How is uterine prolapse surgery performed? Uterine prolapse may occur. Rigid fixation of internal genital organs

Is uterine prolapse surgery or drug treatment? Surgery for uterine prolapse allows for a better and more complete cure of the disease, as well as normalization of the patient’s health. However, surgical treatment is not always used in the treatment of pathology - often the treatment regimen for uterine prolapse includes taking medications, using physiotherapy, as well as performing therapeutic exercises that strengthen the pelvic floor muscles. Surgery for uterine prolapse is prescribed quite rarely, but for some women this method of treatment is still necessary. So, how is the surgical treatment plan for uterine prolapse carried out?

What is prolapse of the reproductive organ?

As gynecology says, uterine prolapse or prolapse is a pathological prolapse of the uterine cavity, as well as the cervix, which has unpleasant consequences for the patient.

Not only elderly and elderly women suffer from the disease, but also young girls. Most often, the pathology is diagnosed in women whose age ranges from 30-45 years.

However, the definition of prolapse means prolapse of not only the uterine cavity, but also the intestines and bladder. For a certain number of reasons, the pelvic floor, or rather its layers, are no longer able to contain the internal organs.

Moreover, when visiting a doctor, the gynecologist notices that the genital organ and its neck are located much lower than their natural presentation, and sometimes even fall out into the vaginal cavity. Of course, in this case, the woman requires urgent treatment, otherwise this pathology will cause a large number of complications for the patient’s health.

What causes partial or complete uterine prolapse? The uterine fundus may begin to descend for a number of reasons, which are important to pay special attention to when making a diagnosis.

These include:

• diseases related to metabolism;
• damage to the pelvic floor that occurs as a result of trauma;
• disruption of the female body’s production of steroid hormones;
• systemic underdevelopment of the base of the connective tissue (for example, the development of a hernia in a woman, varicose veins, joint dysplasia, and so on);
• labor activity;
• patient's age;
• genetic predisposition;
• frequent and prolonged constipation;
• excessive obesity.

Uterine prolapse is known to cause serious complications for women's health. Therefore, it is recommended to begin treatment of the disease immediately after detecting its signs, otherwise the consequences of uterine prolapse will be disastrous.

Symptoms

Uterine prolapse is considered a progressive disease, but in some cases it occurs quickly and in others slowly. Even the first and minor signs, if left untreated, will eventually cause prolapse of the reproductive organ, so a woman should not hesitate.

Symptoms characterizing the course of the disease include:

1. Pain and discomfort in the lower abdomen. This symptom can be noticed immediately, since the appearance of nagging pain and discomfort in the abdomen, as well as stretching of the lower back, is difficult to miss. In their characteristics, these symptoms resemble the onset of menstruation, so if they do not appear in the near future, you should definitely be wary. Also, if the patient has prolapse, she is attacked by severe pain while walking or lifting weights (even minor ones). In addition, such a patient should not engage in sexual intercourse, since it will not only not bring pleasure, but will also become practically impossible.
2. Feeling of a foreign object inside. When a woman has a prolapsed uterus, she will feel as if something is bothering her inside. In addition, this phenomenon will be accompanied by the release of leucorrhoea, blood or blood clots. Also at this time, the lady will be able to feel the prolapsed cervix, and sometimes the uterus itself through the vagina.
3. Irregular menstruation. During the prolapse of the reproductive organ, the patient notices a long and heavy menstruation.
4. Urinary dysfunction. When the uterus descends into the vagina, it compresses the urinary outflows. This leads to incomplete emptying of the bladder, difficulty urinating, and urinary incontinence during stress or laughter.
5. Ulcers on the base of the vagina. Due to constant pressure on the vagina, it becomes dry, and its surface becomes covered with small cracks, which appear as a result of frequent trauma to the membrane.

If the integrity of the vascular network is compromised, bleeding may occur even after the menstrual cycle. In this case, it may appear during overexertion of the body, lifting weights or performing light gymnastic exercises.

How is the operation performed?

If wearing a bandage, following physical therapy and taking certain types of medications do not help get rid of the pathology, the doctor decides to perform an operation to return the uterus to a normal and natural state.

It is important to note that surgery for prolapse of the reproductive organ has certain pros and cons. However, if a woman’s condition is critical, the doctor, without hesitation, decides to perform surgery.

Currently, all types of operations are divided into certain groups:

• operations that can strengthen the pelvic muscles (as a rule, this is a two-stage operation called colpoperineolovatoroplasty);
• an operation performed on the uterine ligaments (it involves suturing and shortening the ligaments of the uterus, which are located on its anterior wall);
• strong fixation of the uterine cavity to the walls or pelvic floor;
• strengthening the uterine ligaments that secure this reproductive organ;
• if the subsidence is severe, which has a negative impact on health, endoprostheses are used to secure the organ in the correct position;
• narrowing of the vaginal cavity, through which the uterus cannot descend;
• removal of the uterus, which only the attending physician has the right to prescribe.

