Uterine prolapse - a complete or partial displacement of the uterus outside the vagina.We can say that uterine prolapse in women is the end result of a chronic, slowly progressive process of displacement of the genitals.
The uterus is a muscular hollow organ pear-shaped, normally located between the bladder (front) and the rectum (back).It is positioned so that her body does not protrude beyond the plane of the entrance border pelvis.
permanent location of the uterus and surrounding organs provided by muscles and ligaments that form the so-called "pelvic floor" - powerful muscular layer of the three-layer capable of maintaining constancy of intra-abdominal pressure and to keep all the internal organs (not just the pelvic organs) on the spot.The pelvic floor muscles are covered with a dense envelope of connective tissue - the fascia, which gives them even more strength.Another important function of the pelvic muscles is to provide a process of physiological delivery, when
Since the uterus during pregnancy is significantly increased in volume and makes active movements (reduction) during labor, it requires additional fixing.To do this, the uterus has its own ligaments, consisting of a round and broad ligament.
To the queen remained at the proper place, the muscles and ligaments of the pelvic floor must retain its properties - strength and elasticity.Any process that leads to a change in these properties, "triggers" mechanism offset genitals.
Omission of the uterus is not an isolated process.Due to the close connection between all the sexual organs are all behind the uterus to varying degrees alter its normal location.Often displacing downward uterus drags the bladder, which puts pressure on the anterior wall of the vagina, gradually forming a protrusion - cystocele.A similar process occurs in the case of involvement in the displacements of the uterus posterior vaginal wall: sinking, she drags the rectum and forms a protrusion in the cavity of the vagina - rectocele.
uterine prolapse precedes its gradual shift.Omission of the uterus occurs mostly in women who have overcome the 45 - year mark, and uterine prolapse in elderly women occurs much more frequently than in other age groups.However, the view that the omission and uterine prolapse is not common in young ladies, is erroneous, out of a hundred women 30 - 45 years, forty found some degree of displacement of the genital organs.
primary role in causing the loss of the uterus belongs to birth trauma and trophic disorders.
Uterine prolapse - a serious disease process, delivering significant distress to patients and reduces their quality of life.Due to the fact that the process has a long bias genital character, it is possible to stop it, and sometimes even eliminated.
for women at risk of developing genital displacement developed a set of preventive measures, the observance of which helps to avoid unwanted changes.
Therapy prolapse involves a large number of therapeutic measures aimed at restoring the integrity of the pelvic floor and the elimination of disorders of adjacent organs.Unfortunately, without surgery with complete prolapse of the uterus to achieve this is extremely difficult, and sometimes impossible.
main cause of uterine prolapse is a functional failure of the ligamentous apparatus of internal genital organs and muscles that form the pelvic floor.As a result, an increase in intra-abdominal pressure (eg, during exercise) bodies can not properly resist him and literally squeezed out of the pelvic floor in the direction of the vagina.The extent of the displacement of the boundaries of their normal position depends on the nature and extent of the pathological changes of ligamentous and muscular apparatus of the pelvic organs, which are due to several reasons:
- Post-traumatic deformity of the pelvic floor.Most often it occurs during birth.
- insolvency fixing organs located outside the pelvic organs.Manifested by the presence of hernias and displacements.
- Hormonal dysfunction (impaired steroidogenesis).
- neginekologicheskie Chronic diseases that lead to disruption of metabolic processes.
- Heavy labor, accompanied by sustained bearing-down period, deep perineal tears, especially if they were not properly sutured.
- Multiple and / or prolific (twins triplets, etc.) labor.
- Complicated obstetric manipulation - manual removal of the fetus in breech, forceps and so forth.
- Complex operations on the genitals.
- Congenital malformations in the pelvic area.
- Excessive exercise: hard physical labor or inadequate sports exercises associated with heavy lifting and strain of the abdominal muscles.
- Advanced age, which is characterized by natural hormonal and structural changes.
- persistent cough with asthma, emphysema or bronchitis, increased pressure in the chest.
