Treatment for uterine prolapse in elderly women. Suturing the vaginal walls

Uterine prolapse is characterized by the spread of this area beyond the functional zone of the body. Very often the disease occurs in women after 50-60 years. It is important to establish why uterine prolapse occurs in older women; treatment in severe forms is only possible with surgery. At the first signs of the disease, it is necessary to consult with a qualified specialist about possible methods of therapy and its consequences.

Symptoms of uterine prolapse in older women

There are cases when loss occurs without obvious signs. This occurs due to the fact that the uterus gradually descends along the vaginal cervix. Therefore, at the initial stage, symptoms may not be obvious.

With partial loss, a woman may experience unpleasant symptoms when straining or exercising. There are a number of common symptoms of hair loss:

disruption of the menstrual cycle;
pain during intercourse;
pain signs in the lower abdomen;
nagging, aching pain in the lower back;
discomfort during “stool”;
urinary and fecal incontinence;
painful passing of gas.

The main symptom is pain in the abdomen or vagina. The disease can occur in women:

who have undergone gynecological surgery;
with a tumor;
adherent to frequent physical activity and hard work;
who had a difficult birth;
with hormonal disorders;
suffering from frequent constipation;
with weakened muscles of the pelvic area;
with diabetes;
with obesity.

To determine the extent of the prolapse, the doctor must examine the patient. Using transaginal ultrasound and palpation, a specialist will be able to determine whether there is prolapse or displacement of the uterus.

Very often, loss occurs in women after 50 years of age. During menopause, hormonal levels change and the amount of estrogen decreases. In this regard, the elasticity of the inner layers of the epidermis decreases. The tone of the pelvic muscles decreases. Because of this, the uterus shifts, as the muscles no longer hold it. This disease is especially common in women over 50-60 years of age.

What to do if uterine prolapse occurs in older women

There are different drug treatments for uterine prolapse. Conservative methods include all methods to strengthen the uterus and internal muscles. The doctor may prescribe special medications based on test results.

Special exercises for internal muscles have a beneficial effect. Classes should be coordinated with a doctor to avoid negative consequences. Kegel exercises have proven themselves to be effective for uterine prolapse. They are also used for urinary incontinence and weakness of intimate muscles.

Surgical procedures are used in a hospital setting. They are necessary in cases where conservative therapy does not help. Surgical methods will allow you to tighten the internal tissues to the desired level. In advanced cases, removal of the uterus is indicated.

In some cases, wearing pissaries helps. These are special silicone implants that are inserted inside the vagina. Such devices allow you to keep the uterus inside. Regular wearing of the ring in combination with gynecological massage can make it possible to treat uterine prolapse without surgery.

Very often, a special bandage is prescribed to wear with the uterine ring. The complex effect and strengthening of the internal muscles will allow you to cure uterine prolapse without surgery at the initial stage of the disease.

Treatment with folk remedies for women after 40 years with hair loss

There are different methods of treatment at home. All methods must be done under the supervision of the attending physician. These can be medicinal tampons, lotions and douching. Some women take herbal decoctions internally. In any case, each prescription should be aimed at strengthening the inner walls of the vagina.

Dried dandelion can be brewed in boiling water. The solution is used for douching. You can twist a gauze pad and soak it, then insert it into the vagina. Exposure can last for more than an hour.
Oak bark has a general strengthening effect. It must be brewed in a thermos or in a water bath. The solution is used for daily douching.
Astragalus wooliflora is often used in the treatment of gynecological diseases. The herb is mixed with alcohol and infused for a week. After the specified period, 1 tsp is added daily to water or tea. The preferred time of administration is morning.
St. John's wort, lemon balm and chamomile herbs are mixed in a 1:1 ratio. The mixture is brewed in a water bath. The decoction is taken 50 ml 3 times a day after meals.

It is useful to combine folk recipes with daily exercises and gymnastics. You can do the following exercises at home:

Alternately squeezing and firing the internal muscles while lying down.
Squeezing the internal muscles for 5-10 seconds while standing, followed by complete relaxation
In a position on all fours, squeeze and relax the muscles of the pelvic area.

It is recommended to repeat this exercise in several steps. The main advantage of home exercises is their accessibility. Classes can be done anywhere. Muscle contraction exercises are not visible to others. Therefore, they can be repeated regularly.

Consequences of uterine prolapse and prevention

If genital prolapse is not eliminated at an early stage, the uterus may fall out completely. Therefore, it is important to contact a qualified specialist in a timely manner. If hormonal pills and the above recommendations do not help, then surgery is necessary. Surgical intervention is especially often needed in older people.

follow a diet;
avoid constipation;
refrain from heavy physical activity;
walk more;
promptly treat gynecological diseases.

If you have genital prolapse, it is important to follow all doctor's instructions. Treatment of uterine prolapse in older women is sometimes difficult due to loss of firmness and elasticity of the vaginal muscles. Monitoring hormonal levels and constant monitoring will eliminate symptoms and tighten the uterus to the desired level.

Age-related weakening of the pelvic floor muscles in postmenopausal women can become the basis for genital prolapse. Prolapse and prolapse of the uterus in old age is almost impossible to cure with the help of gymnastics: the main methods of therapy are the constant use of a special support pessary or surgical correction.

The tendency to prolapse of the internal genital organs in women develops long before postmenopause. The most important factors contributing to the development of the disease are:

complicated childbirth;
any traumatic injuries in the perineal area;
gynecological operations;
severe obesity;
hard physical labor;
constant constipation.

In old age, conditions are created for the progression of genital prolapse in a woman: against the background of a decrease in the elasticity of the perineal tissue, the development of atrophic processes and muscle weakness, the prerequisites for the rapid deterioration of the disease are formed.

Rice. Prolapse of the uterus

Manifestations of the disease

In older postmenopausal women, prolapse of the internal genital organs is much more difficult to treat, especially in the presence of severe pathology of the heart and blood vessels. It is optimal to perform surgery, but if surgical treatment is not possible, a pessary or bandage must be worn to prevent complete uterine prolapse.