The operation is most often performed through the vaginal cavity, or using laparoscopy.

Many women diagnosed with uterine prolapse refuse surgery, preferring to endure the inconvenience caused by this problem. Why is there a persistent prejudice against surgical correction that dominates among women? Is the fear justified? And is it possible to avoid surgery? We are talking about this with Olga Glazkova, Associate Professor of the Department of Obstetrics and Gynecology of the Russian Medical Academy of Postgraduate Education, Candidate of Medical Sciences.

– Olga Leonidovna, what are the symptoms of uterine prolapse? It hurts?
– The genital slit does not close, and when a woman washes herself, she feels the protruding vaginal wall with her fingers. Or, for example, while douching, he feels that before the cervix was high, but now it has descended, and so have the walls of the vagina. One day a patient came running to me in horror, thinking that she had grown a tumor. Within a day, the anterior vaginal wall sank and began to swell, which she mistook for a neoplasm.

The front or back wall of the vagina or both at once may fall out, the cervix may appear from the genital slit, or the uterus may completely prolapse when it hangs in the sac. The genitals, urinary organs, and rectum pass through the pelvic floor. And therefore, in parallel with the uterus, they can also descend and fall out, for example, the front wall of the vagina falls out along with the bladder.

All this is complicated by urinary incontinence and constipation. But the symptoms are usually not painful. Most often, a woman is bothered by a feeling of discomfort, difficulties arise with sexual activity, the partner does not get pleasure: a long and thick cervix makes a man feel that his penis is adjacent inside the vagina with something equal to it in thickness and density.

– How is prolapse diagnosed?
– Visually, during examination on a gynecological chair. The woman is asked to push - and everything becomes clear. The problem is that it is very difficult to correctly localize pelvic floor defects. When the uterus falls out, it is immediately clear that it has been torn off. And when the prolapse is minimal, it is difficult to figure out to what extent the back wall is to blame, and to what extent the front wall. That is why further examination is prescribed according to the questions that arise, for example: “Did the prolapse of the anterior wall lead to kidney pathology?” If yes, then treatment proceeds in parallel - both kidneys and uterine prolapse. An ultrasound is required to find out if there are pathologies associated with prolapse: problems with the ovaries, the presence of fibroids.

– Is there a diagnosis of connective tissues?
- Currently no. But this is already understandable for those who have weak connective tissue. A woman comes to the appointment, she has terrible veins or an umbilical hernia - clear signs that there is prolapse. And if there is a tear or drooping, then the fabric is bad or good, you still need to sew it up.

Educational program
Genital prolapse is a process in which prolapse of the uterus occurs, and subsequently its incomplete or complete prolapse. When prolapsed, the uterus may sag in the vagina and even fall out of it (with a pronounced degree of prolapse).
The uterus is suspended by ligaments in the center of the pelvis and can move freely in the pelvic cavity. Such mobility is necessary for the normal course of pregnancy and childbirth, as well as for the stable functioning of the intestines and bladder. Normally, the uterus is held in place not only by ligaments, but also by the pelvic floor muscles. If the ligaments and muscles weaken, the uterus prolapses, which is usually accompanied by prolapse of the vaginal walls.

– Is it true that there are vaginal suppositories with collagen and tablets with hyaluron that restore elasticity to connective tissues? How effective are dietary supplements and suppositories in the prevention and treatment of prolapse?
– It seems to me that all this is nonsense. If you had a traumatic birth or obvious hypoestrogenism and the bladder and uterus are descending, then even if you take these dietary supplements in droves, the organs will not rise. In the future - such technologies are already being developed - perhaps they will inject stem cells into the pelvic muscles in order to strengthen and regenerate them. In the meantime, prevention consists of giving birth to a good obstetrician who can skillfully stitch up the tears. And second: it is necessary to carefully treat all injuries immediately after childbirth so that they heal completely.

Why does the uterus prolapse?
The primary reason for prolapse is traumatic birth. The medical literature describes a situation where prolapse and even prolapse of the genital organs occurred in virgins, but this is rare and is associated with severe connective tissue weakness syndrome, excessive physical exertion, terrible bronchial asthma, when a woman strains heavily when coughing, or with chronic constipation But in principle, if a woman has not given birth and certainly is not sexually active, then uterine prolapse is not her problem.

