Prolapse of the uterus in old age. What to do? Impact on pregnancy. How to treat uterine prolapse

Many women who are diagnosed with uterine prolapse refuse surgery, preferring to endure the inconvenience of this problem. Why is there a strong prejudice against surgical correction in the female environment? Is the fear justified? And can surgery be avoided? We are talking about this with Olga Glazkova, Associate Professor of the Department of Obstetrics and Gynecology of the Russian medical academy postgraduate education, candidate of medical sciences.

- Olga Leonidovna, what are the symptoms of uterine prolapse? It hurts?
- The genital gap does not close, and when a woman is washed away, she feels the protruding wall of the vagina with her fingers. Or, for example, douching, feels that earlier cervix the uterus was high, and now it has gone down, and the walls of the vagina too. Once a patient came running to me in horror, thinking that she had a tumor. During the day, the anterior vaginal wall sank and began to swell, which she mistook for a neoplasm.

The anterior or posterior wall of the vagina may fall out, or both at once, the cervix may appear from the genital slit, or complete prolapse uterus when it hangs in a bag. Through pelvic floor pass the genitals, urinary tract, rectum. And therefore, in parallel with the uterus, they can also fall and fall out, for example, the front wall of the vagina falls out along with the bladder.

All this is complicated by urinary incontinence, constipation. But the symptoms are usually not painful. Most often, a woman is worried about a feeling of discomfort, there are difficulties with sexual life, 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 omission diagnosed?
- Visually, when viewed on a gynecological chair. The woman is asked to push - and everything becomes clear. The problem is that it is very difficult to properly localize pelvic floor defects. When the uterus fell out, it is immediately clear that it was torn off. And when the omission is minimal, it is difficult to figure out to what extent the back wall is to blame, and to what extent it is the front wall. That is why further examination is prescribed according to emerging questions, for example: “Did the omission of the anterior wall lead to kidney pathology?” If yes, then treatment is on in parallel - and kidneys, and prolapse of the uterus. An ultrasound is necessarily done to find out if there are pathologies associated with the omission: problems with the ovaries, the presence of fibroids.

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

Likbez
Genital prolapse is a process in which the prolapse of the uterus occurs, and later its incomplete or complete prolapse. When prolapsed, the uterus can sag into 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 small 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 not only by ligaments, but also by the muscles of the pelvic floor. If the ligaments and muscles weaken, the uterus descends, which is usually accompanied by the prolapse of the walls of the vagina.

- 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?
“I think it's all nonsense. If you had a traumatic childbirth or obvious hypoestrogenism and the bladder, uterus descend, then at least take these dietary supplements in wagons - the organs will not rise. In the future, such technologies are already being developed, it is possible that they will inject stem cells into the pelvic muscles in order to strengthen and regenerate them. In the meantime, prevention is to give birth to a good obstetrician who will skillfully sew 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 descend?
First of all, the cause of prolapse is traumatic childbirth. IN medical literature a situation is described when the omission and even prolapse of the genital organs was formed in virgins, but this is rare and is associated with a severe weakness syndrome connective tissue, with exorbitant physical exertion, with terrible bronchial asthma, when a woman strains heavily when she coughs, or with chronic constipation. But in principle, if a woman has not given birth, and even more so does not live a sexual life, then uterine prolapse is not her problem.

When a rather serious injury is inflicted during childbirth, the omission can appear immediately. Not always gaps occur through the fault of obstetricians. It happens that a woman is simply not carefully examined and comes to childbirth with a sexual infection, for example, with thrush. And with thrush, the tissues are torn so much that it can be difficult to sew them up. In addition, against the background of inflammation, small wounds and scars heal for a long time and poorly.

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

- Many women after forty years of age ask gynecologists to prescribe hormone replacement therapy (HRT) for them to maintain youthful skin and improve connective tissues. How justified are their hopes?
- HRT, of course, delays the aging of tissues, but it will not correct a prolapsed uterus. Small omissions 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, they try harder. As a treatment and prevention of prolapse, Kegel exercises are used. When there is a tendency to droop, the doctor chooses exercises that do not lead to an increase in abdominal pressure. In this regard, the best option is swimming. For very elderly women, the prolapsed uterus is put in place with the help of a ring.

- What are the disadvantages of the ring?
- This orthopedic correction does not heal, but simply holds the uterus so that it does not fall out. And by and large, one must come to terms with the fact that the prolapse of the pelvic floor is treated only promptly. There are more than 200 methods and methods of operations, but, unfortunately, all of them are not perfect.

“A woman’s belly is cut open?”
– Operations are done either through the vagina, or most often it is a combination of vaginal and laparoscopic accesses. There is also an abdominal approach (through the stomach), but this technique is outdated. In the 1950s and 1960s, it was believed that in case of relapses, there should be a two-stage operation: the vaginal stage and the 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 there frequent relapses after surgery?
- Often - from 3 to 20% of cases. And it does not even depend on the fact that the doctor was not very experienced. The problem is different: it is difficult to detect a gap, a defect in the fascia (dense plates that surround the muscles). But now there are new technologies - grids. They help to significantly reduce the risk of relapse. Initially, 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 conditionally said to be sewn into the fabric.

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

Risk group
In addition to hypoestrogenism, the syndrome of weakness of the connective tissue affects the omission, because it is not the bones that hold the pelvic floor, but the soft tissues. This is an innate condition. There are entire families where umbilical and inguinal hernia, varicose disease limbs, hypermobility of the joints, subluxation of the lens, morphan-like body type (this is usually tall, low weight, characteristic lengthening of the limbs). There are about 20 states in total. In women with weak connective tissue, the brightest external signs- hernias and varicose veins. Many people get trauma during childbirth, but omission is formed in those who have a decrease in estrogen and, more importantly, weak connective tissue from birth. Women at risk are also specific types activity. For example, if a woman unloads a car of cement every day, then she is guaranteed to go down. Paratroopers - even those who have not given birth - hit the ground sharply on landing, and this quite often causes uterine prolapse. Severe constipation, bronchial asthma is also fraught with uterine prolapse. More than 30 neurological diseases can give a situation where the muscles weaken and do not hold the uterus. For example, underdevelopment spinal cord, intervertebral hernia lead to pelvic floor failure.

