the uterus below the anatomical border. This deviation is almost always accompanied by pulling pains and unpleasant sensations in the vagina and lower abdomen, impaired urinary function and pathological vaginal discharge. Prolapse of the uterus occurs when the muscles and fascia of the pelvic floor and uterine ligaments are weakened.
Prolapse of the uterus is a fairly common pathology that occurs in patients of all ages. In 10% of patients, it is diagnosed before the age of 30, in 40% of patients it is detected at the age of 30-40, in 50% of patients the disease manifests itself after 50 years. This pathological condition almost always has a progressive course. As the uterus descends, concomitant functional disorders become more pronounced, which brings the woman moral and physical suffering and most often leads to complete or partial disability.
Classification of prolapse of the uterus
There are several stages of uterine prolapse. At the stage of prolapse of the cervix and body of the uterus, the cervix is determined in the area of the entrance to the vagina, but does not protrude beyond the genital slit. In case of partial prolapse of the uterus, the cervix is shown from the genital crevice when coughing, sneezing, physical exertion, lifting weights. With incomplete prolapse, the body of the uterus (partially) and the cervix protrude from the genital slit. With the complete loss of the bottom and body of the uterus, the uterus leaves the boundaries of the genital crevice.
Reasons for prolapse of the uterus
Uterine prolapse can be caused by damage to the pelvic floor muscles, birth injuries (the imposition of obstetric forceps, vacuum extraction of the fetus or extraction of the fetus by the buttocks), previous surgical operations on the genitals (radical vulvectomy), deep perineal lacerations, congenital malformations of the pelvic region, estrogen deficiency, developing in menopause, connective tissue dysplasia, disorders of the innervation of the urogenital diaphragm.
The risk of uterine prolapse increases in old and senile age, with chronic cough, constipation, heavy lifting and hard physical labor, as well as with increased intra-abdominal pressure caused by obesity, and abdominal tumors. Most often, the interaction of many factors plays a role in the development of this pathology, under the influence of which the muscular apparatus of the pelvic floor and internal organs weakens.
Symptoms of uterine prolapse
In the absence of proper treatment, prolapse of the uterus gradually progresses, displacing the pelvic organs.
Symptoms of prolapse of the uterus in the initial stage can be pulling pains and pressure in the sacrum, lower back, lower abdomen, sensation of a foreign body in the vagina, despareunia (painful intercourse), the appearance of bleeding or leucorrhoea from the vagina. A characteristic manifestation of this pathology is menstrual dysfunction by the type of algomenorrhea and hyperpolymenorrhea.
Later, urological disorders join the symptoms of prolapse of the uterus in 50% of cases: frequent or difficult urination, stagnation in the urinary organs, as well as infection of the upper and lower parts of the urinary tract, leading to the development of cystitis, pyelonephritis and urolithiasis.
Proctological complications of prolapse of the uterus include colitis, constipation, and gas and fecal incontinence. With the progression of the disease, the leading sign of prolapse becomes a formation independently detected by the patient, protruding from the genital slit. Prolapse most often leads to circulatory disorders in the pelvic organs, the occurrence of congestion, cyanosis of the uterine mucosa and edema of adjacent tissues.
Diagnosis and treatment of prolapse of the uterus
Prolapse of the uterus is usually detected during a pelvic exam. With a rectal and vaginal examination, the doctor determines the displacement of the walls of the bladder, vagina and rectum. Colposcopy is mandatory for all patients with this pathology.
To clarify the diagnosis, the doctor may prescribe hysterosalpingoscopy and diagnostic curettage of the uterine cavity, ultrasound diagnostics of the pelvic organs, computed tomography, urine culture, taking smears for flora and excretory urography.
Patients with this pathology are additionally examined by a urologist and proctologist. Doctors evaluate the sphincters of the bladder and rectum to check for stress incontinence and gas.
When choosing the tactics for treating prolapse of the uterus, the severity of the pathology, the presence and nature of gynecological diseases accompanying the prolapse, the possibility and necessity of preserving and restoring the reproductive and menstrual functions are taken into account. Equally important is the patient's age, the nature of the dysfunctions of the sphincters of the rectum and urinary bladder, colon, as well as the degree of surgical and anesthetic risk in the presence of concomitant pathologies.
Conservative treatment of prolapse of the uterus most often includes gynecological massage, therapeutic exercises, the introduction of ointments containing estrogens and metabolites into the vagina. Therapeutic exercises for lowering the uterus are aimed at strengthening the abdominal muscles and pelvic floor.
Elderly patients are shown the use of vaginal pessaries (thick rubber rings of various diameters). The air inside the pessary gives it firmness and elasticity. When inserted into the vagina, the pessary ring rests against the walls of the vagina and fixes the cervix in a special opening. When using pessaries, vaginal douching with furacilin solution, chamomile decoction or potassium permanganate solution should be performed every day. It is recommended to leave pessaries in the vagina for three to four weeks in a row, and then take a break from treatment for two weeks.
If conservative therapy is ineffective, surgical treatment is prescribed. All operations during prolapse of the uterus can be structured according to the main feature - anatomical education, used to correct and strengthen the position of individual organs. Plastic surgery for lowering the uterus is aimed at strengthening the fascia and pelvic floor muscles. Operations to shorten and strengthen the round ligaments supporting the uterus give the greatest number of relapses.
At the present stage, preference is given to combined surgical treatment, which includes both vaginal plastic and fixation of the uterus, and strengthening of the muscular apparatus of the pelvic floor.
After the operation, a course of conservative measures is usually prescribed - physiotherapy exercises, exclusion of heavy physical exertion, diet therapy to eliminate constipation. Exercises for the prolapse of the uterus can be performed to prevent disease.
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The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
