Omission of the uterus
Omission of the uterus - displacement of the anatomical and physiological position of the cervix and uterus below the anatomic border. This deviation is almost always accompanied by a drawing pains and unpleasant sensations in the vagina and lower abdomen, urinary function and infringement of abnormal vaginal discharge. Omission of the uterus occurs when weakened muscles and fascia of the pelvic floor and uterine ligaments.
Omission of the uterus - a rather frequent pathology encountered in patients of all ages. In 10% of patients it is diagnosed up to 30 years, 40% of patients detected in the age of 30-40 years, 50% of patients the disease manifests itself after 50 years. This pathological condition is almost always progressive course. With the omission of the uterus associated functional disorders become more pronounced, that brings a woman moral and physical suffering and often leads to full or partial disability.
Classification of uterine prolapse
There are several stages of uterine prolapse. At the stage of the omission of neck and body of the uterus cervix is defined in the vagina, but not extending beyond the gender gap. In case of partial loss of uterine cervix showing genital slit by coughing, sneezing, exertion, weight lifting. Incomplete loss body of the uterus (in part) and neck protruding from the genital slit. A full roll of the bottom of the body and cervix of the uterus exits beyond the genital slit.
The reasons for the omission of the uterus
Uterine prolapse may help to damage the pelvic floor muscles, birth injury (forceps, vacuum extraction, or extraction of the fetus fetal buttocks) deferred surgery on the genitals (radical vulvectomy) deep perineal tears, congenital pelvic area, estrogen deficiency, developing menopause, connective tissue dysplasia, nervous disorders of the urogenital diaphragm.
The risk of uterine prolapse increases in middle and old age, chronic cough, constipation, when lifting heavy loads and heavy physical labor, as well as increased intra-abdominal pressure caused by obesity, and abdominal swelling. Most often in the development of this disease plays a role the interaction of many factors that influence the muscular system of the pelvic floor and internal organs weakens.
Symptoms of uterine prolapse
In the absence of proper treatment of prolapse of the uterus gradually progresses, shifting the pelvic organs.
Symptoms of uterine prolapse in the initial stage can be nagging pain and pressure in the sacral region, waist, abdomen, foreign body sensation in the vagina, despareuniya (painful intercourse), the occurrence of bleeding from the vagina or cables. A typical manifestation of this disease are disorders of menstrual function and by type algodismenorei giperpolimenorei.
Later symptoms of uterine prolapse in 50% of cases are joined urological disorders: frequent or difficult urination, urinary stagnation in the organs, as well as infection of the upper and lower parts of the urinary tract, which leads to the development of cystitis, pyelonephritis, and urolithiasis.
By proctologic complications in uterine prolapse include colitis, constipation, incontinence of gases and feces. With the progression of the disease leading sign of omission becomes automatically detect patient education, extending from the genital slit. Omission often leads to poor circulation in the pelvic organs, the emergence of stagnation, cyanosis of the mucous membrane of the uterus and surrounding tissue edema.
Diagnosis and treatment of uterine prolapse
Omission of the uterus is usually detected during a pelvic exam. When rectal and vaginal examination the doctor determines the displacement of the walls of the bladder, vagina and rectum. Required for all patients with this pathology appointed colposcopy.
To confirm the diagnosis your doctor may prescribe hysterosalpingoscopy and diagnostic curettage, ultrasound diagnostics pelvic CT scan, urine culture, smears on the flora and excretory urography.
Patients with this pathology is further examined by a urologist and a proctologist. Doctors assess the state of the sphincter of the bladder and rectum to detect urinary incontinence and gases stress.
When choosing tactics of treatment of uterine prolapse is taken into account the severity of disease, the presence and nature of gynecological diseases, concomitant prolapse, the possibility and the need to preserve and restore fertility and menstrual function. Equally important is the age of the patient, the nature of disorders of the sphincter of the rectum and bladder, colon, and the degree of surgical and anesthetic risk in the presence of comorbidities.
Conservative treatment of uterine prolapse often include pelvic massage, therapeutic exercise, the introduction into the vagina ointments containing estrogens and metabolites. Therapeutic exercises in the deletion of the uterus are aimed at strengthening the abdominal muscles and pelvic floor.
Patients older shows the use of vaginal pessaries (thick rubber rings of different diameters). The air inside the pessary gives it firmness and elasticity. When introduced into the vagina pessary ring rests on the wall of the vagina, and fixes in a special opening the cervix. When using pessaries every day should be a vaginal douching solution furatsilina, chamomile broth or a solution of potassium permanganate. Pessaries in the vagina is recommended to leave three or four weeks in a row and then take a break in treatment for two weeks.
With the ineffectiveness of conservative therapy surgical treatment is appointed. All operations at the omission of the uterus can be structured according to the main feature - anatomical structures involved to correct and strengthen the position of the individual organs. Plastic surgery for prolapse of the uterus aimed at strengthening the fascia and muscles of the pelvic floor. Operations for shortening and strengthening of the round ligaments that support the uterus, provide the greatest number of relapses.
At the present stage, preference is given to combined surgical treatment, comprising both plastic sheath, and fixation of the uterus, and strengthen the pelvic floor muscle apparatus.
After the surgery is usually prescribed a course of conservative measures - physiotherapy, exclusion strenuous exercise, diet to eliminate constipation. Exercises in the deletion of the uterus can be performed and to prevent the disease.