Omission of the uterus
Omission of the uterus - this displacement of the uterus down and then "make an issue" in the vaginal cavity through the pelvic floor.
Out female pelvis closed three powerful muscle layer, forming a so-called "pelvic floor".The muscles that form the layer, are arranged in a tile that provides the greatest strength around muscle conglomerate.To increase the strength of the muscle tissue of the pelvic floor muscle, each reinforced fascia is the sheath of dense connective tissue fibers.
importance of the functions of the pelvic floor overestimate impossible:
- pelvic floor muscles provide a constant position of the internal reproductive organs, as well as adjacent bladder and rectum.
- Physiological birth is the active participation of the pelvic floor muscles, which promote the fetus out.After graduating from birth pelvic floor resets.
- The pelvic floor is to support not only the pelvic organs, but also to other internal organs.It is involved in the regulation of
at its permanent location captures the uterus and its ligaments - round and broad ligament.
Any processes associated with the violation of the pelvic floor muscle tone and the weakening of the ligamentous apparatus of the uterus leads to a change in its normal position in the pelvic area.
There is absolutely a misconception that the omission of a uterus is present only in older women.Meanwhile, statistics show that out of a hundred young women up to 30 years each tenth revealed different degrees of uterine prolapse, one hundred women in the 30-45 years, this pathology occurs in forty, and after 50 years it can already be found half of a hundred.These facts suggest that age is not always a reason for the omission of the uterus, in some cases, it helps to exacerbate the process that emerged in the younger years.
Omission of the uterus often is hereditary and is found in female relatives - mothers, grandmothers or sisters.
sometimes omitted along with the uterus and surrounding organs - bladder, rectum and part of the intestine.
uterine prolapse treatment depends on many factors and is selected for each patient individually.Prevention of uterine prolapse in the initial stages of development of pathology is very effective.If you do not ask for help in a timely manner, the process may progress to uterine prolapse.
reasons for the omission of the uterus
With the weakening of the tone of the muscles and ligaments that hold the uterus have a certain standing position takes its omission beyond the physiological limits.This contributes glad following reasons:
- Traumatic injuries to the pelvic floor muscles;
- constitutional features (infantilism, asthenic constitution);
- Obstetric traumatic situation.During obstructed labor is sometimes used very traumatizing methods of delivery: forceps, manual removal of the fetus in the breech presentation, etc .;
- Transferred serious surgery on the genitals;
- Multiple births lower the tone of the pelvic floor muscles;
- Deep perineal tears of any origin;
- Heavy physical work associated with heavy lifting;
- increased abdominal pressure caused by abdominal diseases or chronic constipation;
- Congenital malformations in the pelvic area;
- Connective tissue diseases, manifested by the presence of hernia or prolapse of other internal organs;
- Violation of the production of sex steroids (mainly estrogen) affect the ability of muscle tissue to reduce;
- old age.With age, muscle tissue loses its elasticity, atrophic changes occur.Estrogen deficiency in the elderly contributes to the further weakening of the muscles and ligaments of the pelvic floor.
in the development of uterine prolapse is not dominated by any one provoking factor, and combinations thereof.
Any woman slight ptosis of the uterus during pregnancy is not a disease.With the growth and increase the size of the fruit of the womb is also increased and may slides down.An exception is the omission of the uterus during pregnancy in women suffering from this disease before.In this case, it is caused by other reasons, but it can aggravate pregnancy and prematurely end.
Thus, the omission of a uterus is part of the common disorders of the body and should not be treated in isolation like a local process.
Symptoms of uterine prolapse
specific symptoms of prolapse of the uterus does not exist.Each patient feels this state individually.The process is long, and small variations in the state of health can not attract the attention of women.Much less uterine prolapse occurs quickly.
In most cases, female patients with genital shift marked abdominal pain, different intensity and duration, which may be displaced in the lumbar region and sacrum.Sometimes patients point to the emergence of aching pain in the abdomen after a long stay on his feet.After changing the position of the body the pain subside.Often omission of a uterus provokes pain during intimacy.
slides down the uterus puts pressure on the surrounding tissue than irritating the nerve endings of the vagina, causing the sensation of a foreign body.
