Posterior descent. Vaginal prolapse and prolapse. Forms of the disease and their features

The notorious female “I myself”, unfortunately, often turns into serious illnesses. According to statistics, the most common cause of prolapse of internal organs is the refusal of male help when lifting weights, as well as incommensurate with the characteristics of female physiology physical activity with fanatical sports activities. The same reasons provoke prolapse of the uterus and displacement of other organs.

Causes of prolapse of internal organs and risk factors

In medicine, prolapse of internal organs means a lower than normal location of one or more internal organs (stomach, liver, intestines, kidneys and others). The cause of organ prolapse is stretching and weakening of the ligamentous apparatus that holds them in their normal position. The most common problem that, according to statistics, every third woman over 45 years of age faces today is prolapse of the uterus and vaginal walls.

With age, as a result of weakening of the muscles and structures of the pelvic floor in a woman, the normal physiological relative position of the pelvic organs: uterus, bladder, rectum changes. The muscles surrounding and supporting the uterus are no longer able to hold it, appendages and intestines in their natural state. The ligaments that hold the internal organs stretch and begin to put pressure on the pelvic floor. As a result, the walls of the uterus prolapse, the anatomy of the pelvic floor organs is disrupted, which leads to disruption of the function of neighboring organs - the bladder and rectum.

Causes and risk factors for prolapse of internal organs:

Lifting weights.
Excessive physical activity.
Birth injuries (severe, prolonged, and frequent childbirth).
Obesity.
Chronic constipation.
Miscarriages and abortions with subsequent inflammatory diseases.
Diseases connective tissue.

Degrees of vaginal prolapse and symptoms of the disease

There are three degrees of vaginal prolapse:

1. Complete prolapse of the vagina (accompanied by uterine prolapse).

2. Partial prolapse of the anterior / posterior wall of the vagina (with the release of part of the rectum or bladder).

3. Prolapse of both walls of the vagina or only the back / front (without prolapse from the vaginal opening area).

Symptoms of uterine and vaginal prolapse appear as follows:

Nagging pain in the lower back, aching pain lower abdomen.
Sensation of prolapsed organs in the perineal area.
Difficulty urinating or urinary incontinence.
Problems with defecation, pain when straining, gas incontinence.
Painful sensations during sexual intercourse.
The occurrence of ulcers and erosions.
Dry mucous membrane, tissue irritation, impaired blood supply.

Treatment of uterine prolapse and prevention of the disease

Having identified symptoms of uterine prolapse, treatment, depending on the patient’s age, as well as the degree and severity of the disease, can be either surgical (plastic surgery, including using reinforced mesh) or conservative. Conservative treatment of uterine prolapse includes the use of pessaries (ring-shaped plastic devices that are inserted into the vagina to hold the uterus in a certain position).

Gymnastics for vaginal prolapse has not only a therapeutic, but also a preventive effect. Everyone has long known that it is easier to prevent a disease than to treat it. IN lately Among women all over the world, this type of prevention of uterine prolapse as imbuilding is becoming increasingly popular - intimate gymnastics, which is based on training methods for strengthening and harmonious development of the pelvic muscles in order to acquire natural and necessary skills in mastering them during sexual intercourse, during pregnancy, and childbirth. , as well as for the prevention of various female diseases, including prolapse of the uterus and vaginal walls.

Imbuilding classes for the treatment and prevention of uterine prolapse are carried out under the guidance of experienced specialists, using special unique simulators, including laser ones. However, it is possible to master some of the simplest techniques of intimate gymnastics at home.

Regularly performing exercises during uterine prolapse improves blood circulation and metabolic processes in the pelvic organs. The cycle is stabilized, premenstrual syndrome and pain during menstruation disappear, and the onset of menopause is delayed, youth and beauty are preserved longer.

1. It is very useful to learn how to simultaneously strongly draw in the lower abdomen and pelvic muscles. At the same time, you should get the impression that the anus and abs merge together in the middle of the pelvis and stretch upward.

When performing this exercise when the vagina prolapses, you should pull the lower abdomen inward and upward, while simultaneously drawing in the pelvic floor. It is necessary to hold in this position for several seconds until the muscles of the lower abs and anus become tired. When tightening your stomach, do not lift your chest, but relax and allow excess air to escape. There is no need to hold your breath: breathe through your chest very lightly and shallowly, taking long exhalations and short inhalations. If you do everything correctly, a slight burning sensation should appear in the lower abdomen due to muscle tension.

2. For the vast majority of people, the abdominal and pelvic floor muscles work simultaneously: if you retract the anus, the stomach also automatically retracts. However, to strengthen the pelvic muscles, it is necessary to break this connection and learn to control them separately from the abdominal muscles.

This exercise to strengthen the uterus during prolapse should be performed as follows. Lie on your back and exhale through your belly (it will rise). Holding it up, slightly retract the anus, but at the same time make sure that the stomach does not sink. If he reacts automatically and drops a little, immediately return him to the top and retract the anus again. Next, you should proceed according to the same scheme: retract the anus - check the stomach - return it to its place. When you finally reach the point where your stomach is maximally pushed out and your anus is maximally retracted, hold this position for 5 seconds, and then do the same thing in reverse order: first retract your anus, and then, holding it, do a slow inhale with your belly.

A set of exercises for prolapse of the vaginal walls and to strengthen the uterus

It’s not for nothing that they say that prevention is the mother of safety. Ideally, girls should master these exercises in their youth and do them regularly throughout their lives.

A basic set of exercises for uterine prolapse and for the prevention of the disease is as follows.

1)

1. Get on all fours.

2. At the same time raise left hand up and forward and move away right leg up and back - inhale; return to the starting position - exhale.

3. Do the same right hand and left leg.

The pace is slow.

2)

1. When performing the following exercise, when the vaginal walls prolapse and to prevent the disease, you need to get on all fours, bend your elbows and take a knee-elbow position.

2. Leaning on your forearms, lift your pelvis up as much as possible, rising onto your toes and straightening your legs at the knee joints.

4. Repeat the exercise 4-6 times.

Breathing is free.

3)

1. Get on all fours.

2. Straighten left leg and take it back and up - inhale; return to the starting position - exhale.

3. Do the same with your right foot.

4)

1. Get on all fours.

2. Raise the pelvis up as much as possible, straightening the legs at the knee joints and resting on the feet and palms of straight arms.

3. Return to starting position.

4. Repeat the exercise 4-6 times. Breathing is free.

The pace is slow.

5)

1. To perform this exercise when the walls of the uterus are prolapsed and to prevent the disease, you need to get on all fours, bend your elbows and take a knee-elbow position.

2. Take your straight right leg back and up - inhale; return to the starting position - exhale.

4. Repeat the exercise 10-12 times.

The pace is average.

6)

1. Get on all fours.

2. While inhaling, vigorously draw in the perineum, lower your head and arch your back.

3. As you exhale, just as energetically relax the muscles of the perineum and raise your head, bending at the lower back.

7)

1. Get on all fours.

2. As you exhale, without lifting your hands from the floor, stretching out as much as possible and arching your back, lower your pelvis between your heels.

3. While inhaling, leaning on your hands, gradually straighten up, bending at the lower back, as if crawling under a fence.

4. Repeat the exercise 6-8 times.

The pace is slow.

8)

1. Lie on your back, legs straight, arms along your body.

2. At the same time, raise straight legs at an angle of 30-45° to the floor - exhale; return to the starting position - inhale.

3. Repeat the exercise 6-12 times.

The pace is slow.

9)

2. Raise your legs straight up and completely exhale the air from your lungs.

3. Spread your legs to the sides and take a deep breath.

4. As you exhale, close your legs, while inhaling, return to the starting position.

5. Repeat the exercise 6-8 times.

The pace is slow.