- Nets are produced by size?
No, they are standard. People, despite the different external sizes, inside are very similar to each other. During installation, the grid can be slightly adjusted with scissors. However, with all the advantages of this system, problems remain. For example, erosion of the mucosa over the implant. Sometimes, with improper installation, erosion occurs through the wall of the rectum and the wall of the bladder. Like it or not, this is a foreign tissue, so inflammation cannot be avoided. That is why antibiotic prophylaxis is always carried out after surgery.

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

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

Is it possible to give birth after the operation?
- When the genital organs are prolapsed, most often the neck becomes thick and long. And when during the operation we put the uterus in place, in order to reduce its weight, we cut the neck. But then in the future there may be a problem with bearing, there is a possibility of miscarriage. Therefore, before the operation, the doctor finds out whether the patient is going to give birth in the future. And depending on her plans, she chooses the method of correction. The mesh is good in 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, for those who have a mesh, doctors recommend a caesarean section.

- Suppose a woman had a prolapse and she in the usual way sutured the uterus. What awaits her after giving birth?
- During pregnancy, the uterus enlarges and rises up. And it seems to the woman that the omission has disappeared. And after giving birth, the uterus begins to fall out again. In many, pathological births turn into new breaks and repeated omission.

Good to know
Many gynecologists operate on everyone using one standard technology, although each case of prolapse is individual. Therefore, you first need to understand the nature of a particular omission in order to correctly combine laparoscopic and vaginal approaches and eliminate all defects. If do standard operation, there is a high risk of recurrence. Ideally, the doctor should have different methods- and laparoscopy, and vaginal operations - and offer not what he knows how, but what the patient needs. Unfortunately, in practice it turns out, as in Goethe's Faust: "Everyone who is most arrogant involuntarily believes in him." There are doctors with such frenzied charisma that patients believe them from a half-word, and only colleagues know that this doctor is an empty place.
In order not to run into an amateur, it is better, firstly, to contact public clinics, which are still more controlled, and secondly, to doctors who have experience, but they 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, as 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 deal with the consequences of their operations when the patient's back wall falls out with a bag of intestines. In the 1970s, up to 80% of uterine fixation operations were performed according to Kocher.
Miracle nets 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 on examination by a gynecologist a forty-year-old woman is found to have a small cyst on the ovary, then in Russia, according to at least in Moscow, they will try to exfoliate the cyst and save the ovary. Yes, then relapses are possible, but the woman is young, and the ovary will still be useful to her. In America, they will take everything clean, like with cancer, and prescribe HRT. Because it's cheaper that way. We also learned to count money. If you make an expensive embolization for one woman, then deprive several patients of a coronary stent. Why such expenses when it is possible to operate on myoma with the usual method? It's the same with grids. And besides, a lot is explained by the inertia of surgeons, because you have to go to courses and learn how to put up nets. Therefore, finding a good doctor is 90% of success.

– There is often a statement on the Internet that doctors refuse to operate on older women, explaining that after 70, surgical intervention 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 an operation, referring, for example, to 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
Nearly half of the women in the world who have had multiple vaginal births suffer from some form of uterine prolapse.
Up to 30 years old this pathology- 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 is the risk of ignoring treatment?
- If we take the structure of mortality, then in old age in the first place cardiovascular diseases, on the second - respiratory diseases, and on the third - urinary infections. Therefore, if a woman’s uterus constantly falls out, then this problem entails a number of others: the ureters and bladder are bent, which leads to cystitis, pyelonephritis and even urological sepsis, from which you can die. Of course, the omission itself does not threaten life, so the operation is interpreted as plastic, it can be done, or you can endure discomfort until the end of your days. But if u elderly woman arose urinary infection the only way to deal with it is through surgery.

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

In what cases is the uterus removed?

“Sometimes they remove it because it is too heavy and drags other organs along 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 most correct for older women to remove the uterus. And it is more reasonable for young people to put the Prolift system in order to preserve the reproductive function, although the mesh is placed both with and without the uterus.

- What should those who are still young and healthy do to strengthen the tissues of the small pelvis?- The pelvic fascias cover the muscles and are 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. And strength is achieved with the help of Kegel gymnastics and swimming. I recommend to my patients, especially those who after surgery, to visit the pool, and the most stubborn of them achieve good results.

Mila Serova

Uterine prolapse in women most often occurs in postmenopausal women, after difficult births with ruptures, with a hereditary defect in the connective tissue. On early stages the symptoms of the disease are hardly noticeable, in the later stages - one cannot help but pay attention to the abnormal structure and displacement of the genital organs. The tactics of treatment depends on the degree of prolapse (omission, prolapse) and the age of the woman.

The displacement of the uterus occurs due to weakening or damage to the fascia and muscles of the pelvic floor, which in normal condition hold her position. It develops over the years, with a predisposition to the disease, the first manifestations can be seen after 30 years. Childbirth through the natural birth canal is one of the provocative moments for the development of prolapse.

Classification

According to ICD-10, pathology is classified under the code N81. The prolapse of the uterus looks different - it depends on the severity of the prolapse of the genital organs. The division by degrees is reflected in the table.

Table - Stages (degrees) of uterine prolapse

Degrees	genital gap	The walls of the vagina	Cervix	The body of the uterus
I	gapes	Visible only when pressed	Displaced but does not come out of the vagina	Displaced but not coming out of the vagina
II	gapes	Visible without straining	Appears only when pressed
III	gapes
IV	gapes	Seen at rest from the outside		Protrudes beyond the vestibule of the vagina (incomplete uterine prolapse)
V	- "Eversion" of the genitals; - outside hangs the body of the uterus with the neck and walls of the vagina in the form of a "pear", "ball"

Starting from the second and third stages, the walls of the rectum and bladder protrude into the vagina, forming a recto- and vesicocele. This leads to disruption of the work of these organs - incontinence, poor emptying bladder, constipation.