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Zhumanova Ekaterina Nikolaevna has certificates of an obstetrician-gynecologist, a functional diagnostics doctor, an ultrasound diagnostics doctor, a certificate of a specialist in the field of laser medicine and in the field of intimate contouring. Under her leadership, the laser gynecology department performs about 3,000 operations per year. Author of more than 50 published works, including guidelines for doctors.

What to do if you have uterine prolapse in old age?

Prolapse entails disruption of the functions of all pelvic organs. Therefore, at the slightest beginning of discomfort in the uterine area, you need to consult a doctor and get a diagnosis.

The gynecologist decides how to treat uterine prolapse. The most effective method of treatment remains surgical intervention. Elderly women are recommended to have the organ removed. But there are other methods of treatment.

Laporascopic treatment of uterine prolapse in elderly women

Treatment using this method can be carried out quite quickly and with almost no scars. During the operation to strengthen the fixing apparatus of the uterus, three punctures are made. A miniature video camera is inserted through one, and surgical instruments are inserted through the other two. This shortens the cardinal and uterosacral ligaments. And the uterus returns to its original place.

Alternative to surgery for uterine prolapse

To combat uterine prolapse and uterine prolapse, a pessary is often used. A pessary is a ring that is inserted into the vagina and actually supports the cervix. A modern pessary is made of soft and elastic material, which allows you to achieve the most positive effect. The use of a uterine ring for uterine prolapse is not prescribed for everyone and not always. It's all about the diversity of the course of the disease, and the characteristics of the female body. Here are a few options that use a uterine ring for uterine prolapse. Important information about it is attached below.

Indications for the use of a pessary for prolapse and prolapse of the uterus

In case of acute uterine prolapse, a pessary allows a woman to lead a normal life and at the same time carry out rehabilitation therapy. It protects the pelvic floor organs from deformation and excessive pressure, it keeps the uterus from swelling and makes it possible to get the necessary time for surgical treatment. In this case, the pessary for uterine prolapse is used temporarily.

The uterine ring is used for pregnant women in critical cases. It saves a woman’s body from stress, and provides a kind of respite, a respite, until the child is born and a solution to the problem is found.

For middle-aged and elderly women with uterine prolapse, uterine rings are prescribed for long periods. The fact is that in these cases, muscle recovery is not always possible. Therefore, the uterine ring becomes an insurance option and sometimes a daily option.

Important information about treating uterine prolapse with a pessary

What features does a pessary have, and what you need to know about the uterine ring in case of uterine prolapse in old age.

Modern uterine rings do not react with body fluids, which means they are very convenient for daily use.

In case of uterine prolapse, uterine rings should be removed at night. This is a necessary prevention for normal blood circulation.

The uterine ring requires careful care. Your doctor will advise you on cleaning products and techniques.

Despite the structure and elasticity, not every uterine ring is suitable for uterine prolapse in old age. It is selected by the doctor individually.

The uterine ring during uterine prolapse should not put pressure, cause pain or discomfort. If there are such symptoms, then either it is installed incorrectly or it is not suitable.

The design of this device and the technology of its use go back to ancient history. Therefore, we can consider that a pessary is the most conservative treatment for uterine prolapse in old age.

How to do gymnastics in old age with prolapse and prolapse of the uterus?

Treatment of hair loss with gymnastics has shown positive results, but it requires a lot of patience. The entire course lasts 12 months of constant classes. The most difficult thing in this therapy is consistency. It is necessary to withstand a critical period (about days) and you will feel improvement within 2 months.

List of basic Kegel exercises for uterine prolapse

Training the muscles that hold the uterus is a game of staying ahead of the problem. If you are active, love sports, or are simply determined and persistent, then regular use of Kegel exercises is what you need to treat and prevent uterine prolapse in old age. Moreover, if you don’t like playing sports and self-improvement, even then the method is within your power. The fact is that Kegel gymnastics for uterine prolapse does not require a special place, a special state of mind, or special equipment. All you need to do is take a sitting position.

Kegel exercise to force yourself to stop urinating. Every time you urinate, you need to forcefully stop it and start again. If possible, this should be done as often as possible. In the future, you will begin to feel the necessary effort, and will be able to reproduce it while sitting on a chair or driving.

Kegel exercise to tighten the pelvic muscles. To do this, you need to feel the muscles that hold the uterus - the lower abdomen, and try to pull them up. Ideally, the exercise should be performed rhythmically and quickly.

How to do a Kegel exercise with uterine prolapse for gradual contraction from bottom to top? You need to start contracting the muscles from the entrance to the vagina, and upward. At the same time, the “rise” must be divided into several parts and at each stage delayed for a couple of seconds

Pushing exercise. It is necessary to reproduce the labor force. The exercise has its own rhythm, the exercise must be done with a certain effort, and not at the limit of the possible. The main thing is rhythm and regularity of classes.

Kegel exercises should be done frequently. To do this, you can assign yourself three mandatory times for “approaches”. When you fully master the technique, you can conduct training in any place convenient for this.

Elevate gymnastics to the rank of a habit, and the problem of uterine prolapse will disappear by itself. But remember that using exercises will not save you from an incorrect lifestyle.

Gymnastics for uterine prolapse in older women

Basic exercises of classical gymnastics to maintain the tone of the muscles that support the uterus.

Walking as one of the gymnastics exercises. With this problem, you need to walk a lot, this allows you to gradually pump up the necessary muscle group, and causes little effort in the pelvis, which is very important.

If you have uterine prolapse, try to climb stairs more often or even specifically. You can even build an impromptu step and climb it, then descend it in a certain rhythm.

Doing the bike while lying on your back will also help a lot. If the problem is not in a critical phase, then you can use an ordinary bicycle or an exercise machine of this type.

A set of exercises aimed at developing the buttocks is perfect for these purposes. In particular, raising the pelvis with legs bent at the knees and resting on the floor, raising the pelvis with legs at an angle to the floor.

Swimming works great for uterine prolapse in old age.

It’s not too late for anyone to use Kegel exercises. Even if you have already undergone surgery, this technique will help maintain and strengthen your health.

Types of uterine prolapse and their symptoms

The process of prolapse is the displacement of the uterus down the inguinal canal (prolapse) or the sliding of the uterus into the vagina (in rare cases). In the mildest cases, the uterus protrudes forward at the bottom of the genital slit. Sometimes it partially falls out into the gap, and in the most severe cases of uterine prolapse, it falls out entirely.