When a fairly serious injury is caused during childbirth, prolapse may appear immediately. Ruptures are not always the fault of obstetricians. It happens that a woman is simply not thoroughly examined and comes to childbirth with a sexually transmitted infection, for example, thrush. And with thrush, the tissues tear so much that it can be difficult to sew them up. In addition, against the background of inflammation, small wounds and scars take a long time and heal poorly.

Or another option: during childbirth, the woman was given obstetric forceps and, as a result, the tissue was injured. While a woman is young, there is a lot of estrogen and the connective tissues are quite elastic, she lives to an age close to menopause without any particular complaints. But when the level of estrogen begins to decrease, the tissues and mucous membranes become thinner, lose elasticity, the vessels are poorly supplied with blood, then all the problems that have been hidden underground suddenly suddenly appear. So the root cause lies in childbirth, and the consequence - progressive prolapse - is the lot of already aging women who experience estrogen deficiency.

– Many women after forty years ask gynecologists to prescribe hormone replacement therapy (HRT) to maintain youthful skin and healthy connective tissues. How justified are their hopes?
– HRT, of course, delays tissue aging, but it will not set a prolapsed uterus. Small prolapses are treated with weights. There are special sets - weights one at a time, starting with the lightest, are placed in the vagina and worn for an hour a day. Having learned to wear light ones, they try heavier ones. Kegel exercises are used to treat and prevent prolapse. When there is a tendency for prolapse, the doctor chooses exercises that do not increase abdominal pressure. In this regard, the best option is swimming. For very elderly women, the prolapsed uterus is put back in place using a ring.

– What are the disadvantages of the ring?
– This orthopedic correction does not cure, but simply holds the uterus so that it does not fall out. But by and large, you have to come to terms with the fact that pelvic floor prolapse can only be treated surgically. There are more than 200 methods and techniques of operations, but, unfortunately, all of them are not perfect.

-A woman's stomach is cut?
– Operations are performed either through the vagina, or most often it is a combination of vaginal and laparoscopic approaches. There is also an abdominal approach (through the stomach), but this technique is outdated. In the 50s and 60s, it was believed that in case of relapses there should be a two-stage operation: a vaginal stage and an abdominal one. Now they also believe that a two-stage operation is needed, only the first stage is vaginal, and the second is laparoscopic.

– Are relapses common after surgery?
– Often – from 3 to 20% of cases. And this does not even depend on the fact that the doctor was not very experienced. The problem is different: it can be difficult to detect a gap or a defect in the fascia (dense plates that surround the muscles). But now new technologies have appeared - meshes. They help significantly reduce the risk of relapse. At first they were used in the treatment of urinary incontinence: they tightened the urethra. Then they invented the Prolift system, which allows you to completely reconstruct the pelvic floor. The mesh is made of modern synthetic material; it can be said to be sewn into the fabric.

– There have been publications that meshes cause processes of rejection and suppuration.
– Previously, they produced meshes with small pores; bacteria penetrated them, but macrophages (cells that kill pathogenic bacteria) did not pass through. And such meshes gave a lot of suppuration. Then they began to make the pores larger so that macrophages could penetrate them, and this significantly reduced the problem of inflammation. There were meshes that did not fester, but rough scarring appeared around them: the walls of the vagina hardened like water pipes. This led to painful sensations and made sexual activity impossible. It was only when the prolan material was invented that many problems were solved. New generation meshes gently grow into connective tissue, do not shrink or roughly scar.

Risk group
In addition to hypoestrogenism, prolapse is affected by connective tissue weakness syndrome, because it is not the bones that hold the pelvic floor, but soft tissues. This is a congenital condition. There are entire families where umbilical and inguinal hernias, varicose veins of the extremities, hypermobility of the joints, subluxation of the lens, and a morphan-like body type are inherited (this is usually tall, low weight, and characteristic elongation of the limbs). There are about 20 states in total. In women with weak connective tissue, the most obvious external signs are hernias and varicose veins. Many people suffer injuries during childbirth, but prolapse occurs in those who have a decrease in estrogen and, more importantly, weak connective tissue from birth. Women with specific types of activity are also at risk. For example, if a woman unloads a truck of cement every day, then she is guaranteed to fall down. Skydivers - even those who have not given birth - hit the ground sharply when landing, and this quite often becomes the cause of prolapse of the uterus. Severe constipation and bronchial asthma are also fraught with uterine prolapse. More than 30 neurological diseases can lead to a situation where the muscles weaken and do not support the uterus. For example, underdevelopment of the spinal cord and intervertebral hernias lead to incompetence of the pelvic floor.

– Are the nets produced by size?
- No, they are standard. People, despite their different external sizes, are very similar to each other inside. During installation, the mesh can be slightly adjusted with scissors. However, despite all the advantages of this system, problems remain. For example, erosion of the mucosa above the implant. Sometimes, if installed incorrectly, erosion occurs through the wall of the rectum and the wall of the bladder. Whatever one may say, this is a foreign tissue, so inflammation cannot be avoided. This is why antibiotic prophylaxis is always given after surgery.