Why does

The body of the uterus and cervix normally occupy a median location in the pelvic cavity. They help to keep the position of the ligament - wide, round. Connective tissue fibers go from the cervix anteriorly and posteriorly to the rectum and bladder. The uterus is, as it were, “suspended” in the cavity of the small pelvis. From below, the internal genital organs are held by the muscular apparatus of the perineum. All tissues contain a large number of estrogen receptors. Due to the action of hormones, ligaments are supple, extensible, and durable.

The closer to menopause, the less estrogen exposure. Accordingly, the properties of connective fibers and muscles are lost. The prolapse and subsequent prolapse of the uterus with the anterior, posterior and lateral walls of the vagina occurs due to changes in the properties of tissues in older women: blood supply deteriorates, elasticity is lost, the ligamentous and muscular apparatus of the pelvic floor weakens. Stretching, they can no longer acquire their original form. In addition, tears of the ligaments during attempts at natural childbirth during physical labor. Predispose to genital prolapse and other conditions.

• Pregnancy and childbirth. During all perinatal period increased pressure on the pelvic muscles. The tension is especially felt in the third trimester. During childbirth (especially with their protracted nature, abnormal position of the fetus or large baby, the use of obstetric forceps, as well as a vacuum extractor), tissue trauma occurs, the risk of serious vaginal ruptures increases, pelvic muscles and ligaments. Damage to the latter is often not diagnosed during the examination and even in the early period after childbirth - it is clinically manifested only after a dozen years of loss.
• birth defects. anomalous structure connective tissue in the form of increased extensibility and elasticity - this is the risk of prolapse and prolapse of the genital organs at any age. Especially after childbirth or with other provoking factors.
• Physical overvoltage. Excessive and regular loads lead to sharp increase intra-abdominal pressure. This causes fallout. That is why women are not recommended to do weightlifting, to have a physically overwhelming job.
• Other reasons. Also, prolapse and omission can be associated with neurological diseases, tumor processes in the pelvic organs. Overweight body, persistent flatulence, constipation can also lead to prolapse by increasing the load on the musculoskeletal system.

How does uterine prolapse occur in women?

Uterine and/or vaginal prolapse is characterized by various signs depending on the stage of pathology. The onset of the disease is asymptomatic. There may be slight discomfort in the lower abdomen, pain occurs with muscle tension. As the situation worsens, significant symptoms appear:

• pain - a pulling nature in the lower abdomen, lower back, sacrum, may occur during sexual intercourse;
• discomfort - some note constant feeling « foreign object» in the vagina;
• urological disorders- Difficulty, frequent urination, constant feeling of a full bladder;
• proctological disorders- there are constipations, flatulence, colitis, spontaneous release of gases and feces;
• palpation of the cervix and body of the uterus- during hygiene procedures, a woman can determine a strange tumor-like formation in the vestibule of the vagina.

Due to a violation of local blood circulation, congestion occurs in the small pelvis, cyanosis of the mucous membrane of the vagina and the body of the uterus occurs, and swelling of nearby tissues. With partial or complete loss of tissue, which must be protected from environment are in constant contact with her. There is their drying, ulceration, spotting, profuse leucorrhoea appear.

Complications

Prolapse or prolapse of the uterus, especially if left untreated, is dangerous for the following consequences.

• Urological disorders. Incontinence, incomplete emptying of the bladder provoke infection of other parts of the urinary system.
• Infectious complications. The thin and vulnerable vaginal mucosa is easily infected, resulting in decubital ulcers that may bleed. Perhaps the formation of tissue necrosis and bedsores of the walls of the vagina. IN cervical canal against this background, dysplastic changes are possible.
• Infringement. Prolapse of the uterus can lead to infringement of it, as well as intestinal loops if they fall into the formed hernial sac. This is a serious, life-threatening complication.
• Difficulties in sex. A slight prolapse of the genital organs does not affect intimate relationships, but complete or almost complete prolapse practically excludes classic sex. Even if a woman knows how to independently adjust the body and cervix, during sexual intercourse they will constantly fall out again.
• Venous congestion. A change in the anatomy of the body of the uterus and the vessels that fit it provokes varicose veins of the small pelvis and lower extremities.

The prolapse does not affect reproductive function. If a woman can have a normal sex life and there are no other problems that lead to infertility, pregnancy occurs. Prolapse of the genital organs does not interfere with gestation and does not increase the risk premature birth, miscarriages. On the contrary, after 20 weeks, the enlarged body of the uterus rises higher, pulls the walls of the vagina along with it, and the symptoms of the disease can no longer be noticed.

Confirmation of the diagnosis

Enough to make a diagnosis gynecological examination. With complete prolapse of the uterus, pathology can be detected independently.

To establish the degree of pathology, during the examination on the chair, the doctor suggests the woman to push. In this case, the descent of the cervix or body of the uterus, the anterior, posterior and lateral walls of the vagina relative to its normal location will be noticeable. In violation of the function of the bladder, involuntary urination occurs, gas can pass.

Other types of research may also be used. They are necessary for comorbidities and diseases of the uterus. And also with prolapse or omission, which require surgical intervention with the subsequent preservation of childbearing function. These include:

• curettage or hysteroscopy;
• examination for sexual infections;
• examination by a urologist and proctologist.

How to overcome the disease

Treatment of this pathology is determined depending on the clinical situation. Age, the nature of the prolapse and the presence of complications are important, whether pregnancy is planned in the future. After such interventions, childbirth is possible only by caesarean section.

Treatment of uterine prolapse, as well as its prolapse, can be carried out conservatively or surgically. Methods should be determined by a specialist. Using any option folk treatment inefficient.