Omission of the uterus may be accompanied by the appearance of whiter, bleeding and menstrual dysfunction (heavy and / or painful menstruation).
Sometimes women themselves during the hygiene procedures or after physical exertion detected at the location of the abnormal genitalia and go to the doctor, in the absence of other symptoms.
Omission of the uterus provokes change anatomically normal position adjacent organs.Following the uterus displaced (to varying degrees) the bladder and / or rectum, causing a change in their normal work - there are disorders of urination (dysuria, frequent urination) and bowel movement (constipation).Micturition disorders are much more common disorders of the colon.In severe cases, a harmless inflammation in the urethra or bladder joins the secondary pathogenic flora that can spread to the kidneys.
a long-term shift of sexual organs leads to the development of local inflammatory processes (obesity, cervicitis, vaginitis, and others).In the absence of proper treatment the inflammation extends upward through the pelvic and genital prolapse clinic supplemented symptoms endometritis, adnexitis, etc. salpingoophoritis
most reliable sign of uterine prolapse is the result of visual gynecological examination.During the examination, the woman invited tighter (as in childbirth), to see how the position of the vaginal walls, cervix, and uterus.Diagnosis of uterine prolapse after the inspection in the mirror is not difficult.
main diagnostic criterion for deletion of the uterus is the localization of anatomical changes within the vagina above the genital slit.If the pathological process goes beyond gender gap in part or completely, talking about genital prolapse, which is a testament to the progression of the omission.However, genital prolapse does not always end loss.
moves down the womb causes changes in the provisions of the vaginal walls.In some patients the omission of the uterus accompanied by vaginal prolapse, but such a scenario is not required.The vagina is shifted unevenly.Distinguish omission only the front or only the rear wall of the vagina, as well as two walls together.During the inspection, the uterus is visualized in the mirror outside the entrance to the vagina, on exertion of muscles (straining), it does not appear from the genital slit.
muscular frame of a small basin is organized in such a way that every single body is involved in the maintenance of the other.The front wall of the vagina supports the bladder when it moves down, it drags him along.The bladder falls and starts bulging in the vaginal cavity, forming a cystocele.A similar process occurs with the back wall of the vagina and rectum, forming a rectocele.
Some patients are confused in terms of incorrect and give title to this pathological process.The uterus is a hollow organ that resembles a pear.She has a bottom, front and rear wall.Omission of the uterus and uterine prolapse of the walls are different names for the same process, but the omission of the wall of the uterus is not literate term.Since the uterus descends together with its walls, we talk about the omission of the front wall of the uterus and / or the omission of the rear wall of the uterus wrong - the uterus can not shift down, leaving behind one of its walls.Therefore, the omission of the front wall of the uterus is not possible from the physiological and anatomical point of view, but there is the omission of the front wall of the vagina.Similarly, the omission of the rear wall of the uterus does not exist as a medical term, and includes the omission of the rear wall of the vagina.
process omission accompanies the omission of uterine cervix and / or its extension (elongation).At gynecological examination the omission of the cervix is well visualized.
colposcopy, smear and crops from the vagina is mandatory for all patients with genital prolapse.At displacement or prolapse of the uterus are often observed hypertrophy (increase in volume) of the cervix, pseudo, endocervicitis, polyps of the cervical canal.
Ultrasonography specifies the location of the uterus and pelvic inflammatory diagnoses.
combination of pregnancy and uterine prolapse is not always harmless.If before pregnancy expectant mother knew about the diagnosis, and passed the relevant examination and treatment, pregnancy can occur without serious complications.During pregnancy depends on the degree of ptosis genital weight woman and the fetus, and many other factors.The most common complication of pregnancy in uterine prolapse are premature birth, so expectant mothers with such disorders often placed in a hospital "to save."
survey of women with genital prolapse, as appropriate, carried out jointly with the urologist and proctology, in order to establish cystocele or rectocele special surveys.The important is to establish the diagnosis of the presence of extragenital pathology in patients as uterine prolapse often occurs against the background of endocrine and metabolic disorders.
