Prolapse of the uterus and vagina

Prolapse of the uterus and vagina is the prolapse and omission of these genitals beyond the genital slit. Gynecology interprets uterine prolapse as a protrusion in the form of a hernia, formed due to the weakening of the pelvic floor. Sometimes there is only a displacement of the organ — without its complete exit to the outside. In any case, this is a deviation that requires immediate treatment. For life, the prolapse of the vagina and uterus is not dangerous in itself, but it can provoke the development of other, more serious, diseases, and also becomes an obstacle to the realization of a woman’s reproductive function. In addition, the disease brings considerable physical discomfort and complicates intimate life.

The content of the article:
Anatomical causes of prolapse of the uterus and vagina
Causes of pathology
Symptoms and manifestation of uterine prolapse
Treatment of uterine prolapse
Treatment of uterine prolapse without surgery
Surgical treatment of uterine and vaginal prolapse
Prolapse of the uterus and vagina
Prolapse of the uterus and vagina is a curable disease. After its elimination, the patient almost completely returns to normal life. She can feel the joy of intimacy again, get pregnant and have a baby. Of course, the reproductive function will be preserved only if the uterus has not been removed.

Prevention for nulliparous women consists in simply strengthening the muscles: doing sports or fitness, eliminating heavy physical exertion, maintaining optimal weight and hormonal balance.

Patients after childbirth (especially severe) are recommended to undergo procedures to restore the elasticity of the pelvic floor muscles (laser therapy, electrical stimulation, gynecological massage, gymnastics). Also, a lot depends on the obstetrician who delivered the baby.

There is a myth that the omission of the genitals does not need to be treated, because nature does not do anything just like that. This is a terrible misconception that prevents a very real return to normal life. But when applying for treatment, you need to be extremely careful, because getting a referral for surgery does not guarantee success yet. You should learn more about the surgeon, his qualifications, the quality of the operations performed. Trust your health only to professionals, and then you can forget about the disease forever and live a full life.

Anatomical causes of prolapse of the uterus and vagina
In order to better understand the causes of genital prolapse, we will pay attention to the pelvis as a whole. In a normal state, all his organs are in a fixed state. They are attached to the bone walls of the pelvis. The muscle and ligamentous fascial apparatus play a crucial role in the stability of this system. At the same time, the support of the authorities is carried out at three levels:

At the first level, the uterus and the dome of the vagina are fixed. At the same time, the supporting apparatus is similar to a funnel, the narrow part of which is attached to the cervix, and the wide part to the bone structures.
At the second level, the vaginal walls, urethra, bladder and rectum are fixed. The device is similar in appearance to a hammock.
At the third level, which fixes the three exit openings, the pelvic organs literally lie. This muscular plate is also responsible for ensuring that the mentioned openings (namely, the rectum, urethra and vagina) are closed.
Thus, the third — the lower, basic — level (it is also called the pelvic floor) is a support for the organs lying above. If his muscles are injured, it becomes problematic to keep the upper levels, and this leads to prolapse of the uterus or vagina. At the same time, the displacement can also be caused by stretching (in a more severe case, rupture) of the muscle structures of the upper levels. If they cannot hold their organs, then they (organs) are steadily shifting downwards.

Causes of pathology
As a rule, the weakening of the muscular apparatus occurs under the influence of strong intra-abdominal pressure. Subsequently, even adequate loads become unbearable, and the organs shift.

The reasons for this weakening may be such phenomena as:

surgical interventions;
perineal rupture;
multiple pregnancy;
several genera;
birth injuries;
the birth of large children.
In addition, uterine prolapse in women at the age close to menopause (shortly before or after its onset) may be caused by a decrease in the content of estrogens in the body. These hormones maintain the uterus’ own tone.

The causes of prolapse may not be directly related to the pelvic organs:

lifting unbearable weights;
severe cough (for example, with bronchial asthma);
excess weight;
chronic constipation;
hemorrhoids;
abdominal tumors;
hereditary predisposition.
Women suffering from congenital malformations of the pelvic region, as well as those who were diagnosed with sacral nerve paralysis at an early age, are also at risk.

Vaginal prolapse occurs, as a rule, under the influence of the same factors. Quite often, the organs in question are shifted together. It is also worth noting that when it comes to the displacement of the uterus, there may be several degrees of it:

complete prolapse of the uterus — the entire organ is outside the genital slit;
partial prolapse of the uterus — the organ is displaced from its proper place, but it is not completely outside.
In turn, partial omission can also be divided into:

a slight displacement in which the cervix is hidden in the vagina;
starting prolapse, in which, under tension, the uterus may appear from the genital slit.
The degree of loss depends on the strength of intra-abdominal pressure, the severity of muscle damage and similar factors. The disease develops, as a rule, slowly.

Symptoms and manifestation of uterine prolapse
If the prolapse is in the primary degree, the woman may not even know about its existence. For a long time at rest, he will not manifest himself in any way. But gradually, discomfort will enter the patient’s life, which affects, first of all, the sexual sphere:

difficulty in contracting pelvic floor muscles;
long non-onset of orgasm;
air entering the vagina;
painful sensations during sexual intercourse.
If a woman uses tampons during menstruation, she will notice that they are unable to completely contain the bleeding. The leak is caused by the stretching of the vaginal walls under pressure.