10)

1. Lie on your back, legs together, arms along your body.

2. Raise your straight right leg as high as possible - inhale; return to the starting position - exhale.

3. Do the same with your left foot.

4. Repeat the exercise 8-10 times.

The pace is average.

11)

1. Lie on your back, legs straight, hands under your head.

2. Spread your legs slightly and bend your knees, resting on your entire foot.

3. Raise your pelvis, spreading your knees wide and pulling your anus inward.

4. Repeat the exercise 8-10 times.

12)

1. Lie on your back, legs together, hands under your head.

2. Raise the pelvis, arching in the lumbar region and at the same time pulling the anus inward.

3. Return to starting position.

4. Repeat the exercise 8-10 times.

The pace is slow, breathing is free.

Prolapse of the anterior wall of the uterus is a fairly common and common disease.

This is a dangerous and serious pathology in which a woman cannot conceive and bear a child.

Prolapse of the anterior wall of the uterus is popular name diseases, scientifically this pathology sounds like genital prolapse or cystocele.

Under no circumstances should you self-medicate for this pathology, since improper therapy or the slightest delay can lead to irreversible consequences.

The essence of pathology

Prolapse is a deficiency of the pelvic floor muscles associated mainly with anatomical age-related changes women .

Due to the fact that the ligamentous apparatus that supports the woman’s internal genital organs is relaxed, the uterus prolapses.

Prolapse is dangerous because the disease is progressive in nature and if measures to eliminate the pathology are not taken in time, this can lead to complete removal of the uterus, and, as a rule, to infertility. The most dangerous is this pathology, which arose because the disease threatens not only the health of the expectant mother, but also the life of the child.

Characteristic symptoms

Prolapse of the anterior wall of the uterus early stage can be cured with conservative therapy.

In later stages of the disease, other treatment methods are used.

CAREFULLY!

If the disease is severely advanced, a decision may be made to apply a radical method of therapy, that is, complete removal of the uterus.

Treatment methods

There are several ways to treat prolapse of the anterior wall of the uterus.

Only the attending physician can prescribe treatment based on the degree of the disease.

Conservative therapy

Conservative methods of therapy are effective only if the disease is at an early stage.

Typically, during conservative treatment, general restorative drugs are prescribed, which are aimed at improving the tone of the muscles of the uterus and vaginal walls.

Most effective exercises Kegel exercises are used to train and strengthen the muscles of the vagina and pelvic floor.

The exercises involve squeezing and unclenching the vaginal muscles.

They need to be performed several times a day. If you do such exercises regularly, then after a couple of months you will notice that the situation has improved significantly.

Hormonal drugs

In order to strengthen the ligaments of the uterus, doctors prescribe hormone therapy.

This treatment regulates the level of estrogen in the blood, since a lack of this hormone can lead to disruption of the uterus and weakening of the pelvic floor muscles.

Gynecological massage

This procedure is relevant at the early stage of the disease.

You need to perform it for several months in a row, then repeat the procedure after a short break.

The massage should be performed on a gynecological chair or a table specially equipped for this purpose..

One of the most important criteria when performing a massage is the complete relaxation of the woman, since only in this way can pain and discomfort be avoided.

Immediately before the procedure, the doctor gives instructions on how the patient should behave during the procedure.

After this, you can begin the massage - the doctor inserts one hand into the vagina and begins palpating the uterus. The doctor places his other hand on the patient’s stomach and begins to perform massage actions.

If the patient begins to experience discomfort, then the intensity of the procedure should be slightly reduced, but if severe pain begins, the session should be stopped immediately.

Manual therapy and bandage

Treatment of prolapse of the anterior wall of the uterus is prescribed to patients in whom the disease occurs at an early stage.

The most effective procedures at manual therapy are – pressure and vibration.

Pressure is usually applied with a fist, palm or finger in the area of displacement.

The manipulation must be carried out until the patient experiences slight pain in the area of pressure.

In this case, the doctor should slightly reduce the intensity of the pressure and continue manipulation until the pain completely stops.

Vibration combines gynecological massage and tapping.

Tapping is done with a fist on the massaging hand. In this way, you can completely relax the muscle tissue of the woman’s internal genital organs.

when the walls of the uterus prolapse, it is a very effective and common remedy, since it does not require absolutely any effort from the woman, but at the same time the uterus is fixed on all sides.

You need to wear the bandage for several months, but no more than 12 hours a day. A prerequisite is rest after removing the bandage - the woman should lie down for a while, taking a horizontal position.

Surgical intervention

used in advanced stages of the disease, when partial or complete prolapse of the uterus has occurred.

Colporrhaphy. During the procedure, resection of the injured vaginal tissue is performed, which is then sutured.
Colporineorrhaphy. The vaginal walls are sutured, and at the same time the perineal muscles are tightened.
Hysterectomy. Complete removal of the uterus; in most cases, this operation is performed on women for whom reproductive function no longer matters.

Disease prevention

If there is a risk of developing prolapse of the anterior wall of the uterus due to hereditary characteristics, then preventive measures should be performed from an early age.

The attending physician prescribes a set of exercises to prevent the development of pathology. In addition to this, it is assigned special diet to adjust body weight.

If the disease does occur and the first signs of the disease appear, you should immediately avoid heavy physical activity and consult a doctor.

Like any disease, prolapse of the uterine wall can be prevented; for this you need to regularly visit the gynecologist, exercise, and also avoid obesity and heavy physical activity.

Useful video

From the video you will learn about prolapse of the vaginal walls and whether it is dangerous:

Contrary to popular belief that such a disease can only occur in old age, according to statistics, every tenth woman under the age of 30 experiences manifestations of the disease. The sooner the doctor detects prolapse of the vaginal walls, the simpler and more effective the treatment will be. In the most severe cases, only surgery. Therefore, it is very important to contact a gynecologist for a comprehensive examination at the first signs of discomfort.

The role of the pelvic muscles in the reproductive and excretory system

The term “prolapse of the walls of the vagina,” that is, the vagina, means weakening and displacement of the pelvic muscles. The pelvic cavity contains the reproductive and excretory system. These include: ovaries, fallopian tubes, uterus, rectum, bladder. Thanks to ligaments and muscles, each organ is held in a certain place, so all systems function normally, interacting with each other. The muscles that block the outlet of the small pelvis are the pelvic floor muscles. The latter is a collection of connective tissue, elastic and muscle fibers. The muscle tissue of the pelvic floor performs the following functions:

hold the organs of the excretory and reproductive system, preventing their descent into the vaginal cavity;
responsible for normalizing intra-abdominal pressure;
prevent excessive mobility of the pelvic organs;
provide natural childbirth- without the pelvic muscles this would be impossible;
some muscles form sphincters - natural openings. Due to the normal functioning of the muscles, the sphincters retain the contents;
contribute to orgasm during sexual intercourse due to active muscle contraction.

Numerous negative impacts various external and internal factors, leading to pathological processes in the muscle fibers of the pelvic floor, can cause prolapse of the vaginal walls. Another name for this anomaly is vaginal prolapse. In most cases, this disease occurs in women over 60 years of age. However, young girls and women under 30 are also not immune from the development of the disease, the first signs of which may for a long time remain unnoticed. This is one of the reasons why a preventive gynecological examination should be performed annually.

In different women, prolapse of the anterior and posterior vaginal walls may manifest differently from each other. First of all, the location of the area of weakened muscles, as well as their size, influences. Mostly, one wall of the vagina descends - the back or the front, but the descent of two walls at once is also not uncommon.