– How much does the Prolift system cost?
– This is an expensive technology. The mesh itself costs from 30 to 50 thousand rubles, depending on the distributor. The price also depends on whether a full Prolift is performed, or whether the mesh is implanted only in the anterior or only in the posterior wall of the pelvis. My patients buy the system themselves, and I install it.

– How long after the operation does a woman return to sexual activity?
- In two months. You will have to seriously limit physical activity. After surgery, it is recommended to avoid constipation and try to prevent terrible attacks of suffocation. We sometimes even decide whether to operate if the patient has a history of severe bronchial asthma. The very first attack after the operation will negate the positive result.

– Is it possible to give birth after surgery?
– When the genital organs prolapse, the cervix most often becomes thick and long. And when during the operation we put the uterus in place, we trim the cervix in order to reduce its weight. But then in the future there may be problems with pregnancy, there is a possibility of miscarriage. Therefore, before the operation, the doctor finds out whether the patient intends to give birth in the future. And depending on her plans, she chooses the method of correction. The good thing about mesh is that it minimizes the risk of prolapse during pregnancy, because it is located in the tissue itself. It forms the entire pelvic floor - supports the bladder, rectum and at the same time the uterus. But as for childbirth, doctors recommend cesarean section for those who have mesh.

– Let’s say a woman had prolapse and her uterus was repaired in the usual way. What awaits her after giving birth?
– During pregnancy, the uterus enlarges and rises upward. And it seems to the woman that the prolapse has disappeared. And after childbirth, the uterus begins to fall out again. For many, pathological childbirth results in new ruptures and repeated prolapse.

Good to know
Many gynecologists operate on everyone using the same standard technology, although each case of prolapse is individual. Therefore, you first need to understand the nature of a specific prolapse in order to correctly combine laparoscopic and vaginal approaches and eliminate all defects. If you perform a standard operation, there is a high risk of relapse. Ideally, a doctor should be proficient in different techniques - both laparoscopy and vaginal operations - and offer not what he knows, but what the patient needs. Unfortunately, in practice it turns out, as in Goethe’s Faust: “Everyone involuntarily believes in him who is the most arrogant.” There are doctors with such mad charisma that patients believe them at their word, and only their colleagues know that this doctor is an empty place.
In order not to run into an amateur, it is better, firstly, to contact state clinics, which are still largely controlled, and secondly, to doctors who have experience, but are not too old. There is a proverb: “Look for an old therapist and a young surgeon.”
Unfortunately, many older doctors are stuck with outdated technologies because their age makes it difficult for them to learn new things. They suture the uterus to the anterior abdominal wall (Kocher operation), and the younger generation of surgeons deals with the consequences of their operations when the posterior wall with the intestinal sac falls out in patients. In the 70s, up to 80% of uterine fixation operations were performed according to Kocher.
Miracle meshes are not installed for free and everywhere just because it is cheaper and easier to remove the uterus. This is the situation all over the world. If, during an examination by a gynecologist, a forty-year-old woman is diagnosed with a small cyst on the ovary, then in Russia, at least in Moscow, they will try to remove the cyst and preserve the ovary. Yes, relapses are possible later, but the woman is young, and the ovary will still be useful to her. In America, they will wipe everything clean, like with cancer, and prescribe HRT. Because it's cheaper. We also learned to count money. Performing an expensive embolization on one woman means depriving several patients of a coronary stent. Why spend so much money when you can operate on fibroids using the usual method? It's the same with grids. And besides, a lot is explained by the inertia of surgeons, because they need to go to courses and learn how to install meshes. Therefore, finding a good doctor is 90% of success.

– There is often a statement on the Internet that doctors refuse surgery for older women, explaining that after 70, surgery is useless.
- It is not true. There are no age restrictions, except for contraindications for health reasons. And a 30-year-old woman may be denied surgery, citing, for example, her severe heart failure. And if a person at 60 or even 80 years old is relatively healthy, then his advanced age is not a reason for refusal. But they always do a lot of preliminary examinations first, including sending the patient for a consultation with an anesthesiologist.

Numbers
Almost half of the world's women who have had multiple vaginal births suffer from uterine prolapse to some degree.
Before the age of 30, this pathology affects every 10th out of 100 women.
From 30 to 45 years – every 4th.
After 50 years – every 2nd.
15% of gynecological operations are performed for uterine prolapse.

