Prolapse of the uterus and vagina
The omission of the uterus and vagina is the displacement of the organs down relative to their normal position. Prolapse of the walls of the vagina and uterus is an extreme degree of omission, characterized by the location of the organs below the genital slit.
The prolapse of the uterus may be partial, in which only part of the organ appears below the lumen of the genital slit, and complete when the entire uterus falls out.
Vaginal prolapse is called a clinical situation when only the lower third of the walls of the organ is outside the genital slit, and prolapse – if the upper part of it also comes out. In this case, the omission or prolapse of the vagina can be both an isolated process – while the uterus occupies its usual position, and combined with the pathology of the location of the uterus.
ETIOLOGY
Normally, the position of the uterus in the pelvis is ensured by the joint work of the ligaments of the uterus and the muscles of the pelvic floor and abdominal cavity. Their failure can lead to the development of this pathology. But they also arise for a reason. The failure of these important muscles can lead to:
CONGENITAL CAUSES
– connective tissue insufficiency,
– violation of muscle innervation, due to malformations of the spine or spinal cord
ACQUIRED FORTUNES
– ruptures and violations of the innervation of the pelvic floor muscles during traumatic childbirth,
– increased intra-abdominal pressure, due to straining with constipation, with asthmatic coughing attacks, when performing excessively heavy physical work, with tumors and obesity.
HORMONAL CAUSES
– a sharp decrease in estrogen levels during the menopausal period. (Estrogens are responsible for the elasticity and strength of tissues).
From all of the above, it becomes clear that the risk group consists of women over 40 years old, suffering from obesity or any other disorders accompanied by increased intra-abdominal pressure, especially if there is a history of pathology in childbirth.
symptoms
Most often, this pathology manifests itself when straining, although with a far-reaching process, the prolapse or omission of the vagina and uterus can be observed in a calm state.
The main complaints are:
– Unpleasant, pressing or pulling sensations in the lower abdomen,
– A feeling of the presence of a foreign body (some women mistake the lowered organs for a tumor)
– Violations of urination of varying severity – up to the complete absence of urine excretion and, as a consequence, the development of cystitis.
– Violation of the act of defecation with mechanical obstruction of the passage of feces through the intestine.
– Soreness during sexual intercourse.
– Pulling pains in the lower back and sacral spine.
– Frequent infectious processes.
– Due to constant traumatization, contact bleeding, swelling and the development of pressure sores on the walls of internal organs can develop.
diagnostics
The prolapse or prolapse of the vagina and uterus is primarily determined during a clinical examination on a gynecological chair. The doctor examines the external genitalia, may ask to strain to assess the severity of the condition.
In the presence of ulcers, erosions or bedsores on the walls of organs, it is worth doing a biopsy and cystoscopy to exclude the malignant process. Smears are also taken for bacteriological examination.
When planning an operation, it may be necessary to conduct ultrasound of the pelvic organs to determine the degree of displacement not only of the uterus, but also of adjacent internal organs.
In addition, it may be necessary to consult a urologist, proctologist and nephrologist to supervise situations related to violation of urination and defecation.
treatment
In case of prolapse and prolapse of the vagina and uterus, timely access to a doctor and dynamic observation is especially important.
At the earliest stages of the process, procedures aimed at strengthening the pelvic floor muscles can help: gynecological massage, physical therapy, Kegel exercises.
But the main method of treatment is surgical. In determining the tactics of surgical intervention, both the determination of the severity and severity of the process and the age of the patient will play an important role.
If the patient does not plan to give birth in the future, then she may be offered extirpation, that is, removal of the uterus and damaged vaginal walls.
If childbirth is desirable in the future, the operation will be aimed at strengthening the supporting ligaments of the uterus and vagina, vaginoplasty, excision of necrotic tissues, in addition, pelvic floor reconstruction with synthetic materials is possible.
The nuances of surgical treatment are determined by the attending physician, depending on the clinical situation, concomitant diseases and the presence of complications.
In the postoperative period, it is also necessary to monitor the dynamics, conduct special gymnastics and physical therapy courses, proper regimen and nutrition, and exclude the effects of etiological factors.
forecast
Favorable – with timely access to a doctor and adequate treatment.
PREVENTION
• Sports activities,
• healthy nutrition – for the prevention of obesity and constipation,
• proper management of pregnancy: preparation and delivery, careful suturing of perineal ruptures, in case of their occurrence,
• Regular follow-up by a gynecologist to determine risk factors and detect the disease in the early stages.