Types of pathology

Doctors distinguish three main degrees of disease progression and two key species. Prolapse of the anterior vaginal wall is also called a cystocele, and the prolapse of the posterior wall is called a rectocele. Cystocele is accompanied by a simultaneous change in the position of the bladder, which puts additional pressure on the muscular septum. Prolonged development of the pathological process can provoke complete prolapse of the uterus directly from the vagina.

Severe stretching of the ligaments responsible for holding the bladder, as well as excessive weakening of the muscles, are the main cause of cystocele. This type of vaginal prolapse is often accompanied by cystitis, the sensation of a foreign object inside the vagina, a feeling of dryness, and burning. However, such symptoms do not occur in initial stages. Therefore, the only way to diagnose cystocele at the beginning of its development is a preventive gynecological examination.

The occurrence of rectocele characterizes the appearance of pathological processes in the muscles of the pelvic floor of the posterior vault. In addition to the feeling of a foreign body inside, characteristic of vaginal prolapse, the woman has problems with bowel movements. It becomes difficult to have a bowel movement because a special area forms in the rectum where feces accumulate. IN advanced cases the rectum may prolapse.

Factors preceding vaginal prolapse

The main reason for prolapse of the vaginal walls is excessive weakening of the pelvic muscles. The following factors may precede this process:

often increased intra-abdominal pressure due to chronic cough, constant constipation;
dramatic weight loss for any degree of obesity;
pathological changes genital organs caused by tumor processes;
lack of fixation of the vaginal dome after surgery to remove the uterus;
loss of elasticity of muscle tissue over the age of 50-60 years.

Separately, it is worth paying attention to the presence of a history of childbirth, since often it is the complicated labor process that precedes the prolapse of the vaginal walls. This should include weak labor or, on the contrary, too rapid, significant ruptures of the perineum - damage to the birth canal, large number childbirth - three times or more. In addition, a large fetus, weighing more than 4 kg, can also give rise to the process of cystocele or rectocele. The use of obstetric forceps, manual removal of the placenta by the obstetrician, as well as removal of the fetus by the pelvic end further increases the risk of the disease.

Prolapse of the vaginal walls is mostly considered a pathology of old age due to the fact that with age in women the tone of the muscles of the pelvis and abdominal wall decreases naturally. At the same time, the ligamentous apparatus of the uterus and its appendages is stretched and, as a result, intra-abdominal pressure becomes higher than normal. The combination of these factors provokes a change in the position of the internal organs and can cause prolapse of not only the walls of the vagina, but also the uterus itself. For nulliparous women, pathology is a rare exception. Infantilism, which means developmental delay and all other factors that are not related to labor activity.

Three main stages of disease development:

First stage. Prolapse of both walls at once or only one wall of the vagina, provided that nothing extends beyond the entrance to the vagina;
Second stage. Prolapse of the posterior wall, taking into account a change in the position of the rectum, or prolapse of the anterior wall of the vagina with a change in the position of the bladder. In this case, the walls stick out;
Third stage. Prolapse of two walls simultaneously with subsequent prolapse of the uterus.

The main signs of prolapse of the vaginal walls

The rapid development of a disease such as vaginal prolapse occurs only in the case of difficult childbirth. Then the violation of the tone of the pelvic floor muscle tissue occurs rapidly and in postpartum period is actively progressing. For all other reasons that provoke the onset of the disease, the development of the pathological process occurs very slowly, from several years to several decades. In most cases, the first stage of development of prolapse of the vaginal walls can be detected only during a preventive gynecological examination. Since the woman has no obvious symptoms.

If pathology is not detected in a timely manner, significant displacement of the vaginal walls causes a number of characteristic symptoms. If a woman independently discovers one or another a clear sign vaginal prolapse, which means you need to act immediately, otherwise conservative treatment may be powerless. The clinical picture depends entirely on whether the internal organs have shifted along with the anterior or posterior wall of the vagina.

If the bladder changes its position along with the front wall, the woman is most likely to experience chronic cystitis, pain when urinating, and inflammatory processes in the genitals. The feeling of a foreign body inside is one of the most common symptoms. When the posterior wall of the vagina descends, due to anatomical features, the position of the rectum may change. However, compared to the bladder, there is a possibility of displacement neighboring organ not so likely. Rectocele is often accompanied by constipation alone.

Others characteristic symptoms may be: pain during intercourse, lack of orgasm and decreased sensitivity of the genital organs. The advanced stage of the disease is characterized by prolapse of the vaginal walls, that is, their descent below the entrance. In this case, the main thing hallmark is a kind of pouch hanging from the vagina, formed from the uterus and the inverted walls of the vagina. In this case, the stage is considered terminal and requires surgical intervention.

Conservative treatment of prolapse of the vaginal walls

For slight prolapse of the vaginal walls, without serious displacement of the internal organs of the reproductive and excretory systems, it is used conservative look treatment. Mainly, it consists of a number of specific physical exercise aimed at strengthening the pelvic floor muscles. These are:

Kegel exercises, consisting of 3 different stages: slow compression of the muscles that are used to stop urination - first they should be tensed for 3 seconds, over time increasing the compression time to 30 seconds; rapid muscle contractions - from 20 to 100 rapid times at a time; the pushing stage, which involves tensing not only the pelvic floor muscles, but also the anterior abdominal wall - it is necessary to push, as during childbirth or defecation, holding for a few seconds;

leisurely walking with a half-squat, until the formation of the leg pointed forward, right angle;
in a lying position, raising the pelvis with simultaneous dilation and bringing the knees together;
in the same lying position, raising straight legs until a right angle is formed with the body;
standing, raise alternately straight legs to the body;
in a standing position - circular movements of the pelvis, first clockwise, then counterclockwise.

The set of exercises listed can be used not only for therapeutic, but also for preventive purposes. Regularly performing at least specific Kegel exercises will help get rid of numerous gynecological problems and improve your sex life. Moreover, they can be done even in public places. Physiotherapy is no less popular in the fight against prolapse of the vaginal walls and strengthening the pelvic floor muscles. To increase muscle tone, the following have been successfully used: electrical stimulation with low-frequency current, vibration massage, magnetic therapy and laser therapy. It should be borne in mind that any of these procedures should be prescribed only by the attending physician. Self-medication in such matters should be completely excluded.

If overstretching of the anterior abdominal wall is detected, wearing a bandage belt is recommended. If the stage of prolapse of the vaginal walls is critical, but surgical intervention is contraindicated during this period, special pessary rings are used. They are inserted directly into the vulva and help support the internal organs, preventing them from changing their position. Pessaries can cause a number of side effects and complications, such as:

the appearance of swelling and irritation of the mucous membrane;
development of ulcerative and purulent processes;
ingrowth of a ring into the vulva or cervix, etc.

Based on the possible consequences, the pessary is selected taking into account the individual characteristics of the patient and requires regular gynecological monitoring. Such examinations should be carried out more often than preventive ones in order to avoid unforeseen difficulties in time. Daily washing and douching of the vagina will minimize the likelihood of these difficulties occurring. If the vaginal muscles are so weak that it is not possible to insert the pessary properly, then a special device is used, with which the pessary is connected to a bandage attached to the waist.

Surgical intervention

In case of prolapse of the vaginal walls beyond the entrance, doctors offer the only solution - surgery. To confirm the diagnosis and exclude other treatment options, additional consultation with a urologist and proctologist may be required. Surgical treatment of vaginal prolapse is carried out using plastic methods. There are two main and most common methods:

Colpoperineorrhaphy - involves stretching and suturing the pelvic floor muscles, thereby shortening the posterior wall of the vagina. Used most often after childbirth, due to severe stretching of the posterior vaginal wall;
Colporrhaphy - involves the removal of stretched vaginal walls and their subsequent stitching. This method allows you to restore the normal anatomical location of the internal organs and increase the tone of the pelvic muscles. The method is successfully used for prolapse of both the anterior and posterior vaginal walls.

