Surgery for uterine prolapse in old age. Symptoms of uterine prolapse in older women

Many older women face pathologies such as omission uterus. The loss can be partial or complete.

In this article we will look at the symptoms of organ prolapse in older women, and also learn how to treat this pathology conservatively and surgically.

The process itself is a displacement of the organ down the inguinal canal. In rare cases, the uterus slides completely into the vagina. Today, several types of uterine prolapse in older women are known, namely:

  • Cystocoel. This type of pathology is characterized by prolapse of the uterus along with the anterior wall of the rectum;
  • Partial. Partial prolapse means partial pathological presence of the uterus in the vagina;
  • Complete. In some cases, complete loss of this organ in older women is possible. With complete prolapse, the body of the uterus completely extends beyond the boundaries of the vagina;
  • Rectocele. In this case, the uterine body descends along with the wall of the bladder.

Each of the presented types of loss requires treatment. However, we'll talk about this a little later. Now let’s pay attention to why the uterus can fall out in old age. Here are some reasons:

  • heredity;
  • Lifting weights and intense physical activity. The second reason is especially relevant to women who, in their youth, participated in sports aimed at lifting weights;
  • Another reason for prolapse or loss is hormonal changes. Often, hormonal imbalance in a woman occurs due to constipation, obesity or chronic cough. If, with excess weight, prolapse causes strong pressure on the pelvic muscles, then with constipation, the cause of prolapse is efforts that increase intra-abdominal pressure.
  • congenital pelvic defect;
  • In some cases, prolapse of the uterine body occurs as a result of multiple or multiple births. In women, the muscle tissue of this organ simply weakens. A high degree of weakness contributes to loss. Pathologies of this kind are especially evident during menopause;
  • hernia behind the pelvis;
  • presence of tumors;
  • abortions also lead to uterine prolapse;
  • even a woman’s physique can cause uterine prolapse;
  • injuries that contributed to deformation of the pelvic floor;
  • Obstetric errors. For example, incorrect use of forceps or incorrect removal of the child;
  • Wrong lifestyle. In other words, unhealthy. Regular eating disorders and consumption of unhealthy food can serve as an impetus for the appearance of such pathology;
  • hard work and constant overload.

Symptoms of hair loss

The prolapse or prolapse of this organ is characterized by symptoms such as:

In the initial stages, this pathology occurs without the mentioned symptoms. Painful discomfort, problems with urination and other difficulties arise as the pathology progresses. The stronger the displacement, the more obvious the symptoms given.

Any type of prolapse or prolapse requires quality treatment. There are several ways to treat this pathology. First, he will pay attention to treatment methods without surgery.

If a woman experiences uterine prolapse, what should she do in old age? One of the main pieces of advice in this case is not to self-medicate, that is, not to take any medications without a doctor’s recommendation.

If an elderly woman experiences uterine prolapse, she should first consult a gynecologist. An examination by a specialist will help determine the degree of prolapse of the neck of this organ and correctly prescribe further treatment. In case of loss, the following types of studies are prescribed:

  • urological examination;
  • Ultrasound of the pelvic organs;
  • sowing (allows you to determine the vaginal flora);
  • colposcopy.

Ultrasound and other studies determine the type and causes of uterine prolapse. The choice of subsequent treatment method depends not only on the degree of prolapse of her body or cervix, but also on the presence of additional pathologies in the woman’s body, as well as on age characteristics.

In the early stages of hair loss, a course of drug treatment is prescribed. Additionally, the gynecologist may prescribe certain physical exercises. What exercises can a doctor prescribe?

All recommended exercises will be aimed at training the muscles responsible for holding the uterus. In most cases, doctors recommend Kegel exercises. They are very simple, especially for women leading an active lifestyle. Here are some examples of such exercises and tips to help you perform them correctly:

  • Pushing. This exercise is aimed at reproducing labor. It is recommended to do the pushing exercise regularly, applying maximum effort;
  • Exercise to improve urination. The essence of the exercise is to learn to control the process of urination. It is carried out precisely at the moment of urination. The woman should forcibly stop it and then resume it. Like the previous exercise, this should be done regularly;
  • The following exercise of the technique in question allows tighten the pelvic muscles. The exercise involves pulling the muscles up. All actions should be performed quickly and rhythmically. It is advisable to do exercises regularly;

Such Kegel exercises are very effective for prolapse of the cervix or prolapse of the entire body.