- Chronic constipation, forcing to strain the abdominal muscles and thereby increase intra-abdominal pressure.
- constitutional features (asthenic constitution, general infantilism).
- Genetic predisposition.The presence of uterine prolapse mothers, grandmothers or sisters increases the risk of developing this disease.
None of these factors is not the direct cause of uterine prolapse, the most important is a combination of several conditions.
physiological displacement of the uterus during pregnancy is not seen as a pathology.With the growth of the fetus and uterus increases may shift down.In the postpartum period in healthy women, it returns to its original position.
However, in women diagnosed with pregnancy outside the uterus prolapse, uterine prolapse after birth is a very real situation.In this case the pregnancy is a precipitating factor, and prolapsed uterus after childbirth is the next, end-stage bias genitals.
Symptoms of uterine prolapse
very rare uterine prolapse occurs quickly and diagnosed during primary gynecologic reception.As a rule, the process of displacement of the genitals takes a long period of time, accompanied by an increase of clinical manifestations, which it is impossible not to draw attention.The cause of primary treatment to the gynecologist is in most cases of uterine prolapse.If the process can not be stopped or eliminated in a timely manner, it is aggravated and leads to uterine prolapse.
Diagnostics prolapse causes no difficulties.Women often have self-diagnosed themselves as prolapse and uterine prolapse, finding "foreign body" in the vagina, or feeling like "something to prevent" outside.During the visit of the patient to the doctor diagnosed based on visual and handed a pelvic exam.
loss genital symptoms depend on the specific clinical situation and the degree of displacement of the body.Since the uterus during the downward displacement drags the surrounding structures, along with her loss is detected loss of the cervix and vaginal walls.
distinguished by the degree of displacement incomplete uterine prolapse and complete uterine prolapse beyond the genital slit.This incomplete uterine prolapse is accompanied by loss of the cervix and vaginal walls (in some cases can fall only one wall), and the total loss of the uterus is characterized by the formation of a kind of "bag", composed of the body of the uterus and remove the vaginal walls.
patients should pay attention to the fact that use of the term prolapse of the uterus properly.The uterus can not move "piecemeal" as a single body, and coming out of the uterine wall is impossible, unlike the vaginal walls, which can be displaced partially or completely.
In the initial stage of uterine prolapse occurs only when abdominal pressure increase and straining, but with the progression of the uterus drops without any physical effort.
During the inspection assessed the degree of bias / loss of the uterus and surrounding structures at rest and during straining.Before inspection on the gynecological chair woman offers tighter in an upright position, and then made a two-handed examination in a horizontal position, which identifies the location of the cancer.When incomplete uterine prolapse is located in the cavity of the vagina, the cervix is visualized beyond.The color changes of the cervix, it increases in size due to swelling, sometimes visible on the surface of the damaged areas of the mucosa and multiple small ulcers (bedsores).On the walls of the vagina also revealed cracks and sores.
Uterine prolapse is accompanied by pain in the abdomen and / or back pain, difficulty walking, impaired urination and / or defecation.
dysuria depends on the situation and are extremely diverse - from the difficulty emptying the bladder to the urinary incontinence.
Since uterine prolapse occurs mainly in the elderly, violations of menstrual function speak only in those rare cases where the patient is a young woman with an incomplete precipitation (and often with omission) of the uterus.Characterized by the type of menstrual disorder and algodicmenorei giperpolimenorei.Often there is infertility due to hormonal imbalance.
Violation maintain the integrity of the mucous of the cervix and vagina creates favorable conditions for the development of inflammation and infection.The woman begins to bother discharge from the genital tract, and if the pathogens penetrate the bladder developing cystitis.Infection of the bladder often rises above the kidneys and stimulates secondary pyelonephritis, cystitis, urolithiasis, and so on.
Violations defecation less frequent urological symptoms.The most common of these are constipation.If constipation in women appeared before the displacement of genitals, they are precipitating factors prolapse.Complication prolapse they are considered only if there were on the background of the displacement or loss of the genitals.Less revealed colitis, urinary and fecal gas.
change in normal position of the pelvis leads to disruption of the blood supply, namely the venous outflow of blood.As a result, patients with uterine prolapse develops varicose veins.