Loss is classified by type of loss:

rectocele – prolapse of the back wall of the vagina, right in front of the intestines;

cystocele – prolapse of the anterior vaginal wall;

prolapse is the prolapse of the uterus into the genital opening.

Symptoms of prolapse and prolapse of the uterus in old age

Symptoms accompanying the disease:

pain in the lumbar region;

feeling of heaviness in the pelvic area;

discomfort and pain during sexual intercourse;

abnormal discharge due to uterine prolapse in old age;

frequent cystitis and other infectious diseases of the genitourinary system;

discomfort during urination, false urges due to uterine prolapse.

Causes of uterine prolapse in old age

The tissues of the uterus are stretched during labor and are injured. Especially if the child is big. As a result, the uterus may gradually slip into the vagina, and uterine prolapse will have to be treated.

in old age, muscle tone weakens greatly, hormonal levels are disrupted and the vaginal muscles weaken. It can also lead to uterine prolapse, which will need to be treated.

Tumor of the female genital organs as a cause of uterine prolapse in old age.

Genetics. Women in Africa and Asia are less likely to experience uterine prolapse than women in Europe.

As a result of obesity, pressure on the pelvic muscles increases. This can also cause uterine prolapse in old age.

Chronic cough (bronchial or asthmatic) can cause uterine prolapse.

Women who have a degenerating uterus are at risk.

Excessive muscle tension during bowel movements (during constipation) as a cause of uterine prolapse in old age.

Uterine prolapse in old age

Uterine prolapse is a progressive stage of uterine prolapse, an abnormal change in the anatomical position of the organ with its partial exit from the genital fissure. The pathology has multiple symptoms (dysuric and digestive disorders, discomfort and pain, foreign body sensation, inflammatory processes) and requires professional therapy in the clinic. The treatment method is chosen by the doctor based on the clinical situation, the patient’s age and other factors. Both conservative and radical effects are practiced.

The initial stage of the disease in question is uterine prolapse - downward prolapse of the organ. If proper therapy is not carried out at this stage, the prolapse turns into prolapse. Another name for the disease is diaphragmatic pelvic hernia.

The disease reduces a woman’s quality of life and can cause serious complications in the genitourinary and digestive systems.

Surgical intervention allows you to solve the problem in a radical way, but your health does not always allow you to perform the operation.

Causes

The main contingent of patients are elderly women who have given birth more than 2 times. Menopause itself is a predisposing factor for the occurrence of prolapse and subsequent dystrophic changes, since the lack of sex hormones negatively affects the physiological and anatomical status of the internal genital organs.

The direct cause of the disease is the progressive weakening of the muscles and ligaments of the perineum, pelvic floor, diaphragm and muscle tissue of the abdominal wall. With age, the uterus gradually changes its position, which creates the preconditions for the occurrence of hernial orifices. Relaxed muscles can no longer withstand the natural pressure of the internal organs, and the latter gradually shift downward.

Predisposing factors for such a shift are the following:

Multiple births, multiple or large pregnancies;
Difficult childbirth, accompanied by perineal ruptures and other injuries;
Gynecological surgical operations;
Decreased estrogen production after menopause;
Heavy physical work, heavy lifting, especially in the postpartum period;
Degenerative (involutional) age-related changes in tissues and organs;
Additional pressure on muscles due to obesity;
Weakening of muscle tone due to exhaustion;
History of abortion;
Constant constipation;
Chronic bronchitis, asthma and other diseases accompanied by a constant cough and increased intraperitoneal pressure;
Congenital anomalies of the genital organs that appear with age.

This disease occurs more often in Caucasians than in Asian and African American women. The first signs of uterine prolapse may appear at a young or middle age, the last stage - prolapse - may occur a year after the initial symptoms.

Symptoms

Uterine prolapse is accompanied by multiple disorders of the reproductive organs, excretory system and digestive system. The disease is almost always accompanied by prolapse of the bladder (cystocele) or rectum (rectocele). A change in the anatomical position of the uterus creates favorable conditions for infection of the reproductive organs: a gaping genital slit is especially dangerous. Prolapse is often accompanied by infectious and inflammatory processes in the vagina, bladder, and urethra.

Typical manifestations of the anomaly:

Sensation of a foreign body in the genital area;
Pain, discomfort in the lower abdomen, lower back;
Difficulty walking;
Dysuric disorders - involuntary urination when laughing, coughing, at night (with significant prolapse of the uterus, urination is difficult and is possible only after repositioning the uterus);
Constipation, incomplete emptying of the rectum;
Pain during sexual intercourse or complete inability to perform it.

Constant prolapse of the uterus contributes to traumatization of this organ, leading to the formation of trophic ulcers, bedsores, and the development of endocervicitis - inflammation of the cervical canal.

The abnormal position of the genitals negatively affects blood circulation, lymph outflow, causes disruption of tissue trophism (nutrition), and the formation of blood clots.

Diagnostics

The anomaly usually does not present any difficulties in diagnosis and is easily detected during a standard gynecological examination. To clarify the diagnosis and detect concomitant disorders, blood and urine tests and ultrasound examinations are prescribed. The initial stages of prolapse and prolapse can be detected by the patient on their own - when washing or douching.

Treatment

If the loss is partial or minor, installing an orthopedic ring - a pessary - will help. Other conservative methods at this stage are useless or produce a temporary therapeutic effect.

Most often they resort to radical treatment - surgical correction. The operations are performed as minimally invasive as possible - through the vagina or through laparoscopic access. There are modern medical technologies that can reduce the risk of relapse to a minimum. One of these procedures is the installation of a special synthetic mesh. Sometimes a hysterectomy is prescribed - removal of the uterus; as a rule, this occurs with complete prolapse, which is characterized by the exit of all parts of the uterus beyond the entrance to the vagina (you can read more about this in this article).

In this fragment of the “Doctors” program, Professor K.V. Puchkov. will talk about the causes and modern methods of treating genital prolapse:

Prognosis and possible complications

With timely and professional surgical treatment, the prognosis is relatively favorable. A positive role is played by following medical recommendations regarding limiting physical activity, correcting diet and lifestyle.