Conservative treatment

Correction of uterine displacement without surgery is performed with a slight omission.

• Gynecological massage. The action is aimed at improving the blood circulation of organs reproductive system and increased tone of ligaments and muscles.
• Special gymnastics. Simple exercises are performed at home in order to strengthen the muscles, ligaments of the pelvic region. These are exercises according to Yunusov, Kegel.
• Medical treatment. Appointed hormonal preparations with local or systemic estrogens.

Elderly patients are recommended to use pessaries - special gynecological rings. There are a large number of shapes and sizes, the most suitable option should be determined by the doctor. Such a device is located in the vagina, rests against its arches, creating a mechanical support for the uterus and fixing its neck in a special hole. It acts as a kind of bandage. However, a huge drawback is that rings, like foreign bodies, provoke constant inflammation in the vagina with unpleasant secretions. There is also a risk of pressure sores. Therefore, gynecological pessaries should be changed every two weeks, while taking a break for a couple of weeks for sanitation. And also daily vaginal douching is carried out with infusion of chamomile or a solution of potassium permanganate, "Furacilin".

The vaginal ring with prolapse of the uterus can be made independently from beeswax. To do this, you need to apply melted wax on a wire bent in the shape of a ring and wait for it to dry. The result is a real gynecological pessary, the size of which must be determined by the doctor. Wax rings do not give such inflammatory response like silicone and plastic, and can be worn continuously for months.

Operations

With partial prolapse of the uterus and / or vagina, as well as a severe degree of their prolapse, surgical treatment is used. Recovery period while varying from two to four weeks. The following surgical directions are distinguished.

• Vaginoplasty. These are plastic surgeries that strengthen the fascia and muscles of the pelvic floor, vagina, and bladder. These include the front and posterior colporrhaphy, colpoperineolevathoroplasty. Such manipulations are the main ones in the correction of pathology. They are relatively simple and well tolerated.
• Round ligament shortening. Laparoscopy is performed or classical laparotomy access is used. The round ligaments that support the uterus are partially excised. However, over time, they stretch again, so such operations are less effective and often give relapses.
• Hysteropexy. The body of the uterus is fixed to the anterior abdominal wall with suturing. This eliminates prolapse, and the walls of the vagina rise after the uterus.
• TVT operations. These are operations in which vaginoplasty is performed with the simultaneous installation of an allograft in the area of ​​the bladder and rectum. These artificial materials (mesh) are fixed with sutures and thus prevent the formation of recto- and vesicocele. Until recently, such interventions were very popular, but a number of complications (allograft rejection, suppuration, nerve damage) led to the rejection of this operation.

Dear readers! Today our conversation is about delicate issue like prolapse of the uterus. This, indeed, becomes a problem for many women, which only gets worse over the years. So, according to statistics, such a pathology is diagnosed in every tenth out of a hundred women who have been diagnosed with such a diagnosis. At the age of up to 40 years, it is already diagnosed in 40% of cases, and at an older age, a similar problem is noted in half of women. 15% of all operations on the genitals are performed for prolapse or prolapse of the uterus. In this article I will tell you why uterine prolapse occurs, methods of treatment and whether it is possible to correct the situation at home.

Prolapse of the uterus - causes and consequences

Prolapse of the uterus, or as doctors also call this pathology, uterine prolapse is a pathological condition in which there is a failure of the ligaments and muscles in the pelvis. Under weight and pressure internal organs on the uterus is the displacement of the pelvic organs from top to bottom. First of all, the uterus is subject to displacement, and then the vagina. In addition, the bladder and rectum are affected. If this process is not stopped in time, then the uterus can move outside the genital gap, that is, it will fall out.

The uterus itself also has its own tone. Its normal position is to be in limbo in the middle of the small pelvis at an equal distance from its walls between the bladder and the rectum.

If the muscles and ligaments are not able to support the uterus in a suspended state, it begins to move downward. The reasons for this bias may be the following factors:

• Heavy physical work associated with lifting weights;
• Heavy or multiple births;
• Surgical interventions in the pelvis and perineum, in which the integrity of the pelvic muscles is violated;
• Deficiency of the hormone estrogen in the blood, which occurs during menopause;
• Obesity, overweight;
• Heredity and genetic predisposition, congenital anomalies, inflammatory diseases and tumors in the pelvis;
• Chronic constipation, hernia;
• Sedentary lifestyle,
• Advanced age.

There are 4 degrees of uterine prolapse. If at the first degree there is a slight omission, while straining the uterus does not leave the gaping genital slit, then at the fourth degree it is already outside, outside the genital slit. At this degree, adjacent organs are involved: the wall of the vagina, the bladder and the anterior wall of the rectum prolapse.

The process of weakening the muscles of the pelvic floor occurs gradually, therefore, when the first symptoms appear that indicate this pathology, it is necessary to immediately pay attention and start treatment.

And the first symptoms may be the following signs:

• a feeling of fullness and the presence of a foreign body in the lower abdomen;
• pain radiating to the lumbar or sacral region;
• frequent urination and constipation;
• the likelihood of bleeding from the vagina;
• violation of the menstrual cycle, painful, prolonged or heavy periods;
• discomfort during sexual intercourse.

As the process progresses clinical manifestations aggravated and with the progression of the state of pain become more intense, urinary incontinence develops, which occurs even with a slight sneeze or cough. There is incontinence of the stool and gases. Infection and inflammation of the urethra, bladder, development of pyelonephritis occur.

At last stage in the perineum there is a feeling of prolapse of the uterus. The prolapsed uterus becomes infected, inflammation occurs, trophic ulcers form, and atrophy of the mucosa. When walking, the prolapsed uterus is even more injured, bleeding from cracks, bedsores, and severe pain appear. Surrounding tissues become cyanotic and edematous, stagnation of blood appears and varicose veins veins of the small pelvis and lower extremities. All this chains a woman to bed, she becomes an invalid.