Both methods refer to colpoplasty, which in principle involves reducing the area of the vaginal walls. Surgery is performed under general anesthesia. As a rule, the patient is allowed to go home already on the second day after surgery. The postoperative period has some peculiarities. To avoid complications, you must strictly follow them:

accept antibacterial agents prescribed by a surgeon;
treat with special antiseptic vagina for at least 5 days;
Eat semi-liquid or liquid foods for a month to minimize the risk of constipation;
in the first two weeks it is forbidden to sit;
physical activity is excluded for at least a month;
You can begin sexual activity no earlier than 5-6 weeks after surgery.

Prevention of prolapse of the vaginal walls

Key place among preventive methods takes from many diseases correct image life. You should pay attention to nutrition. It must be properly balanced and include required quantity minerals and vitamins. Any fatty, fried, smoked dishes must be excluded. In addition, physical education should not become a forced necessity, but a way of life. Regular, moderate physical activity before, during and after childbirth will have an effective preventive effect against vaginal prolapse.

To strengthen the muscles of the perineum, constant Kegel exercises are ideal. Along with it, it is worth accustoming yourself to stopping the process of urination several times. When the pelvic floor muscles are toned, this not only guarantees the absence of prolapse of the vaginal walls, but also a childbirth without complications, as well as a successful sex life. Repeating such exercises directly during sexual intercourse will give new sensations to both yourself and your sexual partner.

Among other things, a woman should not carry heavy objects or expose herself to excessive physical exertion. In the event that severe tears remain after childbirth, proper suturing is important, which certainly depends on the professionalism of the doctor. Despite the fact that prolapse of the vaginal walls can cause a lot of serious inconvenience and problems, it is quite possible to prevent such a disease. The main thing is not to neglect regular preventive examinations by a gynecologist.

Delayed consultation with a doctor complicates the treatment of vaginal prolapse. Timely detection of pathology will help to avoid surgical treatment, the development of complications from the digestive, genitourinary system.

Reasons

The pelvic organs are fixed: with the help of ligaments they are connected to each other, as well as to nearby structures. The fat capsule creates a kind of airbag for the bladder and kidneys, further immobilizing them. The muscles of the pelvic floor and anterior abdominal wall hold the organs in an optimal position, preventing displacement. Due to the disruption of several links, prolapse of the uterus and vagina occurs, which leads to disability.

In most cases, the disease occurs in post-age women who have given birth repeatedly. Pregnancy and childbirth tend to stretch the pelvic muscles, which increases the susceptibility to vaginal prolapse. Less commonly, the pathology occurs at a younger age; cases of uterine prolapse have been described even in nulliparous girls.

The main causes of vaginal prolapse include:

Complications during childbirth. A large fetus, polyhydramnios, rapid labor or weakness of labor lead to trauma, rupture of the pelvic floor muscles and perineum. If forceps were used, the risk of mucosal injury increases. Incorrect suture placement, infection, and poor healing in the future lead to vaginal prolapse after childbirth.
Mothers of many children are at risk. Even a normal pregnancy leads to stretched muscles and ligaments. If a woman has given birth to two or more children, it is necessary to regularly visit a gynecologist and perform special exercises to prevent uterine prolapse.
Connective tissue diseases affect the condition of the muscles. They become less elastic, elastic, and capable of stretching.
Increased intra-abdominal pressure leads to gradual prolapse of the vaginal muscles. This is facilitated by prolonged constipation and a rough, hacking cough.
A sharp decrease in body weight in combination with other risk factors. At fast weight loss The fat capsule of many organs decreases. As a result, the uterus, ovaries, and kidneys sag, sink lower, and grade 1 prolapse of the vaginal walls occurs.
At surgical interventions ligaments, muscles, and blood vessels are often injured.
Serious injuries and pelvic fractures are accompanied by impaired innervation and decreased muscle tone.
Removal of the uterus without fixing its dome is complicated by prolapse of the vaginal walls after surgery. To prevent negative consequences It is recommended to perform special exercises and wear a bandage.
Lifting heavy objects is an additional risk factor.

Degrees

Symptoms of prolapse of the vaginal walls primarily depend on the severity of the process.

After a gynecological examination, the doctor determines the degree of the disease:

With vaginal prolapse of the 1st degree, a gaping of the genital fissure is observed, while the internal organs do not extend beyond its limits. During examination in the mirrors, the external os of the uterus is located lower, hanging over the vagina.
Stage 2 vaginal prolapse is characterized by protrusion of the cervix, often involving nearby organs. The vaginal wall forms a kind of hernial sac, in the cavity of which there may be a bladder or rectum. In this case, in clinical picture violations of the relevant authorities will come to the fore.
Grade 3 is the most severe. The vagina and uterus are located below the genital slit, movement causes great discomfort.

Main features

In the initial stages, the disease develops gradually, but when the symptoms are well expressed, a sharp deterioration in the condition is observed. Therefore, it is important to identify vaginal prolapse in the early stages in order to prevent complications from occurring.

The first symptoms are non-specific and easy to miss. Women complain of discomfort during sexual intercourse; intimacy is not enjoyable. These signs should alert you, and it is recommended to visit a doctor to find out the cause. The above-mentioned manifestations are also observed when infectious diseases genitourinary system, psychological trauma, hormonal disorders.

Sex with vaginal prolapse becomes painful. A woman experiences a sensation of a foreign body in the vagina, and as the disease progresses, a protrusion from the genital opening occurs.

The clinical picture depends on the degree of damage to nearby organs. Prolapse of the anterior vaginal wall is accompanied by difficulty urinating. Worry about frequent urge to go to the toilet, urinary incontinence, pain or itching in the area of the urethral opening. These changes are associated with a violation normal shape and location of excretory organs. The bladder, together with the ureters, is located in front of the vagina. When the pelvic muscles weaken, the wall of the bladder descends into the hernial protrusion, which leads to congestion, incomplete emptying, and the development of a bacterial infection. This phenomenon in medicine is called cystocele.

Prolapse of the posterior vaginal wall occurs less frequently. In this case it suffers digestive system. Problems with emptying come to the fore - constipation predominates. A loop of intestine often gets caught in a hernial protrusion, thereby preventing normal movement feces. Patients complain of bloating and discomfort. Pain during vaginal prolapse can be localized in the lower abdomen or umbilical region. In rare cases there are anal fissures, fecal incontinence, hemorrhoids.

Can there be no symptoms?

The disease develops gradually. At the first stage, the protrusion does not extend beyond the genital slit; it is almost impossible to see it visually. Stool and urination are not impaired.

Discomfort during sex or lack of satisfaction with sex life in most cases goes unnoticed. Women associate this with fatigue and stress.

Thus, symptoms of vaginal prolapse are mild or absent at the onset of the disease. As long as the bladder or intestines are not involved in the pathological process, there will be no disturbances from the excretory system and digestive organs.

Which doctor should I contact if I have vaginal prolapse?

A gynecologist treats prolapse of the walls of the vagina or uterus. In severe cases, consultation with a proctologist, urologist, or surgeon is necessary.

Diagnostics

If vaginal or uterine prolapse is observed, making a diagnosis is not difficult. In the early stages, when there are no visual changes, the doctor prescribes additional research methods. Often the symptoms resemble diseases of the urinary system or digestive organs. It is necessary to clearly distinguish between these states in order to choose the right tactics treatment.