The most dangerous complications are inflammatory and infectious processes, kidney pathologies, chronic cystitis and urethritis, erosion, strangulation, and uterine edema. Mechanical damage leads to bleeding and painful ulcers on the organs of the reproductive system.

Prevention

The main method of preventing the disease is to detect uterine prolapse at stage 1 and eliminate muscle defects using conservative therapy - gymnastics, wearing a ring. A positive role is played by limiting stress, stabilizing weight, eliminating constipation, correct delivery, professional and timely treatment of any diseases of the reproductive system.

Causes and treatment of uterine prolapse, is it possible to do without surgery?

Uterine prolapse 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 moves down to the entrance to the vagina or even falls outside of it. In modern practice, this disease is considered as a variant of a pelvic floor hernia, which develops in the area of the vaginal opening.

Doctors in describing this disease and its varieties use the concepts of “prolapse,” “prolapse,” “genital prolapse,” and “cystorectocele.” Prolapse of the anterior wall of the uterus, accompanied by a change in the position of the bladder, is called a “cystocele.” Prolapse of the posterior wall of the uterus involving 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 have surgery for this condition in their lifetime. In women after surgery, in more than a third of cases, recurrence of genital prolapse occurs.

The older a woman is, the higher her likelihood of having this disease. These conditions account for up to a third of all gynecological pathologies. Unfortunately, in Russia, after the onset of menopause, many patients do not turn to a 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 most common gynecological operations. Thus, in the USA, 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 backward, and the body of the organ itself is tilted forward, forming an angle with the axis of the vagina that is open forward. 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 uterus, and the intestinal wall are covered with peritoneum.

The uterus is held in the pelvis by the force of its own ligamentous apparatus and the muscles that form the perineal area. When these formations become weak, they begin to sag or fall out.

There are 4 degrees of the disease.

The external uterine os descends to the middle of the vagina.
The cervix, together with the uterus, moves lower to the entrance to the vagina, but does not protrude from the genital slit.
The external os of the cervix moves outside the vagina, and the body of the uterus is located above, without coming out.
Complete prolapse of the uterus into the perineal area.

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. The modern classification of genital prolapse, accepted by most foreign experts, does not have these shortcomings.

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

Stage I: the most protruding zone is located above the hymen by more than 1 cm;
Stage II: this point is located 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 vaginal length by more than 2 cm.

Causes and mechanism of development

The disease often begins at a woman’s fertile age, that is, before menopause. Its course is always progressive. As the disease develops, dysfunction of the vagina, uterus, and surrounding organs occurs.

For genital prolapse to occur, a combination of two factors is necessary:

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

Causes of uterine prolapse:

decrease in estrogen production that occurs during menopause and postmenopause;
congenital weakness of connective tissue;
trauma to the perineal muscles, in particular during childbirth;
chronic diseases accompanied by poor circulation in the body and increased intra-abdominal pressure (intestinal diseases with constant constipation, respiratory diseases with prolonged severe cough, obesity, tumors of the ovaries, kidneys, 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 its 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 women with prolapse, for example, urinary incontinence when coughing or physical exertion. When the posterior wall subsides, it “pulls” the rectum with it, forming a rectocele in a third of patients. Uterine prolapse often occurs after childbirth, especially if it was accompanied by deep muscle tears.

Multiple births, intense physical activity, and genetic predisposition increase the risk of the disease.

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

Clinical picture

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

Symptoms of uterine prolapse:

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 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 their quality of life, leads to tension in family relationships, negatively affects the woman’s psyche and forms the so-called pelvic descent syndrome, or pelvic dysynergia.

Varicose veins often develop with swelling of the legs, cramps and a feeling of heaviness in them, and trophic disorders.

Diagnostics

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

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

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

An ultrasound examination of the uterus, appendages and bladder is prescribed. It helps determine the extent of surgical intervention. In the early stages of the disease, colposcopy is performed. Magnetic resonance imaging helps to assess the altered anatomy of the pelvis.

To diagnose urinary incontinence, urologists use a combined urodynamic study, but in case of organ prolapse, the results are distorted. Therefore, such a study is optional.

If necessary, endoscopic diagnostics are prescribed: hysteroscopy (examination of the uterus), cystoscopy (examination of the bladder), sigmoidoscopy (examination of the inner surface of the rectum). Typically, such studies are necessary if cystitis, proctitis, endometrial hyperplasia or polyp, or cancer are suspected. Often, after surgery, a woman is referred to a urologist or proctologist for conservative treatment of 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 pelvic floor and their strengthening;
normalization of the functions of neighboring organs.

Stage 1 uterine prolapse is treated conservatively on an outpatient basis. The same tactics are chosen for uncomplicated genital prolapse of the 2nd degree. What to do in case of uterine prolapse in mild cases of the disease:

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

Is it possible to pump up the abs when the uterus prolapses? When lifting the body from a lying position, intra-abdominal pressure increases, which further pushes the organ out. Therefore, therapeutic exercises include bending over, squats, and swinging legs, but without straining. It is performed in a sitting and standing position (according to Atarbekov).

At home

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

Massage

Gynecological massage is often used. It helps restore the normal position of organs, improve their blood supply, and eliminate discomfort. Typically, 10 to 15 massage sessions are performed, during which the doctor or nurse lifts the uterus with the fingers of one hand inserted into the vagina, and with the other hand they make circular massage movements 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 troubles associated with an inadequate sexual life, and is not accompanied by inflammatory and other complications.

Surgery

How to treat grade III–IV uterine prolapse? If, despite all conservative treatment methods or due to the patient’s late seeking medical help, the uterus has moved beyond the vagina, the most effective treatment method is prescribed - surgery. The purpose of the operation is to restore the normal structure of the genital organs and correct the impaired functions of neighboring organs - urination, defecation.

The basis of surgical treatment is vaginopexy, that is, securing the vaginal walls. In case of urinary incontinence, strengthening of the urethral walls (urethropexy) is simultaneously performed. If there is weakness of the perineal muscles, they undergo plastic surgery (restoration) with strengthening of the cervix, peritoneum, and supporting muscles - colpoperineolevatoroplasty, in other words, suturing 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 of the vaginal walls (colporrhaphy), loop operations, sacrospinal fixation of the vagina or uterus, and strengthening of the vagina using special mesh implants are performed.