In addition to these exercises, the specialist may recommend other gymnastic exercises. Let's list just a few of them:

  • Swimming. Swimming is an excellent therapy for uterine prolapse. Like previous exercises, swimming helps strengthen the tone of the uterine muscles;
  • Walking. Women suffering from this pathology are advised to walk as much as possible. Regular walking helps pump up a specific muscle group responsible for maintaining the uterus;
  • Another good gymnastic exercise are exercises designed for buttock development. The exercises involve raising your pelvis with your legs bent (legs bent at the knees). You need to rest on the floor;
  • Exercise bike It is considered an effective way to treat uterine prolapse. This exercise is done lying on your back. It is ideal for almost all types of uterine prolapse, except the latter type. If the prolapse is complete, this exercise should not be performed;
  • In addition to regular walking, when treating cervical prolapse, doctors recommend regular exercise. walking up the steps. Walking involves going up and down steps. All for the sake of strengthening the necessary muscles.

Using a pessary

The next alternative to surgery for treating uterine prolapse is use of a special plastic ring. This ring is placed in the vagina. It serves as good support for older women. In some cases, a vaginal ring is inserted for a certain period, in others it is recommended to wear it for the rest of your life.

However, this treatment method is not suitable for all women suffering from this pathology. When prescribing to wear a vaginal ring, the doctor takes into account all the individual characteristics of the individual patient’s body. So, wearing a plastic ring is acceptable for the following groups of people and in the following situations:

Equally important and useful information regarding the use of a vaginal ring are the tips below:

  • Uterine rings must be removed at night. These actions will involve some care and prevention of blood circulation;
  • Wearing the uterine ring should not cause any discomfort or pain. If a woman experiences pain or other discomfort while wearing the ring, this indicates that the uterine ring is not installed correctly;
  • Uterine rings require constant and careful care. The doctor should inform the woman about the rules for caring for the vaginal ring;
  • It is not recommended to purchase vaginal rings on your own, without a doctor’s recommendation. There are several types of vaginal rings. Not all of them are suitable for an older woman.

Following all of the above tips will increase the chances of wearing a vaginal ring being effective.

When is surgery necessary?

If a woman suffers from complete uterine prolapse, the doctor will immediately prescribe surgery. Surgical intervention is the only and correct way out in this situation. Surgery for uterine prolapse in elderly women has its own characteristics. For example, there are several methods of surgical intervention. Like any other treatment method, the method of surgical intervention for a particular patient is selected individually. The characteristics of the body and the presence of additional diseases are taken into account. Below are some types of surgery for prolapse of the cervix or prolapse of the entire body:

  • correction of the position of the uterus;
  • Installation of a special synthetic urinary loop. This type of surgical treatment is especially relevant for urinary incontinence due to cervical prolapse;
  • surgery to shorten the muscles of the ligamentous apparatus of the prolapsed uterus;
  • Reducing the area of ​​the vaginal walls. This operation is performed by removing the walls of the vagina. If such an operation is performed correctly, the vagina will return to its previous, normal state;
  • Installation of a mesh implant. In old age, the uterus needs support and additional support. Why? Because the uterus has lost its former elasticity. This support becomes a special implant;
  • Final removal of the uterus. Complete uterine prolapse in older women cannot be avoided without this type of surgery. However, such an operation for uterine prolapse in old age is performed only if the woman has stopped menstruating.

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

Causes of physiological displacement

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

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

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

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

Degrees of displacement

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

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

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

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

Reasons for displacement

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

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

Reasons for omission:

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

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

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

Symptoms of the initial stage

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

The following are one of the menstrual disorders:

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

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

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

Pregnancy with uterine prolapse is usually impossible.

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

Symptoms of a developed disease

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

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

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

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

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

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

Physiological prolapse

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

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

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

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

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

Diagnostic measures

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

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

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

  1. Colposcopic examination.
  2. Hysterosalpingoscopic examination.
  3. Ultrasound examination, computed tomography.
  4. Bacterial culture of vaginal flora.
  5. Urine culture for bacterial flora.
  6. Excretory urographic study.

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

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

Therapeutic measures

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

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

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

Conservative therapy

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

Physiotherapy

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

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

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

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

Gynecological massage course

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

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

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

Obstetric pessaries

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

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

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

But this treatment has its disadvantages:

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

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

A woman should visit a specialist twice a month.