Diagnostic measures include:

Collection of patient complaints.
Bimanual examination. The doctor examines the genital opening, vaginal walls, and cervix. If there are protrusions, it is necessary to determine their size, consistency, which organ is located in the hernial sac, and whether it is possible to reduce it.
Ultrasound is indicated to assess the condition of the pelvic organs.
Urinary incontinence, frequent urge, pain - indications for testing general analysis and urine culture.
Excretory urography – additional method diagnostics
To determine the location of the organs of the excretory, reproductive system, intestines, their sizes, and the presence of kinks, magnetic resonance imaging is additionally prescribed.
A urogenital smear is necessary to assess the vaginal microflora and identify infectious diseases.
Prolapse of the vaginal walls of the 2nd degree in most cases is accompanied by the appearance of a cystocele or rectocele. For treatment to be effective, the gynecologist refers the woman to a consultation with a urologist or proctologist, depending on the leading symptom.

Condition during pregnancy

Pregnancy must be planned - an examination by a gynecologist and tests are required. If the disease is detected in the early stages, this is not a contraindication to conceiving a child. Exercises for vaginal prolapse will help strengthen the pelvic muscles. Regular exercise will help a woman get rid of genital prolapse.

When a protrusion forms that extends beyond the boundaries of the genital slit and contains the bladder or intestines, surgical intervention is indicated. Pregnancy is prohibited at this stage. After surgery for prolapse of the vaginal walls, delivery is carried out by cesarean section. Physiological childbirth is contraindicated.

Treatment

The choice of treatment tactics depends on many factors. The doctor takes into account the woman’s age, degree of prolapse, the presence of complications, concomitant diseases, and the need to preserve reproductive function. There are several methods of treating vaginal prolapse: surgery, conservative therapy, use of traditional medicine, special exercises, exercise equipment, gymnastics. The most effective is an integrated approach - a combination of several methods.

Conservative treatment

If the disease is detected in the early stages, surgery can be avoided. The doctor prescribes exercises to strengthen the pelvic floor and abdominal muscles.

If the tone of the vaginal muscles is weakened, the use of a special ring is recommended, which keeps the cervix in its normal position. A pessary for vaginal prolapse is selected individually, depending on the severity of symptoms. The ring is inserted towards the cervix in an oblique position, then it is aligned, resting against the pelvic floor and the pubic symphysis on the other side. In this way, the vagina is fixed, which prevents prolapse.

Patients with a pessary installed should be regularly monitored by a doctor. Improper use and neglect of the rules for caring for the ring during vaginal prolapse leads to complications.

Swelling, redness, irritation of the mucous membrane.
Inflammatory reaction, purulent discharge.
The appearance of ulcers.
Formation of fistulas with the rectum and bladder.
Ingrowth of the ring into the cervix, deposition of mineral salts.

To avoid complications, the doctor prescribes regular douching and rinsing of the pessary. From time to time it is necessary to change the model, the shape of the ring, and use tampons.

Bandage

Special devices are used to strengthen the muscles of the pelvic floor and abdominal wall. The bandage for vaginal prolapse consists of high panties made of elastic material that are worn under clothing. This allows you to stabilize intra-abdominal pressure and muscle tone.

This method is effective for vaginal prolapse after removal of the uterus, second or third birth, or installation of a pessary. The bandage is also used for preventive purposes, in the presence of risk factors.

Gymnastics

Physical activity is the best way to strengthen the muscles of the pelvis and perineum in the first stages of the disease. The main condition is regularity. Gymnastics for vaginal prolapse includes exercises for the abdominals and back.

The most effective exercises are:

Stand in a knee-elbow position. First, round your back as much as possible, stay in this position for 10 seconds, then bend it. During execution, it is recommended to squeeze the muscles of the perineum. Repeat 15 times.
The situation is previous. At the same time, you need to extend your arm and opposite leg forward, fix the pose for a few seconds, then do the same on the other side. Repeat once.
Lie on your back, bend your knees. Slowly raise your pelvis, tensing the muscles of the perineum. Hold for a few seconds and lower. Do 10 repetitions.

In addition to general strengthening exercises, Kegel exercises are effective for vaginal prolapse. The complex is designed specifically to increase the tone of intimate muscles. The big advantage is that the exercises can be performed anywhere: at work, in transport, at home. They are completely invisible to strangers. It is recommended to repeat the complex up to 5-6 times a day, gradually increasing the number of approaches. For greater effect when prolapse of the vagina, simulators are used.

Slowly squeeze your pelvic floor muscles, hold them in this position for a few seconds, then gently relax. For the first lesson, 10 repetitions are enough.
The second block is more intense. The intimate muscles need to be contracted at maximum speed.

Surgical treatment

When the vaginal wall prolapses after childbirth or removal of the uterus, when the protrusion extends beyond the genital slit, surgical restoration of its normal location is indicated. The surgeon takes into account the degree of severity, the presence of concomitant diseases, and the involvement of nearby organs in the process. If there are no contraindications ( diabetes mellitus, severe diseases of the heart, lungs, renal failure), the doctor chooses the most suitable way plastics.

When the anterior wall prolapses, colporrhaphy (suturing) of excess vaginal folds is indicated to restore the physiological location of the organs. During colpoperineorrhaphy, the surgeon sutures the posterior wall of the vagina to the perineal muscles, strengthening the septum.

After surgery, antibiotics, anti-inflammatory suppositories, ointments, and antiseptics are prescribed for rapid wound healing.

To prevent recurrent vaginal prolapse after surgery, you need to follow several rules:

Bed rest is recommended for the first day, sitting is prohibited for the next week, in this position the pelvic floor muscles are maximally tense.
Sexual activity is allowed to begin no earlier than a month after examination by a doctor.
The diet should consist of soups and pureed foods to prevent constipation.
Avoid physical activity for 30 days.

Folk recipes

Decoctions, teas, infusions can complement treatment in the early stages - traditional medicine alone is not enough. All prescriptions must be made by a doctor. It is not recommended to use recipes on your own, as some herbs negatively affect the genitourinary system and cause bleeding.

The following decoction increases the tone of the uterus. It is necessary to take linden and lemon balm flowers in equal proportions (50 grams each), add a tablespoon of alder root and 80 grams of white damask. Mix the ingredients and steam with boiling water. Drink 100 ml of decoction before meals for 3 weeks.

Prevention

To prevent the development of the disease, if there are risk factors, you must follow simple rules:

Strengthen the muscles of the pelvis, abs, and back while planning pregnancy.
Do not lift heavy objects.
Sticking to smaller meals and consuming enough fluids and fiber helps prevent constipation.
Use techniques to protect the perineum during childbirth and perform proper suturing of ruptures.
Wear a bandage during the postpartum period, play sports, and do Kegel exercises.

Decreased tone of the pelvic floor muscles is not only a cosmetic problem, it is serious illness genitourinary system. If you experience discomfort, pain during sex, or problems with urine output, it is recommended to consult a gynecologist. Early diagnosis will help prevent the development of the consequences of vaginal prolapse and avoid surgical treatment.

Prolapse of the vaginal walls, causes, treatment, exercises, surgery for prolapse and prolapse

Prolapse of the vaginal walls (prolapse) is expressed in a change in the anatomical location of the pelvic organs against the background of weakening of the muscles of the abdominal region and pelvic floor. Why is this happening? Due to increased pressure inside the abdominal region, the elasticity of the ligaments is gradually lost, which is why they are unable to maintain the internal organs (in particular the bladder, uterus, rectum) in the required physiological position. Hence, the increase in organ pressure gradually leads to loss of muscle tone of the perineum and prolapse of vaginal tissue.

The course of the disease is characterized by a slow pace at the beginning and rapid progression in the future, often accompanied by inflammatory diseases.

In the early stages of development, the disease does not manifest itself in any way. The first alarm bells signaling the disease are pain during sexual intercourse and weakening of sensations during this process. Further, heaviness and pressure in the vulva may be felt; as it progresses, inflammation, swelling of the genital slit, discomfort during urination, incontinence (urine, stool and gas), nagging pain in the abdomen, lumbar region.