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

Sometimes laparoscopic access is used - a low-traumatic intervention, during which the vaginal walls can be strengthened and defects in the surrounding tissue can be sutured.

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

Vaginal colpopexy (strengthening the cervix through the vagina) can be performed under conduction, epidural anesthesia, intravenous or endotracheal anesthesia, which expands its use in older people. This surgery uses a mesh implant to strengthen the pelvic floor. The duration of the operation is about 1.5 hours, 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 long-term complication is erosion of the vaginal wall.

Laparoscopic surgery is performed under endotracheal anesthesia. During it, a mesh prosthesis is also used. Sometimes amputation or hysterectomy is performed. The surgical field requires early activation of the patient. Discharge takes place 3-4 days after the intervention, outpatient rehabilitation lasts up to 6 weeks.

For 6 weeks after surgery, a woman should not lift weights exceeding 5 kg; sexual rest is required. Physical rest is also necessary for 2 weeks after the intervention, after which you can do light housework. The average period of temporary disability ranges from 27 to 40 days.

What to do in the long term after surgery:

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

Features of treatment of pathology in old age

Gynecological ring (pessary)

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

In the initial stages of the disease in elderly patients with uterine prolapse, a gynecological ring is used. This is a so-called pessary made of synthetic material, which is inserted deep into the vagina and supports its arch, preventing the uterus from descending. The ring is removed at night and washed well, and in the morning the woman puts it back. The gynecological pessary does not have a therapeutic effect. When using it, inflammatory complications are possible - colpitis, vaginitis, cervicitis, as well as erosion (you can read about cervical erosion here).

Therefore, a bandage will provide significant assistance to a woman with uterine prolapse. 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, and reduce the severity of involuntary urination and pain in the lower abdomen. Finding a good bandage is not easy; a gynecologist should help with this.

A woman must perform therapeutic exercises.

If the prolapse is significant, surgery is performed, often removing the uterus through a vaginal approach.

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 if the walls of the uterus prolapse. Yes, there are no special obstacles to conception in the early stages if the disease is asymptomatic. If the prolapse is significant, then before a planned pregnancy it is better to undergo surgery 1-2 years before conception.

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

What are the dangers of uterine prolapse in addition to possible problems with pregnancy:

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

Prevention

Prolapse of the uterine walls can be prevented in this way:

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

Why does uterine prolapse occur in older women?

In some cases, with a number of changes in the reproductive system, prolapse and/or prolapse of the uterus may occur. This process has a great impact not only on the reproductive system, but also on the entire body, as it is potentially dangerous and has a number of very diverse serious consequences. For this reason, it is necessary to know the symptoms of this disease in order to promptly suspect it in yourself and consult a doctor for treatment. This article explains why uterine prolapse occurs in older women and how it manifests itself.

Causes

In itself, prolapse and subsequent prolapse of the uterus can occur in women of any age - both reproductive and post-reproductive, as well as in girls. This is due to a number of external factors, such as injuries, stress, heavy lifting, etc. However, it is noted that the frequency of occurrence of this phenomenon has some age correlation. In older women in particular, uterine prolapse is more common. What is this connected with?

The fact is that with age, the ovaries begin to produce less and less estrogen (which is why the reproductive function gradually declines and the onset of menopause).

But in addition to the fact that estrogen is involved in the functioning of the reproductive system, it also affects the entire body, in particular, the elasticity and extensibility of muscles, and the tone of internal organs. And with a decrease in its content in the blood, the elasticity of the ligaments decreases, just as the tone of the internal organs decreases. This happens throughout the body, but it is on the pelvic organs that it affects the most significantly. As a result, the tone of the pelvic floor decreases, the ligaments become more extensible, and the organ gradually sinks down under the influence of its own weight, since the fascia is no longer able to hold it in place.

It is extremely rare, even in this case, that uterine prolapse in older women occurs on its own, without the influence of any factors. Most often, to activate the process, the influence of some external force is necessary - be it an injury, heavy lifting, damage to the fascia during gynecological surgery, inflammatory processes, etc.

In addition, the condition can develop for all the same reasons for which it develops in a young woman.

With ligament injuries, severe hormonal imbalance, and decreased pelvic tone, the condition develops gradually. First, prolapse is formed, then, after passing through a number of stages, very severe prolapse and prolapse occurs. But when lifting heavy objects, for example, the condition develops rapidly. A rupture or sprain of the ligament occurs suddenly, and the uterus falls out in an elderly woman almost immediately.

Symptoms

By what signs can this condition be diagnosed? Symptoms of uterine prolapse in old age are even more nonspecific than in reproductive age, and therefore it is quite difficult to promptly diagnose and begin to treat such a process in women of post-reproductive age. How can the condition manifest itself, and what symptoms does it cause?

Pain in the lower abdomen, lower back, which is periodic;
Feeling of heaviness in the lower abdomen;
Severe discomfort or pain during sexual intercourse;
Minor spotting, blood in vaginal discharge;
Sometimes there is a sensation of a foreign body and/or pressure on the vaginal vaults.

At the first stage of the development of the condition, there are no symptoms completely, since the uterus has dropped very slightly, and at this stage such prolapse does not in any way affect the condition of the body, the reproductive system and the condition of the patient. At the fourth stage, the main symptoms become visually fixed - the uterus and vagina fall out directly from the body and become visible outside the genital slit. But the patient’s well-being deteriorates quite quickly, so that even without visual recording of the prolapse, women often consult a doctor.

Consequences

This condition cannot be ignored as it has a significant impact on health. In general, the loss of this organ is quite difficult to ignore, since this condition has a significant impact on the quality of life. It not only worsens the state of health, but also significantly limits the patient’s physical activity (sometimes it is uncomfortable or difficult even to simply walk). What other consequences can cause complete uterine prolapse in older women?

Traumatic damage to a prolapsed organ, the likelihood of which is very high due to the specific condition and location of the organ;
The likelihood of an inflammatory, infectious, bacterial, fungal or viral process being associated is also very high;
Inflammatory processes potentially lead to sepsis, peritonitis, abscesses, which can be dangerous not only to health, but also to life in general;
Degradation of the organ, destruction of the mucous membrane, its drying out, erosion, which brings additional discomfort;
The likelihood of attachment and development of the inflammatory process not only on the prolapsed organ, but also on other organs of the reproductive and urinary system, which can manifest itself as cystitis, pyelonephritis, etc.