Home treatment

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

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

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

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

Surgery

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

Possible surgical methods:

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

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

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

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

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

Forecast

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

Prolapse of the uterus (prolapse, ICD code N81) is the loss of its normal position and protrusion into the vaginal cavity.

Pathology develops when the muscles of the pelvic floor and uterine ligaments are weakened. There are a number of measures that can slow the progression of the disease, but the only way to cure it is surgery.

Prolapse may be accompanied by the formation of cystocele and rectocele. A cystocele occurs when the bladder wall protrudes into the vaginal lumen. In this case, the woman is bothered by complaints of difficulty urinating. Sometimes you can urinate only by changing your body position.

With a rectocele, the anterior wall of the rectum protrudes into the vaginal lumen and forms a pocket in which feces accumulate. A woman experiences constipation, a feeling of incomplete bowel movement during bowel movements, and a feeling of heaviness in the perineum.

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    1.

    2. Causes of occurrence

    Uterine prolapse often develops in the presence of risk factors:

    1. 1 Age. Most often, the pathology is diagnosed in women over 40 years of age. With age, degenerative processes in the ligamentous apparatus accelerate, and the uterus descends.
    2. 2 Heredity. The risk is higher if the mother has pelvic organ prolapse.
    3. 3 Repeated births, complicated course of pregnancy, childbirth and the postpartum period (large fetus, prolonged pushing, dissection of the perineum).
    4. 4 General exhaustion of the body(against the background of chronic diseases, starvation, cachexia).

    The main causes of the disease are:

    1. 1 . Changes in hormonal levels and decreased estrogen production lead to weakening and thinning of the ligaments.
    2. 2 Obesity.
    3. 3 Constant increase in intra-abdominal pressure(hard physical labor, abdominal tumors, pregnancy, chronic cough, constipation).
    4. 4 Perineal injuries(perineal ruptures most often occur during childbirth).

    3. Symptoms of the disease

    Some patients may not have any symptoms.

    LocalizationDescription
    From the vaginaFeeling of pressure, fullness, especially when standing for a long time.

    With complete prolapse, the uterus is visible from the genital slit.

    Weakening the jet

    Repeated urinary infections
    From the intestinesIncontinence of gases, stools.

    Fecal retention.

    Chronic constipation
    Pain and discomfort
    Table 1 - Symptoms of uterine prolapse

    4. Stages of prolapse

    There are 4 stages (POP-Q) and 4 degrees of prolapse depending on the length of the uterine displacement. Incomplete (partial) prolapse includes grades 1-3 (see Table 2). corresponds to the fourth stage (see figure below).

    Table 2 - Degrees of uterine prolapse

    What does prolapse look like?

    5. Complications

    The disease is most dangerous due to its consequences:

    1. 1 Displacement of the uterus sometimes leads to, blockage of its lumen and disruption of the outflow of urine from the kidneys. Stagnation of urine and increased pressure in the lumen of the renal pelvis increase the likelihood, leading to gradual atrophy of the renal parenchyma.
    2. 2 cause kidney damage and threaten the development of sepsis.
    3. 3 Prolapse causes deformation and weakening of the septum between the vagina and bladder, rectum. In this case, the prolapse may be complicated by a cystocele (problems with emptying the bladder) or rectocele (the woman complains of constipation, a feeling of heaviness in the rectum).
    4. 4 In rare cases, on the mucous membrane erosion occurs in the shell.

    6. Examination

    The diagnosis is made after examination by a gynecologist. The doctor examines the patient using vaginal speculum and assesses the presence of signs of prolapse and its degree.

    The position of the organ is assessed at rest and when the patient strains. If signs are present, consultation with a urologist is required.

    7. Treatment and observation

    The degree of prolapse does not always correlate with the severity of symptoms. At the initial stage, the most rational tactic is careful observation of the patient.

    Some women prefer observation even at later stages (in this case it is necessary to monitor the development of new symptoms - urinary disturbances and stool retention, the development of vaginal erosions).

    Conservative therapy includes two main methods of correction:

    1. 1 Active lifestyle: pelvic floor muscle training and Kegel exercises. The complexes are effective in treatment, but their role in eliminating prolapse is disputed.
    2. 2 Use of a vaginal pessary. It is the only non-surgical treatment for uterine prolapse.

    7.1. Placing a pessary

    A vaginal pessary (uterine ring) is a silicone ring that is inserted into the vagina to hold the genitals in a normal position. Its selection is carried out by a gynecologist.