Detection of the disease is not difficult; when examined in a gynecological chair, the walls of the vagina and cervix protruding from the genital tract are noticeable. The doctor adjusts them and then assesses the condition of the pelvic floor muscles. In this case, additional consultation with a urologist and proctologist is required.

Pregnancy with this state possible, but the degree of development of the disease should be taken into account. The first degree of the disease allows you to give birth without prior surgery. In this case, exercises to strengthen the pelvic muscles and abs will help. With a progressive degree of the disease, surgical intervention and recovery are necessary, only then can you become pregnant. Otherwise, prolapse of the vagina is fraught with prolapse of the uterus.

And one more nuance, after the operation you will no longer be able to give birth on your own; a caesarean section is indicated.

Treatment of prolapse of the vaginal walls.

Prolapse of the vaginal walls, if diagnosed early, can be eliminated conservatively; in more advanced and complicated cases, surgical intervention is performed. Timely treatment significantly reduces the risk of complications.

Therapy is indicated for minor prolapse of the vaginal walls and is expressed in the use of a set of exercises, the purpose of which is to increase the muscle tone of the pelvic floor, including Kegel exercises (squeezing and relaxing the muscles of the perineum), and physical therapy exercises. At the same time, therapy is prescribed for general strengthening the body, while nutrition is not the least important (no heavy foods that can cause constipation and complicate the problem).

Exercises while lying on your back.

Arms along the body, legs straightened and joined together. Slowly, while exhaling, we raise our legs, while inhaling, we spread them apart, while we exhale, we close them, and while inhaling, we return to the starting position. Do eight repetitions.
Hands under your head, feet together. Raise the pelvis while simultaneously retracting the muscles of the anus. Do ten repetitions slowly.
At an average pace we make a “bicycle” of twenty revolutions.
Raise straight legs one by one. Do eight times with each leg.
We lift our legs off the floor, put them behind our heads, and stretch our toes to the floor. Do six approaches at a slow pace.
Raise your straight legs (together) at an angle of 45° to the floor and return back. Perform slowly eight times.
Bend your knees (foot on the floor, arms under your head) and spread them slightly. Raise your pelvis from the floor, spread your knees wide and pull the anus muscles inward. Do ten approaches.

Exercises should be performed slowly and monitor your breathing. Do it two hours before meals or two hours later. Class time is not limited.

Surgery for prolapse and prolapse of the vaginal walls (vaginal wall plastic surgery).

After examining the patient with the participation of a proctologist and urologist, the doctor prescribes treatment, taking into account the severity of the pathology, the degree of prolapse, the patient’s age and the individual characteristics of her body. As a rule, surgical treatment with elements of plastic surgery is recommended. Basically, this is colpoplasty, which involves suturing the vaginal walls. There are two types of colpoplasty:

Colporrhaphy - removal of “extra” tissue from the vaginal walls and stitching them together during prolapse and prolapse; the operation is aimed at restoring the anatomical location of the organs by strengthening the pelvic floor muscles. Can be front or back.
Colpoperineorrhaphy is a reduction of the posterior wall of the vagina (against the background of overstretching after childbirth) by suturing it and tightening the perineal muscles.

Surgery is performed using general anesthesia. The choice of surgical technique is determined by the surgeon, taking into account visual and video colposcopic examination, analysis of the condition of the tissues of the walls of the vulva and the presence of concomitant diseases of the pelvic organs.

After assessing the patient’s general condition after the intervention, the doctor discharges her, usually on the second day after the intervention. To prevent the development of complications and accelerate recovery period It is necessary to strictly follow all the doctor’s recommendations, namely:

During the first five days, treat the perineum with an antiseptic.
Take antibiotics prescribed by your doctor.
For two weeks, to avoid overstraining the operated muscles, sitting is prohibited.
In the first week, it is recommended to eat liquid or semi-liquid foods to prevent the development of constipation.
Eliminate physical activity, including sports, for at least a month.
It is recommended to resume sexual activity no earlier than five weeks after surgery.

Modern equipment and microsurgery capabilities allow the operation to be performed with minimal trauma. After the intervention there are no visible marks or scars left on the body.

Treatment of prolapse of the vaginal walls with folk remedies.

Treatment with traditional medicine can only be effective at an early stage and in combination with other treatment methods prescribed by a doctor, including exercises.

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Vaginal prolapse

Vaginal prolapse is a downward displacement of a woman’s genital organ from the genital opening. The disease is observed more often in mature women over 40 years of age, since it can be caused by changes in the reproductive system, menopause, the consequences of frequent and difficult childbirth, uterine surgeries, and heavy lifting.

Prolapse of one or two vaginal walls or the entire organ at once often occurs after childbirth. In women who have recently given birth, vaginal prolapse manifests itself as a feeling of heaviness in the lower abdomen due to the bladder pressing on the abdominal wall.

But most often, the pathology does not manifest itself at all at an early stage and is diagnosed only at an appointment with a gynecologist. At the 2nd and 3rd stages, characteristic painful symptoms(pain, urological problems), which indicate that treatment should be started immediately - do gymnastics, massage.

The vagina may prolapse completely or partially. Complete organ prolapse cannot be cured conservatively, and after surgery you will have to wear a bandage, so at the first signs of illness after childbirth and beyond, it is better to consult a doctor.

Types of vaginal prolapse

Vaginal prolapse is divided into 2 types:

Partial (incomplete) vaginal prolapse (prolapsus vaginae partialis) is a displacement of part of the vaginal wall, which protrudes from the vulva in the form of a fold. The front and back walls of the vaginal canal can fall out, both at the same time. If the anterior wall is displaced, the urethra and bladder descend into the cavity of the vaginal canal. When the posterior wall prolapses, vaginal prolapse is complicated by prolapse of the rectum.

Complete prolapse of the vagina (prolapsus vaginae totalis) is the exit of the entire vaginal tube beyond the vulva. Often accompanied by uterine prolapse.

Since the disease develops gradually, there are 3 degrees of vaginal prolapse.

The 1st degree is characterized by prolapse of only the walls (anterior or posterior), while the vulva remains within the boundaries allowed by the anatomy.

2nd degree - the front or back wall and part of the bladder and rectum partially descend.

3rd degree - the vagina falls out of the genital slit along with the uterus, part of the bladder, and rectum.

Symptoms of vaginal prolapse

Vaginal prolapse has various signs, changing with the development of the disease. At first (sometimes for several years) a woman feels pain during sex, discomfort in the vaginal area when straining, nagging pain, heaviness in the lower abdomen, as during menstruation, notices bloody vaginal discharge. Very often these signs are also absent.

Then the disease begins to progress rapidly, and the symptoms become more burdensome. Women feel the presence of a foreign body in the genital fissure, problems with urination and defecation begin, and it becomes impossible to have sexual activity due to severe pain.

Frequent urges to go to the toilet do not bring relief, since congestion begins in the bladder, and a “pocket” forms in the rectum in which feces accumulate. Patients begin to suffer from involuntary urination, gas incontinence, and constipation.

With partial or complete prolapse, the structure of the vaginal mucosa is disrupted, making it vulnerable to infections. Against the background of vaginal prolapse, inflammatory and erosive processes develop (for example, cystitis).

Reasons for the development of the disease

Vaginal prolapse can be caused by various reasons, which depend on the patient’s age, the presence of chronic diseases, and the lifestyle of the patient. These could be:

repeated births birth injuries, for example, at the birth of a large child, twins;
lack of rehabilitation after childbirth;
increased intra-abdominal pressure (hard physical “not female” work, participation in certain sports that create a strong load on the muscular apparatus of the perineum and uterus);
tumors in the pelvis;
intestinal diseases accompanied by frequent constipation;
diseases of the uterus, incorrect operations on the uterus associated with the lack of attachment of the vaginal dome;
obesity, sudden weight loss;
hereditary ligament weakness;
dysplasia and other connective tissue pathologies;
chronic hacking cough;
congenital anomalies of the rectovaginal septum.