The most formidable complications include infringement of the uterus or part of the intestine, which can lead to necrosis of these organs. And only an urgent operation can save a life.

Of course, I repeat, the problem is too delicate and many women are afraid to see a doctor. Although, by starting treatment in the early stages, the progression of the disease and complications can be avoided.

Prolapse of the uterus - treatment without surgery

In modern gynecology, uterine prolapse is not considered terrible diagnosis. Of course, the outcome of treatment primarily depends on the degree of the disease. There are currently modern technologies treatment of uterine prolapse, which are very effective at all stages.

In the early stages, conservative treatment is recommended, in the later stages, surgery is indispensable. An important point at all stages of uterine prolapse is treatment with folk remedies, as well as the use of special gymnastics, but more on that later.

Modern gynecology does not consider uterine prolapse to be a terrible diagnosis, since the disease is very successfully treated at all stages. Although in some cases it is possible serious complications disease and surgery is indispensable. But at any stage of pathology, treatment must always be approached individually. And no matter what method of treatment you choose, you must first consult with a gynecologist. And now we will consider in more detail about the treatment of uterine prolapse without surgery.

Prolapse of the uterus - treatment at home

In the initial stages, doctors prescribe home treatment. I found a lot on the Internet positive feedback when at home women coped with a similar problem on their own, it means without surgical intervention. To do this, they used drugs from medicinal plants combined with special gymnastics. And so we will analyze these two types of treatment in more detail.

Despite the fact that when the uterus is lowered, it is not recommended to engage in heavy physical work, and even more so, sports, but with this problem, this is simply necessary! The fact is that when the uterus is lowered, it is necessary to do special exercises according to Kegel or gymnastics according to Yunusov. What is this gymnastics?

Kegel exercises for uterine prolapse

Kegel gymnastics is the tension of the muscles of the perineum. By straining these muscles, the former tone of the muscles of the pelvic organs returns. As a result, the uterus returns to its normal position. There are no contraindications for this exercise.

The positive thing is that you can do these exercises anywhere and anytime, it all depends on your desire. A huge plus of these exercises: when performing these exercises, no one who is next to you sees that you are doing them. For example, you can do these exercises at home, while doing any household chores, or while sitting at the computer, or when you go to bed. You can perform these exercises in transport, at work, on a walk, but anywhere!

Do not worry if in the first days you do not succeed, the fact is that the muscles are weak and they will not immediately want to obey your will. A positive result can be noted after a week of their regular implementation. You need to do gymnastics every day, you can work out well once, or you can do several approaches in a day.

And further important point. Feeling the result, do not stop doing these exercises. Remember that with age, the muscles of the small pelvis weaken? So do these exercises all the time. In addition to restoring the elasticity of the muscles of the perineum and pelvis, you can get rid of the weakness of the bladder and urinary incontinence.

Therapeutic exercises for uterine prolapse - video

Gymnastics with uterine prolapse

Gymnastics according to Yunusov is also effective. Its essence lies in the contraction of the muscles that are involved in urination. To perform it is necessary to strain the muscles of the perineum, simulating urinary retention. This exercise can be done when, where and as much as you like. But I must say that Kegel exercises are more effective and more muscles of the perineum and small pelvis are involved there.

With a similar problem, it is recommended to practice yoga. I already wrote about how to start doing yoga at home, read by clicking on the link. Yoga has no contraindications for this pathology. And this video will help you.

Exercises to strengthen the abdominal muscles are welcome: “scissors”, “bicycle”, “birch”, slow raising and lowering straight legs, etc. When performing these exercises, not only the abdominal press is strengthened, but also the muscles of the small pelvis.

Omission of the uterus - treatment with folk remedies

Herbal treatment of uterine prolapse has been used since ancient times, the problem of uterine prolapse was with our grandmothers and great-grandmothers. You understand how much hard work they had to do: this was work in wartime in factories, and in the fields, and at home they had to work on an equal basis with men. And numerous births also contributed to the development of this disease. They hardly knew about gymnastics then, but they were treated with herbs.

Now herbal treatment along with gymnastics is widely used and brings tangible results. But you need to know that herbal treatment is long-term, you need to drink regularly, without missing the intake of tinctures and decoctions.

What does traditional medicine offer us?

Plantain syrup. Pour 50 grams of dried plantain leaves with a liter of boiling water and then simmer on low heat for another half an hour, then add a tablespoon of crushed fragrant celery seeds to the broth, Let the broth brew for another 40 minutes and filter through a sieve, Add 500 grams of honey to the cooled broth, mix. Take ¼ cup before meals for a month. If necessary, the course can be repeated.

Infusion with dill seeds. Take dill seeds, St. John's wort, chicory and medicinal chamomile equally. Pour 1 teaspoon of the collection into a thermos and pour a glass of boiling water and leave overnight. Filter in the morning. Drink the resulting decoction throughout the day in small portions. In the evening, make the infusion again. They take the infusion for 3 weeks, then a break for 2 weeks, the course of treatment is 3 months.

Melissa infusion. Brew in a thermos 2 tablespoons of lemon balm leaves (fresh or dried) with 2 cups of boiling water, leave for several hours to infuse. Take a quarter cup an hour before meals.

Melissa can be brewed with other herbs: lemon balm -75 g, oregano - 75 g, coltsfoot 100 g. Mix the mixture and brew in the same way as with one lemon balm. Take a quarter cup an hour before meals.

Tincture with eggshell. Take the shells of 5 eggs, dry and grind in a coffee grinder. Grind 9 lemons and mix them together with the shell, leave for 4 days, then add 0.5 liters of vodka to the mixture and insist for 3 days. Then filter the tincture. Take ¼ cup morning and evening until you have drunk all the tincture. Repeat the course in a month, there should be 3 courses in total.

Bath with a decoction of pine nuts. Pour 1 cup of pine nuts with 2 liters of boiling water, cook in an enamel pan with a closed lid over low heat for an hour, turn off the fire and leave to brew for half an hour. Pour the resulting broth into a bath and soak in water at a temperature of 38º for 15 minutes.