    The introduction of retaining rings can cause irritation of the mucous membrane and the appearance of discharge. A pessary does not cure the disease, but only alleviates the symptoms. Every 3 months a gynecologist examination and ring replacement are required.

    Indications:

    1. 1 The need to reduce the severity of complaints.
    2. 2 Stopping/slowing down the progression of the disease.
    3. 3 Early pregnancy.
    4. 4 The first 6 months of the postpartum period.
    5. 5 Presence of contraindications to surgical treatment or refusal of it.

    Complications:

    1. 1 Ulceration of the vaginal walls, appearance.
    2. 2, discomfort.
    3. 3 (abundant).

    7.2. Is it possible to have sex while wearing a pessary?

    Most often, sex is possible. In some cases, before sex, the pessary is temporarily removed and then replaced by the woman. Some types of rings may make it impossible to have sex, so it is important to discuss this issue with your gynecologist.

    8. Surgical interventions

    The type of surgery proposed depends on the patient’s age, her desire to preserve fertility, general condition, degree of prolapse and type of pathology.

    Depending on the access, operations are open, laparoscopic and transvaginal. Currently, open interventions are losing their relevance due to the higher likelihood of complications and a long recovery period.

    Goals of surgical treatment:

    1. 1 Relieve symptoms.
    2. 2 Restore the normal anatomy of the pelvic organs.
    3. 3 Restore normal sex life.
    4. 4 Prevent relapse.

    As a rule, surgical treatment is not performed in the first 6 months after childbirth, since the likelihood of relapse of the disease is high. This group of patients shows a good effect from conservative treatment (perineal muscle training, physiotherapy).

    Operations should not be performed during pregnancy or the patient’s serious condition.

    Patient groupOptions
    Up to 40 years old
    After 40 years

    Manchester operation.

    8.1. Anterior colporrhaphy

    It is used for cystocele (protrusion of the bladder wall into the vaginal lumen) and is performed from the vaginal lumen. By strengthening the septum between the vagina and the bladder, the latter’s normal position is achieved and urinary tract symptoms are eliminated.

    8.2. Posterior colporrhaphy

    Performed to eliminate rectocele and restore normal perineal anatomy. Local fabrics are used for plastic surgery. Reducing the likelihood of relapse is achieved by suturing mesh prostheses into the back wall.

    8.3. Manchester operation

    This is the name of anterior colporrhaphy with removal of the cervix. It allows you to maintain your menstrual cycle and the ability to get pregnant.

    The operation is suitable for women under 40 years of age who wish to maintain menstruation and fertility. At the same time, cervical amputation increases the risk of miscarriage and premature birth. After the intervention, a scar is formed, which can lead to a narrowing of the cervical canal and complicate natural childbirth.

    8.4. Hysterectomy

    Removal of the uterus is performed in the later stages of prolapse. The intervention is indicated for patients over forty years of age who have children and who do not want to have children again.

    8.5. Loop plastic (sling)

    These operations are indicated for young women and girls suffering from prolapse of 2-3 degrees and wishing to preserve reproductive function. The uterus is “suspended” by a synthetic tape to the sacrum. The method is most effective in the absence of a history of childbirth.

    8.6. Suturing the vaginal walls

    Performed on older women. The walls of the vagina are brought together with several sutures so that a small tunnel remains to drain secretions from the uterine cavity.

    Main indications for the procedure: high risk of complications from other surgical interventions. The operation is not performed on women who are sexually active.

    9. Prevention

    To prevent the occurrence of the disease, the following preventive measures must be taken:

    1. 1 Prenatal physiotherapy, relaxation exercises and strengthening of the perineal muscles.
    2. 2 Normalization of body weight.
    3. 3 Correct management of childbirth.
    4. 4 Suturing perineal tears immediately after childbirth.
    5. 5 Conducting exercise therapy and physiotherapy among pregnant women and postpartum women.
    6. 6 Limiting exercise for the first 6 months after the birth of the child.
    7. 7 Maintaining an interval between births (3 years) to restore muscle tone.
    8. 8 Family planning and limiting the number of pregnancies.
    9. 9 For women during menopause - hormone replacement therapy.
    10. 10 Lifestyle changes: changing jobs, limiting heavy lifting, some physical activity (running, squats, static loads).