In girls, the pathology is often associated with untimely trips to the toilet.

In old age, vaginal prolapse and prolapse are associated with loss of elasticity in muscles and ligaments, weakening of the perineal muscles.

Pregnancy connection

Vaginal prolapse is very common immediately after childbirth, even in young patients or in women who have had several births.

During pregnancy and childbirth, women develop functional insufficiency of the ligamentous apparatus, as a result of injuries during childbirth, the pelvic muscles suffer, tears appear in the perineum, which are often improperly sutured and become infected. All these factors contribute to vaginal prolapse.

The development of muscle weakness is facilitated by passage through birth canal large fruit. If the method of delivery is chosen incorrectly (an episiotomy should be performed), the woman runs the risk of prolapse of the walls or the entire vagina when giving birth.

Too short a period of postpartum rehabilitation is also a risk factor for women with weak muscles and ligaments of the pelvic organs.

In addition, untreated partial or complete vaginal prolapse can prevent the onset and healthy flow pregnancy, cause miscarriages, premature birth.

Treatment

Treatment of pathology is carried out taking into account the type and degree of organ prolapse, the age of the patient, and the presence of concomitant diseases.

Exercise therapy, massage

Treatment of the first stage of the disease begins with the appointment of a complex of physical therapy - Kegel gymnastics. The exercises are designed to strengthen the muscles of the perineum and make the ligaments more elastic. You need to exercise regularly anywhere, several approaches a day.

Stage 1 consists of exercises for slowly squeezing the intimate muscles followed by relaxation (tighten the vaginal muscles as if you want to stop the process of urination). Start with squeezing for a count of 3 and work your way up to 20 seconds or more. Having mastered this exercise, proceed to the second stage.

Stage 2 – dynamic contractions. Tighten and relax your vaginal muscles very quickly. Start with 10 exercises, 5 sets per day, after a week double the number, gradually increasing the number of quick contractions and relaxations every day. Only after mastering the first two stages can you move on to the third.

Stage 3 – pushing out. Tense as if you were constipated or in labor and hold in this state for a few seconds. Gradually increase the time you tense your intimate muscles. When performing the exercise, you should feel tension in the muscles of the peritoneum and perineum.

In addition to exercising at home, it is useful to attend gynecological massage sessions and do Kegel exercises on simulators.

Implants

In addition to physical therapy, the vagina can be returned to its normal anatomical position using special implants: plastic uterine rings (pessaries) that are placed in the vagina to prevent prolapse. They will keep the uterus in the correct position. This treatment is an alternative to surgery when surgery is contraindicated. It is used for minor prolapse, in old age.

Surgical treatment

Surgical treatment for vaginal prolapse is one of the most effective. For grades 2 and 3 vaginal prolapse, colporrhaphy and colpoperineorrhaphy are prescribed to elevate the organs inside the pelvis. The operation is performed under anesthesia and consists of removing part of the vaginal mucosa, suturing the stretched muscles, and the vaginal lining. If the uterus has prolapsed, it is fixed with ligaments. After the operation you need to wear a bandage.

Treatment of vaginal prolapse with folk remedies

Recipe No. 1: baths

Treatment of incomplete vaginal prolapse can be supplemented by taking sitz 10-minute baths with Datura. To prepare the infusion, pour 20 g of herb into 7 liters of boiling water and hold in a water bath for 15 m. Before use, cool the infusion to 38°C.

Recipe No. 3: alcohol tincture

An alcohol tincture with astragalus root in a ratio of 1/9 is also very effective in combating vaginal prolapse. Infuse the roots in a cool, dark place for 14 days. Drink the strained tincture 1 tsp. three times a day before meals for a month. Don't forget to drink the tincture with plenty of water.

Prevention of vaginal prolapse after childbirth

Prolapse of the vagina during pregnancy, after childbirth, and at any other period of life can be prevented by following a number of recommendations and a simple set of exercises.

Prevention includes a special complex of exercise therapy during pregnancy, after childbirth, restriction heavy loads, control over the development of multiple births, a large child.

Prevention is important after a difficult birth and beyond. Do regularly such simple exercises as “bicycle”, “scissors”, raise your legs with and without a roller under your buttocks, try doing the “swallow”, it is also useful to stand on one leg and do circular rotations with the other leg (you can lean on something) .

It is important to try to pull the vulva up when walking. When urinating, try to squeeze the stream several times.

A diet with a lot of plant fiber (vegetables, fruits) is also indicated.

If you have had surgery, wear a bandage to support your internal organs when performing any physical work.

Prolapse and prolapse of the vaginal walls

Vaginal prolapse or prolapse usually occurs in reproductive age women and is a constantly progressive disease.

The prevalence of this pathology is quite high: more than 30% of women over 45 years of age suffer from some degree of vaginal prolapse. In addition to aesthetic discomfort, in such women the normal functioning of the genital organs, as well as some structures of the urinary and digestive systems, is disrupted.

Due to the relevance of this gynecological problem, you need to know the causes of prolapse, its symptoms, methods of treatment and prevention.

Structure of the vagina

Before getting acquainted with the causes and main manifestations of vaginal prolapse, it is necessary to briefly dwell on its anatomy.

The length of the vagina is on average 7–12 cm. It looks like a well-extensible tube. At the top, this “tube” tightly covers the cervix, and at the bottom it ends with the so-called vestibule of the vagina. There are three layers in the structure of the vagina:

Interior. It is represented by a mucous membrane that forms numerous folds with a transverse direction. This structure allows the vagina to change its size (for example, during childbirth or during sexual intercourse).
Average. Formed by muscle fibers having different directions.
Outer.

In the vagina, there are anterior and posterior walls connected to each other.

Front wall

It is somewhat shorter than the back. In the upper part of the vagina, in contact with the cervix, it forms the anterior uterine fornix.

In the upper third, the anterior wall borders on the bladder, and on the remaining length – on the urethra.

Rear wall

Outside, at the top, the posterior wall is covered with peritoneum and forms the rectouterine cavity. In some pathological processes, a puncture of this anatomical formation is performed through the posterior vaginal fornix (the border of the posterior vaginal wall and the cervix). For the rest of its length, the posterior wall borders the rectum and only moves away from it closer to the perineum.

Prolapse of the vaginal walls very often disrupts the functioning of adjacent organs.

Support apparatus

To keep the vagina in physiological state nature provides for a developed system of muscle-ligamentous structures. To facilitate understanding of this system, such anatomical formations can be divided into three levels according to their characteristic appearance:

"Funnel". The top level. Supports top part vagina and cervix. The wide part of this formation is attached to the bones of the pelvis, and the narrow part is attached to the lower part of the uterus.
"Hammock". Fixes the middle part of the vagina, urethra with the bladder and rectum.
“Plate” (pelvic diaphragm; pelvic floor). Educated mainly muscle fibers. In addition to supporting the internal organs and vaginal walls, it forms the external sphincters of the urethra, rectum, and is also responsible for the closure of the lower part of the vagina.

Violation of the structure of the two upper levels provokes displacement of the walls of the vagina and some internal organs. With a noticeable decrease in tone or damage to the musculo-ligamentous apparatus of the pelvic diaphragm, prolapse and prolapse of the vagina occurs, and a significant disruption in the functioning of adjacent structures. That is why prolapse of the vaginal walls is also called “pelvic floor muscle insufficiency.”