In the future, the loss of the genitals leads to pelvic dysfunction:

difficulty urinating or, conversely, urinary incontinence;
increased urination;
constipation or, conversely, fecal incontinence;
inability to contain gases.
Finally, there are painful sensations in the lower abdomen, which can give to the sacrum or lower back. When changing the position of the body, you can feel pain in the perineum area. And the last symptom will be the sensation of a foreign body in the vagina.

In some cases, prolapse of the uterus and vagina is accompanied by such deviations as:

anterior rectocele — protrusion of the rectum towards the vagina;
cystocele — omission of the bladder;
urethrocele — omission of the urethra.
However, the final diagnosis is made by the doctor after a detailed study, which includes:

detailed history collection;
gynecological examination;
Ultrasound of the pelvis.
Anamnesis in this case will consist of three blocks:

patient’s complaints, unpleasant symptoms;
obstetric and gynecological history of the patient, which allows to determine the possible cause of weakening of the pelvic floor muscles;
the patient’s lifestyle, which makes it possible to identify an external source of pressure on the pelvic organs.
Based on the data obtained, the doctor will determine the degree of displacement of organs, the factors that provoked it, and assess the possibility of restoring the normal location while maintaining the optimal functioning of nearby organs.

Treatment of uterine prolapse
So, after a thorough examination, the doctor diagnosed a certain degree of uterine prolapse. Treatment by an ordinary gynecologist is not enough here. For a qualitative solution to such a delicate problem, specialists are needed who are also competent in such areas as:

urology (or even urogynecology);
gynecological orthopedics;
reconstructive surgery;
prosthetics.
So, if uterine prolapse is detected, what to do depends on the degree of neglect of the disease. At the initial stages (with a slight displacement or omission), you can correct the situation with the help of physical exercises aimed at strengthening the pelvic floor.

The most common of them is the Kegel exercise, which includes several stages:

Compression of the muscles of the anus and tightening of the muscles of the vulva.
The delay of this compression (for the first time — for 10 seconds, gradually the time should be increased).
Repeat the exercise (at least 10 times).
Alternate compression and relaxation of muscles (a kind of swing).
Such an exercise can be done at any time and in any place, because such an activity does not give itself away from the outside. Therefore, it can be performed throughout the day. It is worth noting that the Kegel exercise is also useful for improving the quality of sexual life. By the way, if vaginal prolapse is diagnosed, physical exercise treatment will be even more effective.

A similar, but more powerful way is vumbilding — training of the vaginal controlled muscles. For these purposes, either exercises more intense than Kegel exercises or vaginal simulators are most often used:

balloons;
vacuum simulators;
cargo simulators.
Although many people think that vumbilding is used exclusively to achieve success in sex, it serves as a prevention of uterine prolapse and can even help to cope with this problem if it has already arisen. The fact is that the vaginal muscles are connected to the muscles of the uterus. As a result, both the uterus and the vagina are tightened during training.

Treatment of uterine prolapse without surgery
Now let’s consider a method that will help in the event that the uterus really falls out, and not just shifted a little. It consists in the use of a pessary — a uterine ring, which relieves the organ of excess pressure. The pessary is inserted into the vagina and supports the cervix.

There are many types of such rings, because they are also used for other purposes (prevention of the threat of miscarriage, rehabilitation after childbirth). When the uterus falls out, you need a thick enough device that will not allow the organ to descend. Thus, a cubic or mushroom-shaped pessary is recommended, but it cannot be picked up without the help of a doctor. He must ensure that the following conditions are met:

the vaginal mucosa is not damaged (in the presence of microtrauma or ulcers, their treatment is first carried out);
are there any inflammatory processes caused by the omission of the genitals;
does the pessary occupy the full volume of the vagina;
whether the uterus is not infringed by the pessary.
With professional installation of the uterine ring, the procedure will be painless and non-traumatic. However, there are a number of inconveniences associated with wearing a pessary:

the need to remove it during sexual intercourse;
the risk of formation of pressure sores on the walls of the vagina;
the threat of colpitis.
In addition, the study may reveal contraindications to its installation. Then, as an alternative, you can choose external support in the form of a bandage.

Surgical treatment of uterine and vaginal prolapse
If the disease develops to later stages, surgery is likely to be required. It can be such surgical manipulations as:

pelvic floor strengthening vaginal surgeries;
correction of the position of the uterus with access through the abdominal wall;
vaginal plastic surgery (front or back);
plastic surgery of the perineal muscles;
vaginal extirpation (complete removal) of the uterus (in case of uterine prolapse with vaginal inversion);
the Lefor-Neugebauer operation (median colporaphy), which involves the removal of sections of the posterior and anterior walls of the vagina with subsequent stitching of the remaining tissues (after such an operation, it is impossible to live a sexual life, therefore it is carried out only for elderly women).
After the operation, after a certain recovery period, the patient will have to regularly follow the recommendations prescribed by the doctor to strengthen the genital muscles. Relapse of prolapse is an infrequent phenomenon and practically disappears with the development of technology. However, the woman’s body is unique, and it is impossible to predict with great accuracy whether the disease will return. In general, the effectiveness of modern methods of treatment of genital prolapse exceeds 90 percent.

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