Alternative methods of treatment of uterine prolapse - reviews

I found these reviews in a healthy lifestyle magazine, there is such a magazine. Knowing what I'm writing about folk methods treatment, my grandmother-neighbor brought me several files of this magazine. And here are some reviews - I found the results of the treatment of uterine prolapse.

fist massage

In the morning, waking up, lie on your back, stretch your legs, put the fist of your left hand on your stomach, cover your fist from above right palm and squeeze. Get a reinforced double fist. Drive this fist along soft tissues the abdomen with force pressing, first clockwise, then counterclockwise. Start with 2-3 ring movements, increasing the number of movements every morning. After 20 days, you need to do 20 movements in each direction. A woman does such exercises every morning 20 times in each direction. Her uterus fell into place, her stool improved, hemorrhoids disappeared. Against the prolapse of the uterus, it is useful to do other exercises: raise and lower the legs, make scissors, raise the knee to the chin, first with one, then with the other leg (2001, No. 10, p. 20)

Bank treatment

A simple remedy will help to cure prolapse and prolapse of the uterus. You need to take a half-liter jar and lie on it so that the navel is in the center of the neck. It will hurt, but you have to be patient and lie down for 3-5 minutes, as much as you can bear. Then, without rising, turn on your right side and lie down for another 10-15 minutes. Then lie on your back and tie up your lower abdomen with a handkerchief or elastic bandage and then get back on your feet. A sign that the uterus has fallen into place will be the absence of pain in the supine position on the jar. This folk recipe has been passed down in the same family from generation to generation. (2004, No. 9, p. 24).

belly massage

In the evening, before going to bed, lie on your back, relax, bend your knees. With your fingers, you need to walk along the lower abdomen 3-5 times, slightly lifting it. It will hurt a little for the first few days, but then the pain will go away. (HLS 2011, No. 21, p. 31-32).

And one more useful exercise. Waking up in the morning, without getting out of bed, roll over onto your stomach and stand in a knee-elbow position, lower your stomach as low as possible, and raise your hips as high as possible, stay in this position for 15 minutes. Then roll over on your stomach and rest a little without getting out of bed. Do these exercises for at least 20 days, but for best effect you can do them longer. By performing this exercise, the uterus will not only return to its normal position, but constipation will also stop, menstruation will normalize, and such an exercise will be useful for conception.

1. Wear a special bandage in the form of panties, you can buy it at the pharmacy. The bandage prevents prolapse of the uterus and internal organs of the small pelvis. It is worn on the naked body in a prone position so that the abdominal muscles are completely relaxed. Remove it, too, in a prone position. It is recommended to wear it no more than 10-11 hours a day, then it must be removed.
2. It is very useful, both for prevention and for existing uterine prolapse, cycling 2-3 times a week for 30-60 minutes.
3. Do not lift weights greater than 3 kilograms.
4. During sexual intercourse, use the “woman on top” position, in this position the pelvic muscles will be in good shape as a result of constant contraction and relaxation of the muscles.

Dear readers, the topic of uterine prolapse, as you probably already understood, is a fairly common problem in women. And I have consecrated far from all the subtleties of solving this pathology. To be continued.

Prolapse of the uterus is one of the forms of prolapse (displacement, prolapse) of the pelvic organs. It is characterized by a violation of the position of the uterus: the organ is shifted down to the entrance to the vagina or even falls out of it. In modern practice, this disease is considered as a variant of the hernia of the pelvic floor, which develops in the area of ​​the vaginal entrance.

Doctors in the description of this disease and its varieties use the concepts of "omission", "prolapse", "genital prolapse", "cystorectocele". The prolapse of the anterior wall of the uterus, accompanied by a change in the position of the bladder, is called a "cystocele". The prolapse of the posterior wall of the uterus with the capture of the rectum is called "rectocele".

Prevalence

According to modern foreign studies, the risk of prolapse requiring surgical treatment is 11%. This means that at least one in 10 women will undergo surgery for this disease during their lifetime. In women after surgery, in more than a third of cases, a recurrence of genital prolapse occurs.

The older the woman, the more likely she is to have this disease. These states occupy up to a third of the entire gynecological pathology. Unfortunately, in Russia, after the onset, many patients do not go to the gynecologist for many years, trying to cope with the problem on their own, although every second of them has this pathology.

Surgical treatment of the disease is one of the frequent gynecological operations. Thus, in the United States more than 100 thousand patients are operated on annually, spending 3% of the entire healthcare budget on this.

Classification

Normally, the vagina and cervix are tilted back, and the body of the organ itself is tilted forward, forming an angle open to the front with the axis of the vagina. The bladder is adjacent to the anterior wall of the uterus, the posterior wall of the cervix and vagina is in contact with the rectum. From above the bladder, the upper part of the body of the uterus, the intestinal wall are covered with peritoneum.

The uterus is held in the pelvis by the force of its own ligamentous apparatus and muscles that form the perineal region. With the weakness of these formations, its omission or loss begins.

There are 4 degrees of the disease.

1. The external uterine os descends to the middle of the vagina.
2. The cervix, along with the uterus, moves down to the entrance to the vagina, but does not protrude from the genital gap.
3. The external pharynx of the cervix moves outside the vagina, and the body of the uterus is higher without going out.
4. Complete prolapse of the uterus into the perineum.

This classification does not take into account the position of the uterus, it determines only the most prolapsed area, often the results of repeated measurements differ from each other, that is, there is poor reproducibility of the results. These shortcomings are devoid of modern classification genital prolapse, accepted by most foreign experts.

