Prolapse of the uterus - symptoms and treatment, what to do?

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Prolapse of the uterus - symptoms and treatment, what to do?
Prolapse of the uterus - symptoms and treatment, what to do?
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Prolapse of the uterus: causes and treatment

prolapse of the uterus
prolapse of the uterus

Prolapse of the uterus is an incorrect position of the uterus, the displacement of its bottom, as well as the displacement of the cervix below the normal border due to the weakness of the muscle fibers of the pelvic floor and ligaments. Pathology is accompanied by a number of characteristic symptoms: a feeling of pressure, a feeling of discomfort, patients are disturbed by pulling pains in the abdomen and vagina. Patients may experience difficulty urinating, vaginal discharge. The disease is complicated in some cases by partial or complete prolapse of the organ.

Prolapse of the uterus or its prolapse is the most common variant of the abnormal location of the internal genital organs. The prolapse of the uterus is accompanied by a displacement of the cervix of the organ and its bottom below the normal border, however, the cervix is not visible from the genital slit even with attempts. If the uterus extends beyond the genital slit, then this is regarded by experts as one of the symptoms of uterine prolapse. The downward displacement of the uterus serves as the first harbinger of partial or complete prolapse of the organ. In the advanced stage of the process, the uterus or part of it may be outside the vagina.

Prolapse of the uterus is one of the frequent pathologies of the abnormal location of the pelvic organs in women of any age. The frequency of diagnosing uterine prolapse increases in older age populations. More than 50% of all recorded cases are found in women who have crossed the fifty-year mark.

The correct position of the uterus in the small pelvis is provided by the ligamentous-muscular apparatus. To maintain the anatomically correct position of the organ, the tone of the muscular walls of the uterus is important. The pathology is based on weakness of the ligaments and muscle fibers. The clinical picture of uterine prolapse includes symptoms such as a feeling of pressure on the lower abdomen and pain of similar localization. In addition, a woman is diagnosed with dysmenorrhea, bloody discharge from the vagina. There may be disturbances in the activity of the lower intestine, urinary incontinence.

Causes of uterine prolapse

Causes of uterine prolapse
Causes of uterine prolapse

Prolapse of the uterus is very common in patients of any age, but if at the age of 30 years the pathology is detected in 10% of women, then over the age of thirty and under forty the disease worries 40% of patients. In patients older than 50 years, 50% of women suffer from uterine prolapse. Of all the operations that are performed in gynecology on the genitals, 15% are operations for the prolapse or prolapse of the uterus.

The cause of uterine prolapse is most often the weakening of muscle tone and the ligamentous apparatus of the pelvic floor, which is accompanied by a displacement of the rectum or bladder. Often the disease is accompanied by a violation of the work of these internal organs.

Prolapse of the uterus can begin in youth and progress over time. When the organ is lowered, functional disorders become more pronounced, which is accompanied by moral and physical suffering and is the cause of complete disability.

Failure of the ligaments and muscles holding the uterus can be caused by various reasons.

Factors leading to uterine prolapse:

  • Hereditary predisposition;
  • Congenital anomaly of the formation of the pelvic organs;
  • Incorrect management of childbirth, complications of labor activity;
  • Age-related dystrophic changes;
  • Hormonal imbalance during menopause;
  • Surgical intervention on the pelvic organs in history;
  • Irregular weight lifting;
  • Formation of neoplasms affecting the anatomy and functioning of the uterus (cyst, myoma, fibromyoma);
  • Pathologies of the connective tissue of the ligaments holding the uterus.
Prolapse of the uterus
Prolapse of the uterus

To damage the muscles that hold the uterus, lead to perineal ruptures in the breech presentation of the fetus. Muscles and ligaments can be damaged when using a vacuum extractor or obstetrical forceps during delivery.

Experts include frequent childbirth, back-breaking physical labor, heavy lifting, patient age, hereditary factors, high intraperitoneal pressure, obesity, tumors, constipation, severe cough.

Fibroids and other neoplasms provoke prolapse of the uterus due to an increase in the load on the ligaments of the small pelvis. A long-lasting strong cough can also contribute to the displacement of the uterus due to the constant tension of the muscles of the diaphragm.

Important: obesity, chronic constipation, flatulence increase intra-abdominal pressure and become indirect causes of the development of pathology.