When uterine prolapse occurs in old age, the problem is usually solved much easier than in patients of reproductive age, due to the fact that there is no need to preserve reproductive function.

Diagnostics

What to do if you suspect you have uterine prolapse or prolapse? It is necessary to immediately consult a doctor for a comprehensive and high-quality diagnosis, diagnosis and treatment. During the assessment of the patient's condition, a number of the following activities are carried out:

Taking an anamnesis, during which the doctor determines the presence of factors predisposing to organ prolapse;
Examination (standard gynecological, using mirrors), during which prolapse can be determined, as well as palpation of the lower abdominal wall, which helps to suspect the presence of prolapse;
Ultrasound examination is the “gold standard” in gynecology, and it is also informative in this case, as it allows one to assess the position of the organ (carried out, depending on the stage, transvaginally or transabdominally);
Computed tomography of the reproductive system is sometimes prescribed to determine the processes in the pelvis that led to the development of pathology;
Analysis for hereditary predisposition is also sometimes necessary (a congenital tendency to connective tissue dysplasia leads to reduced tone);
A smear for infections is necessary in order to treat them if present and avoid infection during surgery;
Additional studies, such as cytology, scrapings, etc., are prescribed on an individual basis and at the discretion of the doctor.

Timely diagnosis is the key to successful treatment of this condition. Since only with a correct diagnosis is it possible to timely eliminate the consequences of the disease and prevent the development of severe consequences.

Treatment

How to treat uterine prolapse in old age? This depends on the degree of development of the disease and the individual characteristics of the patient and the pathological process. But almost always such treatment is surgical.

Conservative

There is no drug treatment for this disease. However, in the first and second stages of development, therapy without surgery is sometimes possible. A course of special gynecological massage is prescribed, as well as therapeutic exercises (both general, such as exercise therapy, and aimed at strengthening the pelvic muscles, for example, Kegel exercises). This can potentially increase the tone of the pelvis and the elasticity of the ligaments and fascia.

However, in old age such methods are very ineffective due to the altered state of the connective tissue. At the third and fourth stages, such methods are completely ineffective.

Surgical

Surgery is the most effective and efficient method of treatment. It helps with both prolapse and organ prolapse. Several types of surgical intervention are used: suturing ligaments, suturing an organ to the walls of the pelvis, and others. But in older women, the most common procedure for prolapse is hysterectomy. Although in the third stage of prolapse, it is often not used. In this case, hemming is more appropriate and less traumatic.

Folk

It is clear that traditional treatment for uterine prolapse in old age does not bring results, since even medical conservative therapy is not a way to solve this problem. In case of uterine prolapse, only surgery can help. In case of prolapse, as mentioned above, it is possible to use conservative methods, but even in this case, traditional methods of therapy will not have an effect, since the main effect is exerted by massage and gymnastics, that is, a relatively physical effect on the ligaments, muscles and fascia.

In what cases can traditional methods be used? They are not very effective, but can be used during the recovery period after surgery to speed up recovery. They can also sometimes be used when a doctor prescribes conservative therapy, but it is important to remember that they should not be used instead, but together with drugs prescribed by a specialist, exclusively as additional therapy.

In addition, we must not forget that, despite their low effectiveness, such recipes still have contraindications both in terms of the general condition of the body (allergic reactions, effects on other systems and organs) and their effects on the reproductive system. For this reason, you should consult your doctor before using any product.

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A change in the position of the uterus is called prolapse or prolapse. In the initial period, the disease is hidden and asymptomatic, but in the future it can cause serious consequences. What are the symptoms and treatment of uterine prolapse, how dangerous is this disease.

Causes of physiological displacement

Normally, in a healthy woman, the uterus is located at an equal distance relative to the walls of the pelvic ring, rectum, and bladder. The hollow muscular organ has fairly good physiological mobility; the position may change slightly taking into account the fullness of the nearby bladder and rectum. The normal position of the organ is also influenced by its own tone.

Prolapse is a gynecological pathology in which the organ receives anatomical and physiological displacement from weakened muscles, fascia and ligamentous apparatus of the pelvic floor.

When the pathology occurs in the initial stages, the patient complains of a feeling of pressure, discomfort, and nagging pain in the lower third of the abdominal cavity. As the disease progresses, problems with urination begin; the woman discovers a large amount of pathological vaginal discharge mixed with blood. A displaced and prolapsed organ can cause a serious complication - partial or complete prolapse.

When the organ continues to descend and the disease progresses, the woman experiences physical and mental suffering. Complete loss of performance is possible.

Degrees of displacement

With complete or incomplete prolapse, nearby pelvic organs are involved in the pathological process. If the anterior wall of the vagina is involved in the process along with the uterus, it is called a cystocele, if the posterior wall is called a rectocele.

The condition of pelvic organ prolapse is classified into three degrees:

At the first stage of the pathology (prolapse), the uterus is partially displaced downward, but the cervix is still located in the vaginal cavity. The patient has no complaints; the pathology is discovered accidentally during a gynecological examination.
The second stage is incomplete (partial) prolapse. The organ is lowered into the vaginal cavity; a cervix is visible at the entrance to the vagina.
At the third stage, the body and bottom of the organ partially extend beyond the boundaries of the genital opening.
At the fourth stage (complete prolapse), the vaginal walls are completely turned outward, the walls of the organ may drop to a level lower than the external reproductive organs. The body with the bottom of the organ completely protrudes beyond the boundaries of the genital slit.

The pathological process may involve intestinal loops, rectum, and bladder. The displacement of the internal organs is palpated by the doctor through the walls of the vagina.

Reasons for displacement

According to statistics, the disease is more common in mature women from 35 to 55 years old (half of the cases), and at a younger age, every tenth person is affected by the pathology.

The main prerequisite for changes in the position of the organ is weakness of the muscular and ligamentous apparatus of the pelvic organs. In young women, the disease can provoke disturbances in the anatomical structure of the pelvic organs (congenital defects), trauma to muscle structures, prolonged depression and stress. Possible prolapse of the uterus after childbirth.