    10. Treatment with folk remedies

    No medicinal herbs or decoctions can eliminate prolapse. Independent attempts to treat the disease at home can lead to serious consequences. Incorrectly selected physical therapy will only accelerate the progression of the disease.
    Pain during sex.

    Decreased sensitivity of the genital organs

    Organs of the urinary systemFrequent, painful urination.

    Feeling of incomplete emptying of the bladder.

    Weakening the jet

    To begin urination, a change of position is required, screwing back the bulging wall of the bladder with fingers inserted into the vagina.

    Repeated urinary infections

    From the intestinesIncontinence of gases, stools.

    Fecal retention.

    The need to strain during bowel movements.

    Chronic constipation

    Lower abdomen and sacral areaPain and discomfort
    Patient groupOptions
    Pregnancy/postpartum; no history of childbirthPlacement of a pessary for up to 16 weeks.

    Exercises to strengthen the muscles of the perineum.

    After/before childbirth - surgical treatment in the absence of effect from conservative measures (loopplasty).
    Up to 40 years oldFertility-preserving surgeries: removal of cystocele, rectocele (anterior/posterior colporrhaphy), Manchester operation, uterine suspension (loopplasty)
    After 40 yearsColporrhaphy (anterior/posterior).

    Manchester operation.

    Transvaginal hysterectomy and pelvic floor muscle reconstruction

Uterine prolapse is a change in the position of the uterus in the vaginal canal, which occurs due to depletion of the pelvic muscles. Signs are in the lower abdomen, as well as heavy discharge. The disease is often accompanied by pain when urinating.

Uterine prolapse in older women is often diagnosed accidentally during an examination by a gynecologist. There are no age restrictions for uterine prolapse; absolutely any representative of the fair sex can face this diagnosis. Most often, the diagnosis of uterine prolapse is in women over 55 years of age who have given birth to two or more children naturally and/or are in a postmenopausal state. Old age brings with it not only external, but also internal changes. The muscles slowly begin to deplete and lower the pelvic organs. A complete history will show which method of treatment is required, surgical or conservative, and it will also determine the stage of development of the disease.

Photo - what uterine prolapse looks like

In addition to depletion of the pelvic muscles, there may be other reasons:

  • congenital pelvic pathology;
  • heredity;
  • previous surgical interventions of the genitourinary system;
  • systematic heavy physical activity;
  • the presence of various types of tumors;
  • repetition of labor;
  • perineal injuries;
  • hard physical work;
  • excess weight problem;
  • hormonal changes;
  • birth injuries;
  • mature age and old age;
  • disorders of the pelvic floor muscles;
  • neurological diseases.

At the initial stages, there are practically no symptoms and only if uterine prolapse in older women progresses, they begin to appear and cause discomfort.

IMPORTANT: Without proper therapy, the disease develops, and displacement of the pelvic organs worsens over time.

The symptom of heaviness in the pelvic area is characteristic, as well as:

  • nagging pain in the lower abdomen;
  • discomfort when walking;
  • sensation of a foreign body in the vagina;
  • incomplete emptying of the urinary system;
  • pain during sexual intercourse;
  • lower back pain;
  • frequent urinary tract infections (cystitis, pyelonephritis);
  • discomfort when urinating;
  • excessive discharge;
  • impossibility of sexual activity.

If you ignore the symptoms of the disease, there is a risk of urological disorders: congestion in the urinary organs, frequent urination, residual urine syndrome. If these diseases are not treated and the symptoms are ignored, there is a high risk of severe complications:

  • infection in the lower and upper parts of the genitourinary system;
  • urolithiasis disease;
  • urinary incontinence;
  • cystitis;
  • constipation, encopresis.

As a result of constant injury, the protruding organ is often covered with ulcers. Also, prolapse (location of the uterus) is worsened by pinching of organs and intestinal loops.

Stages of development of uterine prolapse

There are four stages of uterine prolapse in elderly patients:

  1. Stage one. Slight displacement of the uterus.
  2. Stage two. The cervix, descending lower, is located outside the vulvar ring.
  3. Stage three. The cervix has noticeably dropped beyond the vagina.
  4. Stage four. The organ fell out of the genital slit.