Appropriate measurements are taken with the woman lying on her back during straining, using a centimeter tape, uterine probe or forceps with a centimeter scale. Point prolapse is evaluated relative to the plane of the hymen (the outer edge of the vagina). Measure the degree of prolapse of the vaginal wall and shortening of the vagina. As a result, uterine prolapse is divided into 4 stages:

• Stage I: the most drop-down zone is more than 1 cm above the hymen;
• Stage II: this point is within ±1 cm of the hymen;
• Stage III: the area of ​​maximum prolapse is more than 1 cm below the hymen, but the length of the vagina is reduced by less than 2 cm;
• Stage IV: complete prolapse, reduction in the length of the vagina by more than 2 cm.

Causes and mechanism of development

The disease often begins at the woman's fertile age, that is, before the onset of menopause. Its course is always progressive. As the disease develops, there are dysfunctions of the vagina, uterus, and surrounding organs.

For the appearance of genital prolapse, a combination of two factors is necessary:

• increased pressure in abdominal cavity;
• weakness of the ligamentous apparatus and muscles.

Causes of uterine prolapse:

• a decrease in estrogen production that occurs during menopause and postmenopause;
• congenital weakness of the connective tissue;
• trauma to the muscles of the perineum, in particular, during childbirth;
• chronic diseases accompanied by circulatory disorders in the body and increased intra-abdominal pressure (intestinal diseases with persistent constipation, respiratory diseases with prolonged severe cough, obesity, kidney, liver, intestines, stomach).

These factors in various combinations lead to weakness of the ligaments and muscles, and they become unable to hold the uterus in a normal position. Increased pressure in the abdominal cavity "squeezes" the organ down. Since the anterior wall is connected to the bladder, this organ also begins to follow it, forming a cystocele. The result is urological disorders in half of the women with prolapse, for example, urinary incontinence when coughing, physical effort. The posterior wall, when lowered, "pulls" the rectum behind it with the formation of a rectocele in a third of patients. Often there is a prolapse of the uterus after childbirth, especially if they were accompanied by deep muscle ruptures.

Increase the risk of disease multiple births, intense physical activity, genetic predisposition.

Separately, it is worth mentioning the possibility of vaginal prolapse after amputation of the uterus for another reason. According to different authors, this complication occurs in 0.2-3% of operated patients with a removed uterus.

Clinical picture

Patients with pelvic organ prolapse are mostly elderly and old age. Younger patients usually have early stages of the disease and are in no hurry to see a doctor, although the chances of successful treatment in this case are much greater.

• feeling that there is some kind of formation in the vagina or perineum;
• prolonged pain in the lower abdomen, in the lower back, tiring the patient;
• protrusion of a hernia in the perineum, which is easily injured and infected;
• painful and prolonged menstruation.

Additional signs of uterine prolapse arising from the pathology of neighboring organs:

• episodes of acute urinary retention, that is, the inability to urinate;
• urinary incontinence;
• frequent urination in small portions;
• constipation;
• in severe cases, fecal incontinence.

More than a third of patients experience pain during sexual intercourse. This worsens the quality of their life, leads to tension in family relationships, negatively affects the psyche of a woman and forms the so-called pelvic descent syndrome, or pelvic dysynergia.

Often develops varicose veins with swelling of the legs, cramps and a feeling of heaviness in them, trophic disorders.

Diagnostics

How to recognize uterine prolapse? To do this, the doctor collects an anamnesis, examines the patient, prescribes additional methods research.

A woman needs to tell the gynecologist about the number of births and their course, surgeries, diseases of internal organs, mention the presence of constipation, bloating.

The main diagnostic method is a thorough two-handed gynecological examination. The doctor determines how much the uterus or vagina has sunk, finds defects in the muscles of the pelvic floor, performs functional tests - a test with straining (Valsalva test) and cough. A rectovaginal examination is also carried out to assess the condition of the rectum and structural features of the pelvic floor.

To diagnose urinary incontinence, urologists use a combined urodynamic study, but when organs are prolapsed, its results are distorted. Therefore, such a study is optional.

If necessary, endoscopic diagnostics is prescribed: (examination of the uterus), cystoscopy (examination of the bladder), sigmoidoscopy (study inner surface rectum). Typically, such studies are necessary if cystitis, proctitis, hyperplasia, or cancer are suspected. Often, after the operation, a woman goes to a urologist or proctologist for conservative treatment identified inflammatory processes.

Treatment

Conservative treatment

Treatment of uterine prolapse should achieve the following goals:

• restoration of the integrity of the muscles that form the bottom of the small pelvis, and their strengthening;
• normalization of the functions of neighboring organs.

Prolapse of the uterus 1 degree is treated conservatively in outpatient settings. The same tactic is chosen for uncomplicated genital prolapse of the 2nd degree. What to do with the prolapse of the uterus in mild cases of the disease:

• strengthen the muscles of the pelvic floor with the help of therapeutic exercises;
• refuse heavy physical activity;
• get rid of constipation and other problems that increase intra-abdominal pressure.

Is it possible to pump the press when the uterus is lowered? When lifting the body from a prone position, intra-abdominal pressure increases, which contributes to further pushing the organ out. That's why physiotherapy includes tilts, squats, leg swings, but without straining. It is carried out in a sitting and standing position (according to Atarbekov).

At home

Treatment at home includes a diet rich in vegetable fiber, reduced in fat. It is possible to use vaginal applicators. These small devices produce electrical stimulation of the muscles of the perineum, strengthening them. There are developments in SCENAR therapy aimed at improving metabolic processes and strengthening ligaments. Can be performed.

Massage

Gynecological massage is often used. It helps to restore the normal position of the organs, improve their blood supply, and eliminate discomfort. Usually, 10 to 15 massage sessions are performed, during which the doctor or nurse, with the fingers of one hand inserted into the vagina, lifts the uterus, and with the other hand, circular massage movements are made through the abdominal wall, as a result of which the organ returns to its normal place.

However, all conservative methods can only stop the progression of the disease, but not get rid of it.

Is it possible to do without surgery? Yes, but only if the prolapse of the uterus does not lead to its prolapse outside the vagina, does not impede the function of neighboring organs, does not cause the patient trouble associated with an inferior sex life, is not accompanied by inflammatory and other complications.