Why does prolapse occur?

In the process of formation of prolapse of the vaginal walls, two criteria play a major role: an increase in intra-abdominal pressure for various reasons and dysfunction of the muscular layer of the pelvic diaphragm. All factors leading to such violations can be divided into several groups:

Endocrine dysfunction (especially in the sexual sphere).
Congenital abnormalities of connective and muscle tissue.
Traumatic injuries of the muscular-ligamentous apparatus.
Pathology of internal organs, accompanied by an increase in intra-abdominal pressure, circulatory and metabolic disorders.

Consequently, the causes of vaginal prolapse are many diseases and pathological conditions, which are usually combined. Examples of such reasons could be:

Frequent constipation, prolonged cough (for example, with chronic bronchial obstruction) - contribute to an increase in intra-abdominal pressure.
Fast weight loss.
Obesity.
Pathological labor process: prolonged, rapid or rapid labor, application of obstetric forceps, damage to the perineum.
A large number of births, polyhydramnios, multiple births, large fetus.
Large tumor formations of the pelvic organs or abdominal cavity.
Prolonged heavy physical activity, frequent lifting and carrying heavy objects (especially at the age of puberty or menopause and after childbirth).
Age factor (decrease in tissue elasticity in older women).
Some surgical interventions on the internal genital organs.
Hereditary and systemic pathology (with damage to connective and muscle tissue) and other factors.

Most often, vaginal prolapse is detected after childbirth or surgery (especially when removing the uterus). Let us consider in more detail the mechanism of formation of vaginal prolapse in such conditions.

Prolapse after childbirth

Vaginal prolapse in women who have given birth can occur for various reasons. First of all, this is carrying heavy weights immediately after childbirth and poor nutrition, leading to constipation. Weakened muscles and ligaments after pregnancy and childbirth are not able to withstand the constantly increasing intra-abdominal pressure and physical stress.

Second no less important reason postpartum vaginal prolapse are various birth injuries of the perineum, leading to insufficiency of the pelvic floor muscles. A particularly important role is played by deep ruptures with a violation of the integrity of the wall of the rectum or urethra, failure or infection of the sutures in the perineum and other injuries.

Numerous or pathological birth In addition, they also cause weakening of the musculo-ligamentous apparatus of the pelvis and perineum.

Postoperative prolapse

According to statistics, after surgery to remove the uterus (hysterectomy), prolapse of the vaginal walls is diagnosed in approximately 45% of women undergoing surgery. There are several reasons for this:

Injury to the periuterine tissue.
Filling of the “vacated” space with internal organs and, as a result, disruption of their normal anatomical position.
Insufficient fixation of the vaginal dome by the surgeon after removal of the uterus.
Lifestyle: excessive physical activity, constipation and other provoking factors.

Prolapse and prolapse of the vaginal walls often occurs after complete removal uterus (extirpation).

Symptoms

At the beginning of its development, the disease can be completely asymptomatic, without the appearance of any specific signs. Menstrual function in such women it is usually not impaired.

Often the first symptoms of prolapse are a deterioration in the quality of sexual life (for example, a slowdown or lack of sexual satisfaction in a woman and her partner, frequent entry of air into the vagina during coitus).

Further symptoms appear as the disease progresses, depending on the location of the prolapse:

Pain in the lower abdomen and back increases with increasing degree of prolapse of the vaginal walls. Their intensity becomes greater after prolonged standing in an upright position or physical activity.
There is a feeling of the presence of a foreign body in the vagina, pressing pain in the pubic area.
When straining, a formation protruding from the genital slit is identified.
The prolapse of the anterior vaginal wall is accompanied by a violation of the act of urination: there is a need for more frequent visits toilet, stress urinary incontinence occurs (when coughing, sneezing, laughing).
Incomplete emptying of the bladder contributes to inflammatory lesion(cystitis).
Prolapse of the posterior vaginal wall provokes problems with the act of defecation, which contributes to constipation or, conversely, incontinence of feces and gases.
In the later stages of prolapse, it is sometimes possible to perform the act of urination or defecation only after repositioning the vaginal walls.
The displacement of the pelvic organs and the gaping of the genital fissure favors the penetration of infectious agents with the subsequent development of inflammatory processes in the genital tract.
Due to poor circulation, bedsores often form on prolapsed genitals, trophic ulcers, swelling of the mucous membrane, contact bleeding occurs.

Complete loss of the vaginal walls may be complicated by their pinching in the genital cleft due to severe tissue swelling.

Diagnostics

Diagnosis of vaginal prolapse is usually not difficult even with a routine examination by a gynecologist. Depending on the location of the pathological process, the following types of prolapse are distinguished:

Isolated prolapse of the anterior or posterior vaginal wall.
Prolapse of both vaginal walls.
Prolapse of the vaginal walls together with the cervix and body of the uterus. It can be incomplete and complete.

If the pathological process involves the urethra (urethra), bladder and/or rectum, ureterocele, cystocele and rectocele occur, respectively. These terms characterize the presence of a pathological protrusion of the wall of an adjacent organ towards the vagina with a violation of their function.

In addition to this, in clinical classification prolapse is traditionally divided into four degrees of disease according to severity.

For full characteristics diseases and assessing the degree of dysfunction of internal organs, ultrasound scanning of the pelvic organs and urinary system, cystoscopy, sigmoidoscopy and other research methods are additionally used.

Principles of therapy

The goal of treating prolapse of the vaginal walls is to restore the normal anatomical relationship and function of the perineum and adjacent organs.

Treatment of prolapse is possible with conservative or surgical methods.

Conservative treatment

The effectiveness of such methods of therapy is greatest with small degrees of prolapse, when there are no pronounced symptoms of dysfunction of adjacent organs. To the complex conservative treatment Vaginal prolapses include:

Normalization of lifestyle, proper nutrition and the fight against constipation, moderate physical activity.
Treatment of concomitant somatic diseases.
Performing special exercises to strengthen the muscle layer of the pelvic floor and anterior abdominal wall.
Application of some medications according to indications (for example, estrogen in case of estrogen deficiency).
If there are contraindications to surgical treatment of prolapse, the doctor may recommend wearing a special uterine ring(pessary), which is selected individually. Its goal is to keep the internal organs in an anatomically correct position and reduce the severity of negative symptoms associated with prolapse.

Physical therapy exercises (physical therapy) and special gymnastics for the perineal muscles (Kegel exercises) serve both for the treatment and prevention of vaginal prolapse with a high risk of its development. Such exercises must be done daily.

Complex physical therapy exercises is selected by the doctor individually for each woman, taking into account possible contraindications. Almost all women can do Kegel exercises, as this complex is simple and safe.

Principles of Kegel exercises:

Exercises are done daily 4-5 times a day.
First, you need to make an effort and hold the stream of urine to understand which muscles are involved.
Next, the “detected” muscles are slowly compressed and relaxed.
The second stage is rapid compression and relaxation.
“Pushing out” is the third stage. Tension occurs in the muscles of the abdominal wall (as during pushing).

All three exercises should be done at least ten times, adding five repetitions each week. It is optimal to perform each stage 30 times several times a day.

Surgical treatment

Surgical treatment is performed for the third and fourth degrees of vaginal prolapse, as well as in the presence of its complications.

When choosing specific method Many factors are taken into account during the operation:

Degree of prolapse.
The woman’s age and her desire to preserve reproductive function.
Presence of concomitant pathology, etc.

The essence of some operations is to remove part of the altered vaginal wall and restore the normal anatomical position of the organ. Other methods involve the installation of a special “prosthesis” made of inert material, which acts as a muscle corset and supports internal organs. Sometimes you have to do radical surgery– removal of the uterus with strengthening of its ligamentous apparatus.