Diagnosis of the disease often occurs by chance at an appointment with a gynecologist. To determine the stage of prolapse, the doctor asks the woman to push. In this way, the displacement of the rectum, vaginal walls and bladder is checked. Also prescribed:

  • colposcopy (examination of the walls of the vagina, cervix, vaginal opening with a special device - a colposcope);
  • hysterosalpingoscopy (a method for studying the uterine cavity and the patency of its tubes);
  • conducting ultrasound examination;
  • taking a smear for flora (inoculation tank);
  • urine culture tank;
  • excretory urography;
  • CT scan.

Based on the results of a comprehensive examination, a qualified specialist makes a decision on the treatment method. There is surgical and conservative therapy.

The second is prescribed if the performance of adjacent organs is in order and uterine prolapse has not reached the genital slit. The doctor prescribes gynecological massage and special gymnastics to strengthen the pelvic muscles. In addition, doctors recommend the use of ointments and suppositories with estrogens for insertion into the vagina; it is possible to take estrogens as a replacement conservative therapy, which will improve tissue trophism, restore blood flow and, to some extent, elasticity of the mucous membrane, thereby helping to retain and strengthen the muscular-ligamentous apparatus of internal organs . The concept of “trophism” refers to the nutrition of organs, which depends on the volume of muscles and their ability to generate force.

If surgical intervention is contraindicated, the doctor prescribes the elderly patient to use pessaries (special rubber rings inflated with air and having different sizes) and tampons. Support for the displaced organ is created by using a pessary, but it is important to know that the vaginal ring cannot be left in place for a long time. This can cause bedsores.

When using a pessary, women will have to douche daily (the procedure involves washing the vagina). A decoction of chamomile or a solution of furatsilin are perfect for this. You will also need to visit a gynecologist twice a month.

In advanced cases, surgery cannot be avoided. Sometimes these are operations using laparoscopic access and even special mesh implants that create artificial support for organs. If conservative therapy is insufficiently effective and there is a greater degree of organ confusion, the doctor resorts to surgical intervention. The operation is efficient and effective.

There are several types of operations that modern surgery can offer:

  1. vagipoplasty – strengthening of the pelvic muscles;
  2. strengthening and shortening of uterine fibers (high percentage of relapses, therefore used extremely rarely)
  3. securing the organ by suturing ligaments together;
  4. securing the prolapsed organ to the walls of the pelvic floor;
  5. fixation of the uterus and strengthening of ligaments using a special mesh material;
  6. partial narrowing of the vaginal lumen;
  7. removal of a prolapsed organ.

At the moment, doctors combine several methods of therapy - vaginal plastic surgery with fixation of the uterus and strengthening of the pelvic muscles.

The danger of refusing surgery is that sooner or later the quality of life will decrease so much that it will be difficult for the patient to move even within the city and apartment.

The lower the degree of prolapse, the sooner the patient sees a doctor, the sooner the attending physician pays attention to this problem, the more effective and simpler it is to correct anatomical disorders that have arisen as a result of the disease.

The operation in the early stages of the disease is not difficult and it is often enough to perform vaginal plastic surgery.

What treatment can be done at home? Don't get carried away with traditional methods. Trust the doctors. They will recommend Kegel exercises.

Arnold Kegel exercises were created specifically for women with uterine prolapse and have received positive reviews around the world. The therapeutic effect is possible with systematic completion of tasks. It is necessary to do exercises 3 times a day, gradually increasing to 300 exercises per day. It does not take much time and does not require any special equipment or space. It is an effective way to counteract the disease.

First you need to determine which muscles need to be used. To do this, during urination you need to stop the process and feel which muscles were involved. You can also insert your finger into the vagina and try to squeeze it.

These procedures do not need to be repeated; once will be enough to understand which muscles are needed for the next exercise.

Before you begin, you need to make sure that your bladder is empty.

The essence of gymnastics is to contract those same muscles and relax them. First exercise: muscle contraction and hold in this state for 10 seconds, relax for 10 seconds and repeat. General practice is 5 minutes per day.

Second exercise: muscle contraction and hold in this state for 5 seconds, then relax for 5 seconds and repeat. General practice: 1 minute per day.

Exercise to strengthen intimate muscles

One of the main exercises to restore elasticity to the pelvic floor muscles.

  1. Starting position: lie on your back, bend your legs, heels on the floor. One hand lies under the navel, the other above it.
  2. Exhale – contract the pelvic floor muscles, then the transverse muscles.
  3. Login - relax.
  4. Repeat.