– What are the consequences of ignoring treatment?
– If we take the structure of mortality, then in old age cardiovascular diseases come first, respiratory diseases come second, and urinary infections come third. Therefore, if a woman’s uterus constantly prolapses, then this problem brings with it a number of others: the ureters and bladder become bent, which leads to cystitis, pyelonephritis and even urological sepsis, from which you can die. Of course, prolapse in itself is not life-threatening, so the operation is interpreted as plastic; it can be done, or you can endure discomfort for the rest of your days. But if an elderly woman has a urinary infection, then it can only be dealt with surgically.

– Is it true that prolapse always leads to urinary incontinence?
- Not necessary. Prolapse makes urination difficult and sometimes causes constipation.

– In what cases is the uterus removed?

– Sometimes they remove it because it is too heavy and pulls other organs with it. But most often we remove the diseased uterus, for example, if it is burdened with fibroids or a precancerous condition. In general, the trend is that it is best for older women to have the uterus removed. For a young woman, it is wiser to install the Prolift system in order to preserve reproductive function, although the mesh is installed with or without a uterus.

– What should those who are still young and healthy do to strengthen the tissues of the small pelvis?– The pelvic fascia covers the muscles and is supported by them. And if the muscles are pumped up, then the fasciae are less likely to be injured. Therefore, it is good when the muscles in the pelvis are strong. Strength is achieved through Kegel exercises and swimming. I recommend to my patients, especially those after surgery, to visit the pool, and the most stubborn of them achieve good results.

Mila Serova

Unpleasant sensations and pain in the lower abdomen, frequent infections of the genital organs, the inability to receive joy from intimacy, problems with bowel movements - all these troubles can be avoided by a fairly simple operation with the complex name of perineolevatoplasty. We just need to not waste time.

SEE THE PROBLEM IN A SMALL WAY
Unfortunately, the first signs of trouble in the pelvic floor often escape the attention of not only the women themselves, but also the gynecologists who observe them. Most doctors consider a slightly open entrance to the vagina and slight sagging of its walls to be normal. Is it any wonder that the fight against infections almost always turns out to be ineffective, because inflammation, accompanied by itching, burning, and pathological discharge, arise precisely because the open genital slit does not fulfill its protective role for the ecological niche of the vagina.

But if you carry out preventive surgical correction of the pelvic floor in time, then in the future you can not only avoid uterine prolapse, but also preserve the vaginal flora, reduce the risk of inflammatory diseases of the genitals and pathological conditions of the cervix, improve the quality of sexual life, cope with chronic constipation, gas incontinence and urine.

ROOT OF EVIL
What are the causes of uterine and vaginal prolapse? There are many of them - a chronic increase in intra-abdominal pressure when lifting heavy objects, and; age-related degradation of collagen fibers that form the basis of connective tissue; decrease in estrogen levels during menopause; microcirculation disorders in the pelvic area.

However, most often pelvic organ prolapse occurs as a result of injuries (ruptures or cuts of the pelvic floor muscles) in women who gave birth naturally. The easiest way for a young mother to find out whether everything is okay with her pelvic floor anatomy and whether the muscles were damaged during childbirth is to consult a doctor. If the genital fissure is in a slightly open state, it is worth going for surgery, and the sooner the better. Incompetence of the pelvic floor muscles and prolapse of the uterus and adjacent organs can develop within a few years after childbirth, so very little time is available to solve the problem. If you don’t hurry up, then by the age of forty there will be a dubious chance of joining the list of patients suffering from this disease.

THE MAIN THING IS TO BE ON TIME
There are conservative methods for treating prolapse: exercises to strengthen the pelvic floor muscles; hormone replacement therapy, which replenishes the deficiency of female sex hormones estrogen; vaginal pessary (a special ring is inserted into the vagina for a long time, which supports the uterus in the correct position). None of them treat prolapse itself, but only help cope with the symptoms. Gynecologists rightly believe that the problem of pelvic floor muscle failure can only be solved surgically.

The operation to prevent uterine prolapse is quite simple. A triangular flap of the vaginal mucosa is excised through the vaginal opening, then the pelvic floor muscles, which have lost their normal location, are exposed. After this, the muscles that have left their place are captured by ligatures (binding threads) and pulled towards each other. They are returned to the position in which they should be. After this, the vaginal mucosa and perineal skin are restored.

The relatively short surgical procedure does not require general anesthesia. As a rule, everything is managed with gentle spinal anesthesia, which blocks the innervation below the belt.

The postoperative period lasts from 7 to 10 days. The only restriction at this time is that you cannot sit, but physical activity is welcome. It’s even better if, right in the hospital, a woman starts training her pelvic floor muscles using well-known ones. They will improve blood circulation and speed up recovery. In this case, there is no need to be afraid that the seams will come apart. Today, such surgical interventions are performed with special synthetic long-absorbable threads. Such seams will dissolve on their own in 30-90 days.

