Prolapse Of The Uterus - Symptoms And Treatment, What To Do?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-15 09:49

Uterine prolapse: causes and treatment

The prolapse of the uterus is an incorrect position of the uterus, displacement of its bottom, as well as displacement of the cervix below the level of the normal border due to the weakness of the muscle fibers of the pelvic floor and ligaments. The pathology is accompanied by a number of characteristic symptoms: a feeling of pressure, a feeling of discomfort, the patients are disturbed by pulling pains in the abdomen and vagina. Patients may experience difficulty urinating, vaginal discharge. The disease is complicated in some cases by partial or complete organ prolapse.

Uterine prolapse or prolapse is the most common variant of the abnormal location of the internal genital organs. The prolapse of the uterus is accompanied by a displacement of the cervix of the organ and its bottom below the normal border, however, the cervix is not visible from the genital slit even with attempts. If the uterus extends beyond the genital slit, then this is regarded by specialists as one of the symptoms of uterine prolapse. The displacement of the uterus downwards serves as the first harbinger of partial or complete organ prolapse. At an advanced stage of the process, the uterus or part of it may be outside the vagina.

Uterine prolapse is one of the common pathologies of the abnormal location of the pelvic organs in women of any age. The frequency of diagnosis of prolapse of the uterus increases in older age populations. More than 50% of all recorded cases are found in women who have crossed the fifty-year line.

The correct position of the uterus in the small pelvis is ensured by the ligamentous-muscular apparatus. To maintain the anatomically correct position of the organ, the tone of the muscular walls of the uterus is important. The pathology is based on the weakness of the ligaments and muscle fibers. The clinical picture of uterine prolapse includes symptoms such as a feeling of pressure on the lower abdomen and pain of similar localization. In addition, a woman is diagnosed with dysmenorrhea, spotting from the vagina. Possible violations of the lower intestine, urinary incontinence.

Content:

• Reasons for prolapse of the uterus
• The degree of prolapse of the uterus
• Symptoms of uterine prolapse
• Consequences of prolapse of the uterus
• Treatment of prolapse of the uterus
• Operative treatment
• Prevention
• Exercises to prevent prolapse of the uterus

Reasons for prolapse of the uterus

Prolapse of the uterus is very common in patients of any age, but if at the age of 30 years, pathology is determined in 10% of women, then at the age of over thirty and younger than forty, 40% of patients are concerned about the disease. In patients over 50 years old, 50% of women suffer from uterine prolapse. Of all the operations carried out in gynecology on the genitals, 15% are operations for prolapse or prolapse of the uterus.

The reason for the prolapse of the uterus is most often a weakening of the muscle tone and ligamentous apparatus of the pelvic floor, which is accompanied by a displacement of the rectum or bladder. Often the disease is accompanied by a disruption in the work of these internal organs.

Uterine prolapse can begin in youth and progress over time. When the organ is omitted, functional disorders become more obvious, which is accompanied by moral and physical torment and is the cause of complete disability.

The failure of the ligaments and muscles that hold the uterus can be caused by various reasons.

Factors leading to prolapse of the uterus:

• Hereditary predisposition;
• Congenital malformation of the pelvic organs;
• Incorrect management of childbirth, complications of labor;
• Age-related dystrophic changes;
• Hormonal imbalance during menopause;
• History of surgery on the pelvic organs;
• Irregular weight lifting;
• Formation of neoplasms affecting the anatomy and functioning of the uterus (cyst, myoma, fibroids);
• Pathologies of the connective tissue of the ligaments that hold the uterus.

Damage to the muscles holding the uterus is caused by perineal ruptures in breech presentation of the fetus. Muscles and ligaments can be damaged if a vacuum extractor or forceps is used during delivery.

Specialists include frequent childbirth, excessive physical labor, heavy lifting, age of patients, hereditary factors, high pressure inside the peritoneum, obesity, tumors, constipation, and severe cough as risk factors.

Fibroids and other neoplasms provoke prolapse of the uterus due to an increase in the load on the pelvic ligaments. A long-term severe cough can also contribute to the displacement of the uterus due to the constant tension of the muscles of the diaphragm.