Reasons for omission:

Surgical interventions.
Hormonal imbalance in combination with connective tissue dysplasia, excessive physical activity during menopause.
Excess body weight.
Intestinal motility disorders (frequent constipation).
Chronic cough.
Abortion.
Hormonal deficiency.
Numerous and long labors.
Birth injuries
Neoplasms of malignant and benign nature of the pelvic organs.
Neurological diseases in which the innervation of the genitourinary diaphragm is impaired.

Basically, a single cause is not enough for a disease to develop. Typically, prolapse with organ prolapse is the result of several unfavorable factors.

Uterine prolapse after childbirth as a complication is equally common both after natural delivery and after cesarean section.

Symptoms of the initial stage

In the initial stages, the pathology is asymptomatic. With the progression of the disease, when the mixing intensifies, the patient develops nagging pain and a feeling of pressure in the lower third of the abdominal cavity. The pain radiates to the sacrum, lower back, and groin. A woman feels that there is a foreign body in the vagina, sexual intercourse becomes uncomfortable and painful.

The following are one of the menstrual disorders:

Hyperpolymenorrhea - heavy menstruation with preserved frequency.
Algodysmenorrhea - menstruation with constant pain and accompanied by disturbances in bowel function and psycho-emotional disorders.

Between menstruation, profuse leucorrhoea appears, sometimes streaked with blood.

In the initial stage, the patient begins to experience discomfort during movements.

Pregnancy with uterine prolapse is usually impossible.

Cervical prolapse is a serious obstacle to healthy conception and pregnancy. The probability of fading and intrauterine fetal death reaches 95%.

Symptoms of a developed disease

The beginning of the second stage in half of the cases is accompanied by disorders in the urological sphere: difficulty urinating or frequent urination, congestion in the organs of the urinary system. From chronic stagnation, ascending infection develops, first in the lower and then in the upper sections: cystitis, pyelonephritis. A woman suffers from urinary incontinence.

At the second and third stages of the disease, overstretching of the ureters and expansion of the renal-pelvic system are observed. A lowered cervix is susceptible to injury, and the risk of developing cancer in a woman increases.

Of the proctological complications that occur in 30% of cases of the disease, women are concerned about constipation and colitis. Possible incontinence of feces and gases.

What does a prolapsed uterus look like: shiny or matte, with cracks or abrasions. From trauma while walking and sitting, ulcerations and bedsores form on the bulging surface. Wound mucosal surfaces bleed and quickly become infected.

Due to congestion in the pelvis, the mucous membrane becomes cyanotic, and swelling spreads to nearby tissues.

Sex during uterine prolapse is usually impossible: discomfort, pain, unpleasant sensations. During sexual contact, vaginal inversion can occur, which can cause severe psychological trauma for a woman.

Physiological prolapse

By late pregnancy, cervical prolapse is a normal phenomenon, which indicates the imminent onset of labor. The pelvic organs prepare for the birth of the fetus: they move it closer to the exit, providing a physiological position for passage through the birth canal.

Physiological cervical prolapse in late pregnancy can be identified by the following symptoms:

The contours of the abdomen change.
Digestive discomfort goes away.
The pressure on the diaphragm is relieved. The shortness of breath goes away and the woman breathes easier.
Frequent urge to urinate.
Difficulty walking.
Sleep disorders.

Such signs of uterine prolapse, if they appear three weeks before the expected birth, are considered normal and do not threaten pregnancy and the normal birth of a child.

If pathology is detected before 36 weeks, then to prevent the threat of miscarriage, the pregnant woman is hospitalized for conservation.

Diagnostic measures

Cervical prolapse and the degree of prolapse are determined by a gynecologist during an examination. Before treating uterine prolapse, the specialist takes into account complaints and anamnestic data (number of births and abortions, concomitant diseases, heavy physical labor).

After a vaginal and rectal examination, a specialist determines the degree of displacement in the pelvis. At the next stage, endoscopic and transvaginal ultrasound examinations are prescribed. With the help of these diagnostic procedures, the doctor determines how much blood circulation is impaired and how much the work of adjacent organs is impaired.

To determine the causes of uterine prolapse, the following are additionally prescribed:

Colposcopic examination.
Hysterosalpingoscopic examination.
Ultrasound examination, computed tomography.
Bacterial culture of vaginal flora.
Urine culture for bacterial flora.
Excretory urographic study.

The gynecologist prescribes consultations with related specialists: proctologist, urologist, endocrinologist.

A woman with a confirmed diagnosis is registered with a dispensary.

Therapeutic measures

The choice of therapeutic tactics takes into account the degree of severity, the presence of concomitant pathologies, age and constitutional data, concomitant sphincter disorders in the bladder and rectum.

If complete uterine prolapse is observed in older women, the degree of anesthetic and surgical risk is assessed.

Based on the aggregate data, the choice of therapeutic tactics is determined: surgical or conservative.

Conservative therapy

If the pathology does not cause disturbances in the functioning of adjacent organs, the body of the uterus is located above the genital slit, conservative therapy is indicated. Treatment without surgery for uterine prolapse includes: gymnastics, massage, use of special tampons, pessaries. In conservative therapy, the doctor may include special replacement therapy, vaginal medications with metabolites and estrogens.

Physiotherapy

To strengthen the abdominal muscles and pelvic floor muscles, therapeutic exercises are prescribed - a set of Kegel and Yunusov exercises.

Methods allow you to prevent the causes and consequences of uterine prolapse, and they can be used at home. A course of gymnastics prevents urinary and fecal incontinence, sexual dysfunction, and the development of hemorrhoids. Conditions for which gymnastics is indicated:

Difficult birth.
Gynecological injuries.
Pregnancy planning, preparation for childbirth.
Prolapse of the uterus after childbirth in the initial stage.

As a preventive measure, a gymnastic course is indicated for women with congenital weak muscles and ligaments, and those with excess body weight.

Gynecological massage course

The procedure can only be effective if it is performed by a highly qualified specialist. Objectives of the procedure: strengthening the muscular and ligamentous apparatus of the organ, eliminating minor prolapse, improving blood flow and lymph flow. Gynecological massage gives a chance to restore the normal position of the uterus without surgery. A course of procedures improves physical and psycho-emotional state, normalizes the menstrual cycle and intestinal function.