Perineolevatoplasty is one of the oldest operations aimed at treating genital prolapse. We can only regret that women aged 45 and older will no longer be able to use it with full effectiveness due to the neglect of the problem. For them, this chance is irretrievably lost, but there are other opportunities.

IF TIME IS LOST
To solve this problem, there are hundreds of more or less effective surgical methods:

• colporrhaphy: suturing the anterior, posterior or both walls of the vagina;
• Neugebauer-Lefort operation: suturing the anterior and posterior walls of the vagina together, leaving only two lateral canals - only for elderly patients who are no longer sexually active;
• operations with rigid fixation of the uterus or vaginal vault to the walls of the pelvis - to the pubic bones, sacrum, sacrospinous ligament;
• shortening the uterine ligaments in various ways, etc.

Unfortunately, many of these technologies have a high percentage of relapses.

It’s hard to believe, but every second woman over the age of 50 learns from her treating gynecologist that the cause of her constant pulling and pressing pain in the lower abdomen is prolapse of the uterus (in the words of medical textbooks - genital prolapse or uterocele). The pelvic floor muscles have weakened so much that they can no longer hold the uterus (and often neighboring organs - the bladder, rectum) in its natural position.

The pathology develops unnoticed and, most likely, the impetus for the disease was given in youth - difficult childbirth, carrying heavy loads, pelvic injuries and inflammation. Such situations are not uncommon; in India, for example, uterine prolapse is almost epidemiological in nature, and even in the prosperous United States, more than 15 million women suffer from this disease.

The uterus is the most mobile organ of the abdominal cavity. Even in a healthy woman, it can constantly change its position depending on the filling of the colon and bladder - the uterus is located right between them. When it descends into the vagina, neighboring organs are forced to “move.”

Often the situation is aggravated by displacement of the bladder (cystocele) and rectum (rectocele), hence problems with urination and constipation. There is a persistent feeling as if something is pressing down below, interfering, bloody discharge and pain may appear, radiating to the lower back and sacrum. As prolapse occurs, either difficulty urinating or, on the contrary, urinary incontinence is possible.

The menstrual cycle often gets confused and throws up unexpected surprises every now and then, and bleeding is accompanied by intense pain.

As a rule, the more prolapsed the uterus, the heavier your periods. In some cases, the amount of blood loss is so significant that there is a real risk of developing anemia.

During sexual intercourse, a woman also feels discomfort. If the uterus drops so much that its cervix protrudes beyond the genital slit, then intimacy will be impossible at all.

Every second patient whose uterus is displaced downward also suffers from various urological disorders. Difficulty urinating provokes the development of the symptom of residual urine, followed by infection of various parts of the urinary tract. Cystitis, pyelonephritis, urolithiasis - this is an incomplete list of consequences that will have to be eliminated.

4 stages of pathology development

Stage 1– slight downward displacement of the organ. The initial stage of development of pathology is spoken of until the cervix is ​​not visible from the outside, even with strong tension. The walls of the vagina are also slightly lowered, the genital slit may not close.

Stage 2– most of the time the cervix is ​​hidden in the vagina, but when straining it can be seen outside the genital slit.

Stage 3- not only the cervix, but also some part of its body is constantly below the level of the entrance to the vagina.

Stage 4- complete prolapse of the uterus.

The insidiousness of the situation is that at an early stage a woman may not feel any discomfort at all. But uterine prolapse has already begun, and if it is not diagnosed in time, then soon the uterus will drop so much that it will be visible. Most often this occurs due to incompetence of the pelvic floor muscles. They stretch, lose tone and can no longer hold the uterus in its normal physiological position.

Regularly visiting a gynecologist and monitoring the position of the uterus is especially important if your medical history includes:

• injuries sustained during childbirth due to breech presentation, the use of obstetric forceps or a vacuum extractor;
• deep perineal lacerations;
• surgical operations performed on the organs of the reproductive system;
• benign formations - cysts, fibroids, fibroids;
• congenital malformations of organs located in the pelvic area.

Work associated with regular physical activity and lifting objects weighing more than 10 kg is contraindicated for women of any age. This provision is enshrined at the legislative level and is listed as a separate item in the set of instructions on labor protection.

A common cause of uterine prolapse is increased intra-abdominal pressure. It can develop due to obesity, chronic constipation and flatulence. Even a strong, prolonged cough can force the uterus to move - it creates increased pressure in the abdominal cavity.

Most often, not one, but several factors play a role in the development of pathology. The situation is further aggravated if a woman is going through menopause - the lack of female sex hormones (estrogens) in the body certainly affects muscle tone.