If you intend to genital prolapse surgery, complex survey expanded with additional diagnostic methods.
Degrees of prolapse of the uterus
gynecological examination of patients with genital prolapse is determined by the degree of prolapse of the uterus, which plays an important role as a diagnostic criterion.
It is important to differentiate the omission of the uterus and / or vaginal walls of their loss (total or partial).As the visual boundaries of accepted diagnostic pudendal cleft.If the uterus is displaced downward and does not go beyond gender gap, they say its deletion if the border is broken partially or completely - a prolapsed uterus.Similarly, regulate the process of displacement of the vagina and cervix.The degree of uterine prolapse graphically describes the process of moving the uterus to the gender gap and is determined visually during the general gynecological examination.
first degree prolapse of the vaginal walls and the uterus can be seen at the very beginning of their displacement.When viewed from the uterus is displaced downward, but the cervix remains within the vagina.
second degree of ptosis is diagnosed if the cervix is located at the vestibule or below it, and the body of the uterus is rendered into the vagina.
Further development of displacements leads to the fact that a significant portion of the uterus and the vagina are located outside the sex gap - the third degree.
correctly establish the degree of prolapse of the uterus is essential for the definition of further tactics of examination and treatment.
treatment of uterine prolapse
choose the right treatment policy when the uterine prolapse is not easy.It is necessary to take into account:
- age of the patient.Restore normal muscle tone is much easier if the muscle tissue does not undergo age-related changes.In addition, complex surgical procedures are not always shown in elderly patients.
- At what stage is the pathological process, that is, to determine its extent.
- presence of concomitant gynecological diseases.
- Is there a need to restore menstrual function in case of violations.
- Does the patient in the future to become a mother.
- Features dysfunction of the bladder and / or rectum (if any).
- In some cases, the combination of uterine prolapse with extragenital pathology choice of method of therapy is carried out jointly with other doctors.
If the displacement of the uterus expressed slightly and gives a woman the inconvenience of specific treatment is required and we can restrict the methods of preventing further progression of uterine displacement.
If the uterus is within the vagina, and the functioning of adjacent organs is not broken, you can start therapy with conservative methods.Before treatment to lead to physiological age and normal life of the patient.Avoid excessive physical activity, a balanced diet, weight loss and treatment of foci of chronic infection will have a beneficial effect on the body's ability to stop the progression of the disease.
Patients with uterine prolapse recommended enhanced hygienic measures in the intimate zone as well as the displacement of genital contributes to the development of inflammatory and infectious processes in the vagina.
aim of conservative therapies offset genitals are to strengthen the pelvic muscles and prevent further displacement.Treatment includes:
- Kegel exercises for vaginal muscles.Increased muscle tone of the vagina to prevent aggravation of the displacement of the uterus.Also appointed as a prophylactic measure.
- Physiotherapy in the deletion of the uterus as described Yunusov.
- lubrication of the vaginal mucosa and ointments with estrogen metabolites to improve the elasticity and attenuation processes atrophy (used in menopausal and post-menopausal).
- Using the pessaries (tubal rings) in older women with contraindications to surgery.Pessaries are rubber rings filled with air of different diameters.It is sized individually.Introduced into the vagina pessary prevents the uterus move lower.Pessary disadvantage is the inability to enter it for the long term.More likely to develop pressure ulcers and inflammation of the need to change pessaries at least twice in the past month and make regular douching with herbs and antibacterial agents.
rubber rings can be used in young women in a situation where they are planning to give birth or have contraindications to surgery.
- Special banadazh when uterine prolapse for patients of all ages.Appointed in the early stages of the disease and is suitable for short-term use.Well-established himself in the shroud omission of the uterus in pregnant patients.
- Gynecologic massage restores blood flow to the pelvic area, normalizes the intestine and removes inflammatory processes and increases the tone of vaginal muscles.It can be used as an independent method for minor changes to the provisions of the uterus or in the complex therapy.The massage is performed only in a medical institution by trained personnel.
If conservative therapy failed to stop the displacement of the genitals, have to decide on surgical treatment.If a patient is diagnosed severe degree of prolapse, or uterine prolapse, proceed to surgery immediately.