Surgery

How to treat uterine prolapse III-IV degree? If, despite all conservative methods of treatment or due to the patient's late request for medical help, the uterus has gone beyond the vagina, the most effective method of treatment is prescribed - surgical. The purpose of the operation is to restore the normal structure of the genital organs and correct the disturbed functions of neighboring organs - urination, defecation.

The basis of surgical treatment is vaginopexy, that is, fixing the walls of the vagina. With urinary incontinence, the strengthening of the walls of the urethra (urethropexy) is simultaneously performed. If there is weakness of the muscles of the perineum, they are plastic (recovered) with strengthening of the neck, peritoneum, supporting muscles - colpoperineolevathoroplasty, in other words, suturing of the uterus during prolapse.

Depending on the required volume, the operation can be performed using transvaginal access (through the vagina). This is how, for example, removal of the uterus, suturing the walls of the vagina (colporrhaphy), loop operations, sacrospinal fixation of the vagina or uterus, strengthening the vagina with the help of special mesh implants are performed.

With laparotomy (an incision of the anterior abdominal wall), the operation for prolapse of the uterus consists in fixing the vagina and cervix with its own tissues (ligaments, aponeurosis).

Sometimes laparoscopic access is also used - a low-traumatic intervention, during which it is possible to strengthen the walls of the vagina and suture defects in the surrounding tissues.

Laparotomy and vaginal access do not differ in long-term results. Vaginal is less traumatic, with less blood loss and the formation of adhesions in the pelvis. Application may be limited due to lack of necessary equipment or qualified personnel.

Vaginal colpopexy (strengthening the cervix with access through the vagina) can be performed under conduction, epidural anesthesia, intravenous or endotracheal anesthesia, which expands its use in the elderly. This operation uses a mesh-like implant that strengthens the pelvic floor. The duration of the operation is about 1.5 hours, the blood loss is insignificant - up to 100 ml. Starting from the second day after the intervention, the woman can already sit down. The patient is discharged after 5 days, after which she undergoes treatment and rehabilitation in the clinic for another 1-1.5 months. The most common complication in remote period- erosion of the vaginal wall.

Laparoscopic surgery is performed under endotracheal anesthesia. During it, a mesh prosthesis is also used. Sometimes amputation or extirpation of the uterus is performed. The field of operation requires early activation of the patient. An extract is carried out on the 3-4th day after the intervention, outpatient rehabilitation lasts up to 6 weeks.

Within 6 weeks after the operation, a woman should not lift weights of more than 5 kg, sexual rest is required. Within 2 weeks after the intervention, physical rest is also necessary, then you can already do light housework. The average period of temporary disability is from 27 to 40 days.

What to do in the long term after the operation:

• do not lift weights more than 10 kg;
• normalize stool, avoid constipation;
• time to treat diseases respiratory tract accompanied by cough;
• long-term use of estrogen suppositories (Ovestin) as prescribed by a doctor;
• do not engage in certain sports: cycling, rowing, weightlifting.

Features of the treatment of pathology in the elderly

Gynecological ring (pessary)

Treatment of uterine prolapse in the elderly is often difficult due to concomitant diseases. In addition, often this disease is already present in advanced stage. Therefore, doctors face significant difficulties. To improve the results of treatment, at the first signs of pathology, a woman should contact a gynecologist at any age.

Therefore, a bandage will provide significant assistance to a woman when the uterus is lowered. It can also be used by younger patients. These are special supportive panties that tightly cover the abdominal area. They prevent uterine prolapse, support other pelvic organs, reduce the severity involuntary urination and pain in the lower abdomen. Choosing a good bandage is not easy, a gynecologist should help with this.

A woman must perform therapeutic exercises.

With a significant prolapse, a surgical operation is performed, often this is the removal of the uterus through a vaginal access.

Consequences

If the disease is diagnosed in a woman of fertile age, she often has the question of whether it is possible to become pregnant with the prolapse of the walls of the uterus. Yes, there are no special obstacles to conception in the early stages if the disease is asymptomatic. If the omission is significant, then before the planned pregnancy it is better to be operated on 1-2 years before conception.

Preservation of pregnancy with proven uterine prolapse is fraught with difficulties . Is it possible to bear a child with this disease? Of course, yes, although the risk of pathology of pregnancy, miscarriage, premature and rapid birth, bleeding in the postpartum period is significantly increased. In order for the pregnancy to develop successfully, you need to constantly be observed by a gynecologist, wear a bandage, use a pessary if necessary, exercise physical therapy take medications prescribed by your doctor.

What threatens the prolapse of the uterus in addition to possible problems with pregnancy:

• cystitis, pyelonephritis - infections of the urinary system;
• vesicocele - saccular dilation of the bladder, in which urine remains, causing a feeling of incomplete emptying;
• urinary incontinence with irritation of the skin of the perineum;
• rectocele - expansion and prolapse of the ampulla of the rectum, accompanied by constipation and pain during bowel movements;
• infringement of intestinal loops, as well as the uterus itself;
• eversion of the uterus with its subsequent necrosis;
• deterioration in the quality of sexual life;
• decrease in the overall quality of life: a woman is embarrassed to go out public place, because she constantly has to run to the toilet, change incontinence pads, she is exhausted constant pain and discomfort when walking, she does not feel healthy.

Prevention

The prolapse of the walls of the uterus can be prevented in this way:

• minimize prolonged traumatic childbirth, if necessary, excluding the straining period or performing a caesarean section;
• timely identify and treat diseases accompanied by increased pressure in the abdominal cavity, including chronic constipation;
• in the event of ruptures or dissection of the perineum during childbirth, carefully restore the integrity of all layers of the perineum;
• recommend women with estrogen deficiency replacement hormone therapy, in particular, with menopause;
• assign patients at risk of genital prolapse special exercises to strengthen the muscles that form the pelvic floor.