How is the problem diagnosed?

The fact that the uterus is not in place can be understood during a routine gynecological examination. To determine the stage of prolapse, the doctor asks the patient to push. But since prolapse of not only the vaginal walls, but also neighboring organs is often observed, two more specialists must assess the situation - a urologist and a proctologist.

In addition to superficial examinations, you will have to undergo another mandatory examination - colposcopy. If no concomitant diseases of the uterus are found, the need for surgical intervention will disappear, then the woman will be registered at the dispensary and conservative treatment will be prescribed.

But if it is determined that the only way to solve the problem is organ-preserving plastic surgery, then the day before the patient will have to undergo several additional examinations:

• curettage and diagnosis of the uterine cavity;
• smears on flora, bacterial culture;
• excretory urography;
• computed tomography, necessary to clarify the condition of all pelvic organs.

Prolapse of 1st and 2nd degree: conservative treatment methods

As long as the uterus has not yet descended below the genital slit and the functions of adjacent organs are not impaired, the situation can be corrected by conservative methods:

• physical therapy aimed at strengthening the abdominal and pelvic floor muscles (a set of gymnastic exercises according to Kegel or Yunusov);
• gynecological massage (performed regularly for several months);
• a course of medications containing estrogen (this hormone is necessary to strengthen the ligamentous apparatus);
• local introduction into the vagina of ointments with a high content of metabolites and the same estrogens.

Gynecological massage has long been recognized as an effective method of restoring the tone of the perineal muscles. The main thing is that it is performed by an experienced gynecologist. Any pain during a massage is a reason to abandon this technique and look for other ways of conservative treatment.

It is important to take into account the individual characteristics of the patient, her reactions and, based on this, select the optimal speed and intensity of movements. The duration of each session is individual. On average it takes about 10-15 minutes.

The impact on the uterus occurs through palpation. With one hand the doctor massages the organ from the inside, and with the other he feels through the abdomen. In this way, the uterus is thoroughly palpated from all sides. It is also recommended for a woman to sleep on her stomach.

The effect of this technique: it is eliminated, adhesions disappear, blood circulation in all pelvic organs improves, and overall tone increases. Many women experience a long-awaited pregnancy after a course of massage.

Prolapse of the 3rd and 4th degree: various types of operations

If conservative therapy does not produce results and the uterus is already visible outside the genital slit, then surgery remains the only way to solve the problem. This is a common practice - 15 out of 100 gynecological operations are performed due to uterine prolapse.

1. Vaginoplasty is a complex of plastic surgeries aimed at strengthening the muscles of the pelvic floor, bladder and vagina. Since these muscles are involved in the prolapse of the uterus, vaginoplasty is always performed as a primary or additional measure.
2. Fixation of the round ligaments of the uterus to its anterior or posterior wall. Such operations are not performed often - the relapse rate is too high. The fact is that it is possible to fix the uterus with its own round ligaments, but they stretch over time, which means the uterus can descend again.
3. Stitching the uterine ligaments together. An effective technique, but sometimes leads to loss of fertility function.
4. Fixation of displaced organs to the walls of the pelvic floor. Most often they are attached to the sacral or pubic bone, as well as the pelvic ligaments.
5. Strengthening ligaments and fixing the uterus using alloplastic materials. The method has its own risks - the body can reject the foreign alloplast, and fistulas can develop.
6. Another way to prevent the uterus from falling out is to partially narrow the vaginal lumen.
7. The last radical method used when it is simply impossible to return the uterus to its place is hysterectomy, that is, removal of the organ. This is an extreme measure that they try to avoid. Since, by removing the uterus, you can provoke a strong displacement of other organs of the pelvic floor.

Most often, surgeons use combined techniques that make it possible to simultaneously perform vaginal plastic surgery, fix the uterus, and strengthen the ligamentous-muscular apparatus of the pelvic floor. This is the only way to be sure that the genitals are securely attached and relapses will not occur.

After surgery, you must completely avoid physical activity and follow a diet to avoid constipation.

Laparoscopic method

Another method of surgical treatment of uterine prolapse involves securing it with a special mesh. The mesh is elastic and can stretch, for example, during pregnancy. The same mesh can be used to secure the bladder and rectum during surgery.

The intervention is performed using a modern laparoscopic method, through a miniature (no more than 2 cm) incision in the abdominal cavity. After such an operation, there are no scars or adhesions left, which means it will not affect the condition of the vagina or the woman’s sex life.

This is the least traumatic and most effective method of treating pathology. Already on the 3rd day the patient was discharged home. The average duration of the recovery period is about a month. Relapses and repeated organ prolapses are excluded.

Contraindications for the operation?