Prevention of uterine prolapse

In order to avoid a disease such as uterine prolapse in old age, disease prevention is required. Some tips:

  • physical education (equestrian and cycling sports, as well as swimming);
  • proper nutrition;
  • limiting heavy physical activity;
  • Meet with a gynecologist for an examination 2 times a year;
  • childbirth in special institutions (perinatal centers and maternity hospitals);
  • following the recommendations of a specialist after labor;
  • lead an active life.

Video: Prolapse and prolapse of the uterus and vagina

Video: Prolapse of the uterus - kegel exercise (a set of exercises for training the pelvic floor muscles)

Prolapse or complete loss of genital organs in adulthood is a common diagnosis. This is the end result of chronic genital misalignment that remains unnoticed for a long time. what to do in old age? Let's talk about this topic in more detail.

Uterine prolapse is the complete or partial displacement of an organ outside the vagina.
Experts distinguish several stages of the disease:

  • Prolapse - the uterus descends below the interspinal line and does not emerge from the genital fissure;
  • Incomplete prolapse - the uterus is located within the genital slit, and the cervix remains in the pelvis;
  • Complete prolapse - the uterus and vaginal walls emerge from the genital slit.

Uterine prolapse in old age - causes

      • Consequences of labor. Numerous, pathological and multiple births lead to weakening of muscle tissue, which makes itself felt only during menopause. Weakened muscles that are unable to hold the uterus in its anatomical position lead to its prolapse.
      • Excess weight. Under the influence of various factors, the female body can gain a lot of weight. Extra pounds put a lot of pressure on the pelvic muscles, thereby causing prolapse of the uterus.
      • Problems with stool. Older women often complain of constipation. Disturbances in bowel function and the strong straining that accompanies them increase intra-abdominal pressure and contribute to the development of the disease.
      • Unhealthy Lifestyle. Long years of hard work, regular overload, poor diet - uterine prolapse is often a consequence of such unhealthy habits.
      • Playing sports that involve lifting weights and tensing your abdominal muscles.
      • Hernias and displacements of organs that are located behind the pelvis.
      • Hormonal disorders.
      • Deformation of the pelvic floor resulting from trauma.
      • Obstetric manipulations - the use of forceps, manual extraction of the child with a breech presentation.
      • Congenital malformations of the pelvis.
      • Severe and prolonged cough.
      • Physique features – infantilism, asceticism.
      • Heredity.

This video talks about genital prolapse:

Important! The immediate cause of uterine prolapse and prolapse is a complex of causes. A single factor cannot lead to the development of the disease.

Signs of uterine prolapse in older women

Partial or complete uterine prolapse in older women can be recognized by the following symptoms:

      • Painful discomfort in the genital area and lower back. The pain is aching in nature, intensifies if a woman sits in one place for a long time, and subsides when changing body position;
      • Sensation of a foreign body in the vagina;
      • Disorders of defecation and urination;
      • False urge to urinate;
      • Difficulty walking;
      • Inflammatory processes in the pelvic organs - discharge from the genital tract, cystitis, pyelonephritis, urolithiasis, etc.
      • Development of varicose veins of the lower extremities. Occurs as a result of disruption of blood supply and venous outflow of blood.

Many women do not respond to the symptoms of the disease, dulling the pain with pills and leaving a visit to the doctor for later. The result of such delay is complete prolapse of the uterus, which can only be eliminated surgically.

Diagnostics

In old age, the disease develops more intensively than in young people. Therefore, it is extremely important to diagnose it in time.
Patients with uterine prolapse undergo an ultrasound examination of the pelvic organs, colposcopy, smears and cultures to determine the vaginal flora, proctological and urological examination by specialists.

Drug treatment

Treatment of uterine prolapse without surgery involves the use of supporting implants (pessaries or rings) made from bio-inert synthetics and biological material. A pessary inserted into the vagina actually supports the cervix and prevents it from descending.

This method is used in the first stages of the disease and is considered the most effective. A woman will have to walk with a support ring for the rest of her life, because self-healing of muscles in old age is almost impossible
When wearing an implant, you need to douche daily with disinfectant solutions and adhere to personal hygiene rules. At night, the ring must be removed and disinfected. Otherwise, inflammatory processes may develop. After receiving advice, the woman will be able to remove the pessary independently.

What else to do if the uterus prolapses in old age? In the first stages, drug therapy is practiced, which can only be prescribed by a doctor. These are mainly medications with a high dosage of female sex hormones (estrogens), as well as hormonal ointments that are injected into the vagina.

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