In most cases, the clinical picture of prolapse develops when several conditions are combined.

Degrees of uterine prolapse

Degrees of uterine prolapse
Degrees of uterine prolapse

In its development, the disease goes through several stages.

There are 4 degrees of pathological changes:

  1. First degree - the uterus or its cervix are slightly displaced relative to the norm. The walls of the vagina are slightly lowered. The lower border of the neck is not visible during physical exertion. The genital slit may gape.
  2. Second degree - the uterus partially prolapses, with physical exertion the cervix comes out through the genital slit.
  3. Third degree - incomplete uterine prolapse is diagnosed, when straining, both the cervix and part of the uterus come out of the vagina.
  4. Fourth degree - the uterus falls out completely.

Symptoms of uterine prolapse

Symptoms of uterine prolapse
Symptoms of uterine prolapse

The clinical picture is manifested by a large number of vivid sensations, so the diagnosis is not difficult.

Symptoms of pathology:

  • Feeling of pressure on the bottom of the pelvis;
  • Pain in the lower abdomen, "radiates" to the lower back and sacrum;
  • Sensation of a foreign body in the vagina;
  • Bloody vaginal discharge (not always present);
  • Impaired urination;
  • Pain during sexual contact, the inability to carry it out in the last stages of the development of pathology;
  • Painful and heavy periods leading to anemia;
  • Irregular menstruation.

Important: some of the symptoms do not appear immediately, they join at the stage of progression of the pathological process.

Without treatment, the symptoms of uterine prolapse progress. Initially, the disease is manifested by pulling pains, a feeling of heaviness in the lower abdomen, in the region of the sacrum, lower back; in the vaginal area there is a sensation of a foreign body. During sexual intercourse, patients are concerned about pain and spotting. In patients, the menstrual function changes, the discharge becomes abundant or scarce. Pathology is accompanied by infertility, but the onset of pregnancy is not excluded.

Over time, disturbances in the functioning of the urinary tract join the manifestations of the disease, they are observed in half of the patients. With a prolonged course, prolapse of the uterus provokes stretching of the walls of the ureters and kidneys. The downward displacement of the uterus may also be accompanied by enuresis.

In every third case, women experience complications from the rectum: constipation, colitis, incontinence of feces and gases.

In the later stages of the development of the disease, a woman can independently feel the uterus protruding from the vagina.

Consequences of uterine prolapse

Consequences of uterine prolapse
Consequences of uterine prolapse

Impaired urination with uterine prolapse causes the development of an infectious process due to the addition of a bacterial component - inflammation of the kidneys, bladder, urethra.

Approximately 30% of patients are diagnosed with proctological pathologies:

  • Colitis;
  • Constipation;
  • Fecal incontinence;
  • Meteorism.

The surface of the uterus protruding from the vagina is covered with cracks. When walking, the body is subjected to mechanical stress, the risk of infection, bleeding ulcers, pressure sores increases. The tissues of the uterus swell, become bluish in color, cyanosis appears. The cyanosis of the organ is due to stagnation of blood due to impaired microcirculation in the vessels of the uterus.

Severe complications of uterine prolapse - varicose veins of regional veins, infringement of the organ in the last stages of prolapse, infringement of part of the intestine.

Treatment of uterine prolapse

Treatment of uterine prolapse
Treatment of uterine prolapse

The tactics of treating uterine prolapse chosen by the doctor depends on how far the pathological process has gone, whether the woman plans to have a baby in the future.

Please note: methods such as massage and gymnastics are most often used to prevent prolapse of the uterus, to strengthen the muscles of the pelvis and diaphragm. At 3-4 degrees, surgery is most often indicated.