Often, uterine prolapse is a problem for older and elderly women, so surgical intervention is not always possible. If there are contraindications for surgical intervention, the situation can be controlled using vaginal tampons or pessaries.

- This is a thick rubber ring that serves as a temporary support for the displaced uterus. There is air inside it, thanks to which the ring can be both elastic and elastic, without creating discomfort for the woman. You cannot leave the pessary in the vagina for a long time - bedsores may appear. It is worn for 3-4 weeks, then a short break is taken and after 2 weeks it is inserted again.

To avoid inflammation while the ring is in the vagina, special douching must be done every day. To do this, you can use a decoction of chamomile and antiseptics - a solution of furatsilin or potassium permanganate.

Another way to fix the uterus at a normal physiological level is to wear a bandage. The design of the bandage designed to support the uterus is different from other bandage systems. It tightly encircles the thighs, supporting the uterus from the sides, and passes through the perineum, supporting it from below. Wearing a bandage for more than 12 hours a day is not recommended, so as not to put excessive stress on the pelvic organs.

Uterine prolapse and pregnancy

Grade 1 uterine prolapse is not a contraindication to pregnancy and, on the contrary, can promote rapid conception. Since mild forms of the pathology are practically asymptomatic, a woman can only find out that the uterus is not in place when registering and undergoing a mandatory gynecological examination. Pregnancy and childbirth are possible in this case, but the expectant mother should immediately prepare for some difficulties.

1. She will often be bothered by nagging, aching pain in the lower abdomen. Many pregnant women with uterine prolapse find it difficult not only to walk, but also to stand.
2. Prolapse can become a threat to the life of not only the unborn child, but also the mother.
3. Prolapse of the uterus during pregnancy is a direct indication for wearing a bandage. This is the only way to support the internal organs in the correct position and relieve excessive stress on the spine.
4. It is important for a pregnant woman with prolapse to control her weight. The more kilograms she gains, the heavier the fetus will be and the greater the load will be on the already weakened uterine ligaments. If the baby is too large, there is a high probability of premature birth.
5. The birth process also has its own specifics. The doctor must choose a special position for the woman that will ensure minimal stress on her genitals. In this case, you cannot pull the baby by the head, and the arms and legs should be pulled out especially carefully. The qualifications of the doctor in this case are crucial. If he allows ruptures and treats them unsuccessfully, then after childbirth the uterus will drop even lower, and the pathology will move to the next, more severe stage.

Prevention of uterine prolapse - physical therapy

Train your perineal muscles by doing the lift exercise.

First, you need to smoothly tense the muscles and hold in this position for 4-5 seconds, then just as slowly relax. Now tense your muscles again and try to stay in this position for a few seconds longer than the first time. Gradually increase the pace and duration. It’s great if you can stay tense for at least 20 seconds.

Exercise "bicycle"

Lie on your back and move your legs in a circular motion as if you were riding a bicycle. Turn the pedals as much as you can. After a minute, repeat the exercise and try to “ride” a little longer.

Make “scissors” with your feet

Remaining on your back, straighten your legs and then lift them up one at a time. The angle formed between the leg and the floor should be approximately 45 degrees. Try to keep your leg straight, do not bend it at the knee joint and hold it at an angle for 5-6 seconds. Then lower and lift your other leg. Each time, try to keep your leg up for as long as possible, gradually increasing this time to 20 seconds.

"Triangle"

When you're done with the scissors, bend your knees and place your feet on the floor. While remaining lying down, raise your torso and lean on your elbows. Now lift your pelvis and tense your perineal muscles with all your might. Freeze in this position for a few seconds, relax and repeat from the beginning.

"Boat"

Roll over onto your stomach, and now try to bend over and raise both your arms and legs at the same time. Count to 5, return to the starting position and bend again, but this time try to count to 6. Repeat until you reach 20.

You need to increase the load gradually. Starting with 5-7 approaches, after a month of regular exercise, the number of repetitions of each exercise must be increased to 20 - only in this case there will be an effect. Such exercises will not take much time - only 30-40 minutes a day, but the benefits of exercise therapy are significant. With its help, you can not only reliably strengthen the uterus in place, but also prevent the development of a number of diseases of the genitourinary system and digestive tract.

Try to use the elevator as little as possible. Every time you climb stairs, your pelvic area muscles become stronger.

Such simple exercises are an important part of recovery after childbirth and effective prevention of gynecological diseases during menopause. Uterine prolapse is a serious problem, which is nevertheless easily solvable in the early stages. As soon as you feel that you are going to the toilet more often than usual, you cannot stand it for long and you are afraid of coughing or sneezing again - this is the first, but very serious “bell”. The sooner you suspect something is wrong and consult a doctor, the greater your chances of avoiding surgery.