All women with uterine prolapse colposcopy, smear to determine the flora of the vagina crops.
Ultrasound study helps to define more precisely how much has changed the topography of the pelvic organs with special quantitative indicators.
To diagnose changes in the topography of the bladder and rectum, as well as clarify the diagnosis are special urological and proctology examination by related professionals.If you intend to
prolapse surgery, volume expanded inspection.
Treatment of uterine prolapse
loss treatment of the uterus and surrounding structures in most cases carry out surgical methods.In the initial stages horizontally produce manual reposition the uterus, but the positive effect of such intervention is maintained for a short time, as the process tends to progression.
Conservative treatment of uterine prolapse is not widely applied as an independent method and used as part of the pre and post-operative medical complex.Rarely in the initial stage of prolapse in the absence of atrophic changes of tissues in persistent denial of the woman's surgical treatment should be conservative therapy, but with negative dynamics pathology removed surgically.
well-proven method of orthopedic correction loss of the genitals.Its essence is to use a special tubal rings - pessaries.They are intended for elderly women, or for those who are contraindicated for surgery.In fact, pessaries are analogues of the prosthesis.Royal ring when the uterine prolapse is adjusted individually based on the size and shape of the vagina.All women applying pessary on a roll of the uterus need to observe good personal hygiene: wash and douche regularly with disinfectant or herbs to prevent the development of inflammation.Prolonged contact with the mucous uterine ring causes inflammatory and traumatic reactions.Therefore, you must extract the pessary at night and regularly disinfected.To properly remove and re-enter the pessary, you need the appropriate skill that teaches a woman doctor.Not having these skills to patients need to undergo the process of scanning and processing pessary in the doctor's office at least once in 8 - 12 weeks.The negative effects of wearing tubal rings are local inflammatory processes, trauma mucous and pressure sores.Pessaries are not prolapse treatment, since they can not eliminate or stop the pathological process.Often, after a while pessary stopped to help.
treatment of disorders of the urinary tract and the colon is carried out in conjunction with urology and proctology.
women with uterine prolapse is recommended diet with high fiber content to regulate normal chair.You should avoid excessive exercise, especially related to the heavy lifting.
Surgical treatment remains one of the most effective methods of eliminating loss of the uterus and vagina.
Surgery for uterine prolapse
largest group therapies loss genitals up surgery.Surgical treatment of this disease has several hundred (!) types of operations, each of which has its advantages and disadvantages.
Unfortunately, none of the existing methods of surgical treatment of uterine prolapse does not preclude recurrence of the disease, regardless of the skill of surgeons.Uterine prolapse is not only a gynecological problem and develops as a result of a combination of many factors - physical, genetic and psychological, so to eliminate it is extremely difficult.The threat of recurrence is greatest in the first three years after surgery and occurs in approximately 30-35% of the operated patients.
before surgery is not an easy task - for a particular patient choose the best surgical treatment option based on important factors such as age, presence of concomitant gynecological and extragenital pathology, the degree of uterine prolapse, cystocele and rectocele presence.All aspects of surgical treatment of uterine prolapse are discussed with the patient.
aim of surgery is to restore the loss of the uterus its normal position, strengthening the pelvic floor and the removal of anatomical and functional disorders of the bladder and rectum.Often, for the full restoration of the anatomy of the pelvic organs, a combination of surgical operations performed simultaneously or sequentially.
Regardless of the name, any operation involves initial fixation of the uterus at the proper place, followed by strengthening the pelvic muscles.In the first step to fix the round ligament of the uterus shorten or crosslinked are all available in a single "skeleton."When difficult situations can lock the uterus to the pelvic bones.Restoring the integrity and strengthening of the pelvic muscles is performed during the second stage.
The most radical way to eliminate uterine prolapse is its removal.Many women are afraid of removing practically healthy body, but after such an operation to restore the pelvic muscles is much easier.