  • The use of drugs. Conservative therapy can be effective at the stage of slight displacement of the uterus and its cervix. To improve the blood supply to the organ, ointments and drugs with estrogen for oral use are prescribed.
  • Gynecological massage. At the beginning of the disease, gynecological massage is used, conducted in courses with a break. Massage is performed by a specialist on a gynecological chair for 10-15 minutes. Pain during the procedure is a reason to stop the manipulation.
  • Therapeutic exercise. At the first stage of the development of prolapse, gymnastics according to Yunusov is prescribed. Kegel exercises should be done to strengthen the pelvic floor muscles.
  • Wearing a bandage. The method is used as a preventive measure at the initial stage of the disease. Properly worn bandage supports the uterus in an anatomically correct position, allows you to get rid of pain and discomfort. The bandage is widely used to restore the elasticity of the pelvic tissues after childbirth and after operations to restore the ligamentous apparatus of the uterus.
  • Use of pessaries. If a woman is contraindicated in surgical correction of uterine prolapse, at 3-4 stages of the pathological process, the doctor recommends that she install a pessary - rubber or PVC rings to hold the uterus in the correct position. After a month, the ring is removed, as you need to take a break. Every 3-7 days of wearing the pessary, it is briefly removed for aseptic processing and protection of the vagina from bedsores. Cons of wearing a pessary - the vagina is stretched, the uterus drops even more.

Surgical treatment

Surgical treatment
Surgical treatment

If possible, the doctor tries to save the uterus, because when it is removed, the risk of letting other organs increase.

Groups of operations for the treatment of uterine prolapse:

  • Colpoperine levatoroplasty - strengthening the muscles of the pelvic floor;
  • Plasty of the ligaments of the uterus - shortening and suturing them to the front wall of the organ;
  • Strengthening the cardinal and sacro-uterine ligaments that fix the uterus - reproductive function may be impaired;
  • Suturing the uterus to the walls of the pelvis - to the sacrum, to the pubic joint;
  • Implantation of endoprostheses;
  • Narrowing of the vagina;
  • Removal of the uterus when there is good reason.

These operations are performed in several stages, by laparotomy, through the vagina, by the method of abdominal surgery. In 30% of cases, a recurrence of pathology occurs.

Please note: modern surgical techniques can strengthen the walls of the vagina and the musculoskeletal system by installing biologically inert reinforcing devices that reduce the likelihood of relapse.

After surgery, carrying weights over 5 kg, sexual contacts, any physical activity is limited for a month and a half.

Prevention

Prevention
Prevention

Although uterine prolapse is rare in young women (only 10%), the onset of the disease should be prevented from adolescence. Prevention consists in strengthening the muscles of the press and small pelvis, dosed physical activity. To prevent uterine prolapse, significant physical exertion should be avoided.

Please note: Occupational safety regulations prohibit women from lifting weights over 10kg!

Women suffering from constipation should follow a special diet, take laxatives.

To prevent uterine prolapse, one should be skilled in pregnancy and childbirth. Women should follow all the recommendations of the doctor in charge of the pregnancy in a timely manner, give birth exclusively in maternity hospitals and perinatal centers.

Immediately after the birth of a child, you need to limit physical activity, apply a set of exercises to maintain the muscles of the pelvic floor and abdominal wall. It is desirable that the optimal load, the frequency of exercises and the start of training should be determined by a specialist in physical therapy.

During menopause, the risk of developing uterine prolapse increases, so the following actions should be taken:

  • Practice physical therapy;
  • Take drugs to increase the tone of the ligamentous apparatus of the uterus and improve its blood supply;
  • As prescribed by a doctor, use hormone replacement therapy.

Exercise to prevent uterine prolapse

There are simple exercises to prevent the development of prolapse:

"Lift" - the execution begins with a smooth tension and relaxation of the muscles of the perineum for 4-5 seconds alternately. Then the time of tension and relaxation is increased to 20 seconds. After that, the pace and duration of stress cycles increases by the maximum possible duration in time

uterine prolapse exercises
uterine prolapse exercises
  • "Bicycle" - lie on your back, bend your knees, "pedal" as if riding a bicycle.
  • Lie on your back with your legs extended. Alternately raise them at an angle of 45 °, holding in an elevated position for 5-6 seconds, constantly extending the time (up to 20 seconds).
  • Lie on your back with your knees bent. Lean on your elbows, raise your pelvis, tighten the muscles of the perineum. Hold in this position for 4-5 seconds, relax, repeat the exercise several times.
  • Lie on your stomach, alternately raising and lowering your limbs, arching your back.
uterine prolapse exercises
uterine prolapse exercises

Gradually the number of approaches increases from 6-7 to 20-22 in one session.

Please note: Even just walking up stairs will help strengthen your pelvic and abdominal muscles.

The duration of a daily workout is 30-40 minutes. Such care for your he alth will reduce several times the risk of uterine prolapse, the development of pathologies of the pelvic organs and lower intestines.

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