Important: obesity, chronic constipation, flatulence increase intra-abdominal pressure and become indirect causes of the development of pathology.

In most cases of the disease, the clinical picture of prolapse develops with a combination of several prerequisites.

The degree of prolapse of the uterus

In its development, the disease goes through several stages.

There are 4 degrees of pathological changes:

1. The first degree - the uterus or its cervix are mixed relative to the norm for a small distance. The walls of the vagina are lowered slightly. The lower border of the neck is not visible during physical exertion. The genital gap may gap.
2. Second degree - the uterus partially falls out, with physical stress, the cervix exits through the genital slit.
3. Third degree - incomplete prolapse of the uterus is diagnosed; when straining, both the cervix and part of the uterus come out of the vagina.
4. Fourth degree - the uterus completely falls out.

Symptoms of uterine prolapse

The clinical picture is manifested by a large number of vivid sensations, so diagnosis is not difficult.

Symptoms of pathology:

• Feeling of pressure on the bottom of the pelvis;
• Pain in the lower abdomen, "gives" to the lower back and sacrum;
• Feeling of a foreign body in the vagina;
• Bloody vaginal discharge (does not always appear);
• Impaired urination;
• Soreness during sexual contact, the inability to carry it out at the last stages of the development of pathology;
• Painful and heavy menstruation, leading to the development of anemia;
• Menstrual irregularities.

Important: some of the symptoms do not appear immediately, they join at the stage of progression of the pathological process.

Without treatment, the symptoms of prolapse of the uterus progress. In the beginning, the disease manifests itself as pulling pains, a feeling of heaviness in the lower abdomen, in the region of the sacrum, lower back; a foreign body sensation appears in the vaginal area. During intercourse, patients are worried about pain and spotting. In patients, menstrual function changes, the discharge becomes abundant or scarce. Pathology is accompanied by infertility, but pregnancy is not excluded.

Over time, disorders in the work of the urinary tract join the manifestations of the disease, they are observed in half of the patients. With a prolonged course, prolapse of the uterus provokes stretching of the walls of the ureters and kidneys. Downward displacement of the uterus may also be accompanied by enuresis.

In every third case, women have complications from the rectum: constipation, colitis, fecal and gas incontinence occur.

In the later stages of the development of the disease, a woman can independently feel the uterus protruding from the vagina.

Consequences of prolapse of the uterus

Violation of urination with prolapse of the uterus causes the development of an infectious process due to the addition of a bacterial component - inflammation of the kidneys, bladder, urethra.

About 30% of patients are diagnosed with proctological pathologies:

• Colitis;
• Constipation;
• Fecal incontinence;
• Flatulence.

The surface of the uterus protruding from the vagina becomes cracked. When walking, the organ is exposed to mechanical stress, the risk of infection, bleeding ulcers, and bedsores increases. The tissues of the uterus swell, become cyanotic, and cyanosis appears. The blueness of the organ is caused by blood stagnation due to a violation of microcirculation in the vessels of the uterus.

Severe complications of prolapse of the uterus - varicose expansion of regional veins, entrapment of an organ in the last stages of prolapse, entrapment of part of the intestine.

Treatment of prolapse of the uterus

The tactics of treating uterine prolapse, chosen by the doctor, depends on how far the pathological process has gone, whether the woman plans to have a child in the future.

Please note: methods such as massage and gymnastics are most often used to prevent prolapse of the uterus, to strengthen the muscles of the pelvis and diaphragm. At 3-4 degrees, surgical intervention is most often indicated.