On average, the procedure lasts 15 minutes. The course of treatment is from 15 to 20 procedures.

Gynecological massage should be performed exclusively by a specialist. For self-treatment, the procedure is strictly prohibited!

Obstetric pessaries

What to do in old age with uterine prolapse? Typically, surgery is contraindicated for older patients, and therefore vaginal pessaries are used as conservative methods.

A pessary is an obstetric device made in the form of a small plastic or silicone ring. They are installed along the vaginal walls to fix the organs in a physiological position.

Pessaries are also used for the treatment and prevention of uterine prolapse during pregnancy, and for uterine prolapse after childbirth.

But this treatment has its disadvantages:

It is ineffective if the organ falls out completely.
Pessaries and tampons can cause bedsores.
Requires regular disinfection.
Requires regular visits to the doctor.
Only a doctor should insert and remove the pessary.

The use of pessaries requires daily douching from a decoction of chamomile, furacilin, and a pink solution of manganese.

A woman should visit a specialist twice a month.

Home treatment

In the initial stages of the disease, when the uterus is partially prolapsed, the attending physician may prescribe a course of herbal infusions.

What herbs are used to treat the uterus using folk remedies:

Tincture of astragalus roots.
Herbal collection of white claret, linden flowers, alder roots, lemon balm.
Quince infusion.
Herbal mixture of St. John's wort, calendula, burnet.

In order for the course of treatment at home to be effective, herbal medicine must be supplemented with gymnastics.

Surgery

When the uterus prolapses, surgery is inevitable if conservative methods to cure the pathology are ineffective.

Possible surgical methods:

Plastic surgery with strengthening of the muscular system. Indications: uterine prolapse in women planning to give birth; prolapse of the uterus after childbirth.
An operation to strengthen and shorten the muscular and ligamentous apparatus, subsequent fixation to the uterine wall. Indications: incomplete uterine prolapse.
An operation to strengthen the muscular-ligamentous apparatus followed by circular stitching.
An operation for fixation to nearby organs (sacrum, pubic bone, pelvic ligamentous apparatus). Indications: complete confluence of the cervix.
An operation to narrow the lumen of the vaginal wall. Indications: cervical prolapse in older patients.
Complete surgical removal of the organ.

After surgical treatment of uterine prolapse, a recovery period begins, which lasts two months.

To avoid complications and prevent recurrent uterine prolapse, the patient is recommended during this period:

Avoid sexual intercourse completely.
Avoid physical activity and heavy lifting.
Avoid baths and use showers for hygiene procedures.
Don't use tampons.

For patients diagnosed with uterine prolapse, surgical treatment is supplemented with a course of conservative therapy: gymnastics, special dietary nutrition, lifestyle adjustments with the exception of physical activity, and adherence to a drinking regime.

Forecast

The prognosis can only be favorable if the woman consults a doctor on time and has fully undergone qualified therapy. If previously it was believed that prolapse and conception are incompatible concepts, then in modern gynecology it is believed that with this pathology it is possible to become pregnant and carry a fetus to term. The main thing: the earlier cervical prolapse is diagnosed, the easier the treatment and recovery process is.

Prevalence

The older a woman is, the higher her likelihood of having this disease. These conditions account for up to a third of all gynecological pathologies. Unfortunately, in Russia, after the onset, many patients do not turn to a gynecologist for many years, trying to cope with the problem on their own, although every second of them has this pathology.

Classification

The uterus is held in the pelvis by the force of its own ligamentous apparatus and the muscles that form the perineal area. When these formations become weak, they begin to sag or fall out.

There are 4 degrees of the disease.

The external uterine os descends to the middle of the vagina.
The cervix, together with the uterus, moves lower to the entrance to the vagina, but does not protrude from the genital slit.
The external os of the cervix moves outside the vagina, and the body of the uterus is located above, without coming out.
Complete prolapse of the uterus into the perineal area.

Stage I: the most protruding zone is located above the hymen by more than 1 cm;
Stage II: this point is located 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 vaginal length by more than 2 cm.

Causes and mechanism of development

For genital prolapse to occur, a combination of two factors is necessary:

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

Causes of uterine prolapse:

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

Multiple births, intense physical activity, and genetic predisposition increase the risk of the disease.

Clinical picture

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 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.

Varicose veins often develop with swelling of the legs, cramps and a feeling of heaviness in them, and trophic disorders.

Diagnostics

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

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

To diagnose urinary incontinence, urologists use a combined urodynamic study, but in case of organ prolapse, the results are distorted. Therefore, such a study is optional.

If necessary, endoscopic diagnostics are prescribed: (examination of the uterus), cystoscopy (examination of the bladder), sigmoidoscopy (examination of the inner surface of the rectum). Typically, such studies are necessary if cystitis, proctitis, hyperplasia or cancer is suspected. Often, after surgery, a woman is referred to a urologist or proctologist for conservative treatment of 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 pelvic floor and their strengthening;
normalization of the functions of neighboring organs.

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

At home

Massage

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

Surgery

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

Sometimes laparoscopic access is used - a low-traumatic intervention, during which the vaginal walls can be strengthened and defects in the surrounding tissue can be sutured.

Laparotomy and vaginal access do not differ from each other 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.

What to do in the long term after surgery:

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

Features of treatment of pathology in old age

Gynecological ring (pessary)

A woman must perform therapeutic exercises.

If the prolapse is significant, surgery is performed, often removing the uterus through a vaginal approach.

Consequences

Maintaining pregnancy with proven uterine prolapse is difficult . Is it possible to carry a child to term with this disease? Of course, yes, although the risk of pregnancy pathology, miscarriage, premature and rapid labor, and bleeding in the postpartum period increases significantly. In order for the pregnancy to develop successfully, you need to be constantly monitored by a gynecologist, wear a bandage, use a pessary if necessary, engage in physical therapy, and take medications prescribed by your doctor.

What are the dangers of uterine prolapse in addition to possible problems with pregnancy:

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

Prevention

Prolapse of the uterine walls can be prevented in this way:

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