• The use of drugs. Conservative therapy can be effective at the stage of minor displacement of the uterus and its cervix. To improve the blood supply to the organ, ointments and medications with estrogens for oral use are prescribed.
• Gynecological massage. At the beginning of the disease, gynecological massage is used, carried out by courses with a break. The massage is performed by a specialist on a gynecological chair for 10-15 minutes. Pain during the procedure is the reason for stopping the manipulation.
• Physiotherapy. At the first stage of prolapse development, gymnastics according to Yunusov is prescribed. Kegel exercises should be done to strengthen the pelvic floor muscles.
• Wearing a bandage. The method is used as a preventive measure at the initial stage of the disease. A correctly worn bandage supports the uterus in an anatomically correct position, relieving pain and discomfort. The bandage is widely used to restore the elasticity of the pelvic tissues after childbirth and after operations to restore the ligamentous apparatus of the uterus.
• Use of pessaries. If a woman is contraindicated in operative correction of prolapse of the uterus, at 3-4 stages of the pathological process, the doctor recommends that she install a pessary - rubber or PVC rings to keep the uterus in the correct position. A month later, the ring is removed, as you need to take a break. Every 3-7 days of wearing the pessary, it is briefly removed for aseptic processing and protection of the vagina from pressure sores. Cons of wearing a pessary - the vagina stretches, the uterus sinks even more.

Operative treatment

If possible, the doctor tries to preserve the uterus, because when it is removed, the risk of allowing other organs increases.

Groups of operations for the treatment of prolapse of the uterus:

• Colpoperinelevatoroplasty - strengthening the muscles of the pelvic floor;
• Plastic ligaments of the uterus - shortening and stitching them to the anterior wall of the organ;
• Strengthening the cardinal and sacro-uterine ligaments that fix the uterus - fertility may be impaired;
• Suturing the uterus to the walls of the pelvis - to the sacrum, to the pubic articulation;
• Implantation of endoprostheses;
• Narrowing of the vagina;
• Removal of the uterus if there is a good reason.

These operations are performed in several stages, by laparotomy, through the vagina, by the method of abdominal surgery. In 30% of cases, there is a relapse of the pathology.

Please note: modern surgical methods make it possible to strengthen the walls of the vagina and the musculo-ligamentous apparatus by installing biologically inert reinforcing devices that reduce the likelihood of recurrence.

After surgery, carrying weights over 5 kg, sexual contacts, any physical activity are limited for a month and a half.

Prevention

Although prolapse of the uterus is rare in young women (only 10%), the onset of pathology should be prevented from adolescence. Prevention consists in strengthening the muscles of the press and small pelvis, dosed physical activity. To prevent prolapse of the uterus, significant physical exertion should be avoided.

Please note: labor protection requirements prohibit women from lifting heavy weights over 10 kg!

Women suffering from constipation should follow a special diet and take laxatives.

To prevent prolapse of the uterus, pregnancy and childbirth should be qualified. Women should promptly follow all the recommendations of the doctor leading the pregnancy, give birth exclusively in maternity hospitals and perinatal centers.

Immediately after the birth of a child, you need to limit physical activity, apply a set of exercises to maintain the muscles of the pelvic floor and abdominal wall. It is advisable that the optimal load, frequency of exercise and the start of training are determined by a physiotherapy specialist.

During menopause, the risk of developing prolapse of the uterus increases, so the following measures should be taken:

• Engage in physiotherapy exercises;
• Take drugs to increase the tone of the ligamentous apparatus of the uterus and improve its blood supply;
• Use hormone replacement therapy as directed by your doctor.

Exercises to prevent prolapse of the uterus

There are simple exercises to prevent the development of prolapse:

"Lift" - execution begins with smooth tension and relaxation of the muscles of the perineum for 4-5 seconds alternately. Then the time of tension and relaxation is increased to 20 seconds. Thereafter, the rate and duration of voltage cycles is increased by the maximum possible duration in time.

• "Bicycle" - lie on your back, bend your knees, "pedal", as when riding a bicycle.
• Lie on your back with your legs extended. Raise them alternately at an angle of 45 °, holding them in a raised position for 5-6 seconds, constantly extending the time (up to 20 seconds).
• Lie on your back with your knees bent. Lean on your elbows, raise the pelvis, tighten the muscles of the perineum. Withstand in this position for 4-5 seconds, relax, repeat the exercise several times.
• Lie on your stomach, take turns raising and lowering your limbs, arching your back.

Gradually, the number of approaches increases from 6-7 to 20-22 per lesson.

Note that even walking up and down stairs will help strengthen your pelvic and abdominal muscles.

The duration of a daily workout is 30-40 minutes. Such concern for your health will reduce the risk of prolapse of the uterus, the development of pathologies of the pelvic organs and the lower intestines by several times.

The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist

Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.