Uterine prolapse

The process during which the uterus changes its position downwards is called "uterine prolapse". In the future, this condition may lead to complications: prolapse (complete or partial) of the uterus into the vaginal cavity. Is uterine prolapse dangerous? We will discuss the causes, symptoms, consequences and treatment measures in this article.

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Causes of uterine prolapse

Prolapse can be found in women of all age groups, but this condition is most often diagnosed in women aged 30 to 50. The disease is quite common: of all gynecological surgeries, about 15% are diagnosed with prolapse (or loss) of the uterus.

What can cause a change in the position of the uterus? As a rule, this is weakness of the muscles and ligaments of the pelvic area. As a result of this weakness, the rectum can also shift and the position of the bladder can change, which will lead to a disorder in their work.

The beginning of organ prolapse can occur at a young age, progressing over time. In this case, uterine dysfunctions come to the fore, which provokes both physical and psychological suffering, and can also act as a factor in further disability.

In a normal state, the uterus is at equal distances from the right and left borders of the small pelvis, located behind the bladder and in front of the rectum. The correct position of the uterus is with a partial tilt forward and the formation of an obtuse angle with the cervix. Any violations of this position can become a fundamental factor in the development of uterine prolapse.

The next cause of pathology can be considered a violation of the anatomical structure of the pelvic organs, which can occur as a result of trauma to the muscle fibers of the pelvic floor. Prolapse of the uterus after childbirth is one of the consequences of such trauma. Damage can occur both during childbirth and during surgical interventions in the reproductive sphere, with perineal ruptures, and tissue innervation disorders.

Uterine prolapse during pregnancy usually does not occur. However, the presence of pathology during the period of conception of a child can serve as an obstacle to normal gestation and timely birth of the baby. Labor with prolapse occurs with certain difficulties, therefore, when planning conception, it is recommended to conduct appropriate therapy for this pathology.

Uterine prolapse after a cesarean section occurs no more often than during natural childbirth. The reason for this is the same injury to the ligamentous-muscular apparatus, which provokes the displacement of all reproductive organs in the woman in labor, which were held by these muscles until the injury. The same injury is a factor that provokes the prolapse of the uterus from the genital slit.

Uterine prolapse in old age may be associated with hormonal imbalance (for example, during menopause), with dysplasia of connective tissue fibers, with prolonged heavy physical exertion and lifting heavy loads. The provoking factor may be excess weight, frequent and prolonged constipation, chronic cough.

Abortion is also considered a provoking factor for the occurrence of prolapse. Therefore, for the purpose of healthy prevention, it is recommended to use contraceptives in advance if the pregnancy is not desired. In order not to aggravate the situation, for the same reason, it is not recommended to perform an abortion in case of prolapse of the uterus. Such actions will definitely lead to complications of the existing pathology.

Symptoms of uterine prolapse

Symptoms of uterine prolapse may not attract a woman's attention at first. Often, women tend to tolerate discomfort without consulting a doctor. And only when pain occurs with uterine prolapse, the patient decides to consult a specialist. However, it is important to remember that a timely visit to the doctor significantly improves the prognosis of the disease and makes treatment more effective. Pay attention to the following symptoms:

• pain, initially barely noticeable, pulling. It is felt in the lower abdomen. The pain is constant and monotonous, which significantly affects the general condition and mood of the patient. Sometimes the pain manifests itself in the perineum, in the lumbar and sacral region: in these cases, it is especially pronounced and intense. It becomes uncomfortable to walk, and in general to be in an upright position;
• a feeling of a foreign body being in the vaginal cavity arises, which causes additional discomfort. This sensation is most pronounced when the body is in a vertical position;
• loss of control over the process of urination. This can happen when the back or front wall of the uterus descends;
• Disturbances in the act of defecation. The change in the position of the uterus puts pressure on the intestines, which can contribute to the appearance of constipation;
• discharge during uterine prolapse is often profuse, and the appearance of leucorrhoea, either light in color or with streaks of blood, is possible;
• When the uterus prolapses, periods may become more painful, longer and heavier, and there may be difficulties with conception;
• a feeling of discomfort during sexual intercourse, loss of pleasure from sex. Pain may be felt, or any sensations may disappear altogether.

Prolapse of the uterine walls in the future makes it impossible for a woman to have a full sexual life.

The gradual development of the pathology can be detected by the woman herself. But often this happens only when the prolapsed uterus is already protruding from the vagina. The visible element of the uterus can be matte, pale pink, with multiple small hemorrhages and even ulcers. Such a surface can easily become infected.

Physiological prolapse of the uterine fundus can be observed in the late stages of pregnancy, which is one of the signs of the imminent onset of labor. This is due to the baby's preparation for birth: it presses closer to the exit from the small pelvis, taking the most comfortable position for passing through the birth canal. Symptoms of physiological prolapse of the uterine fundus are:

• reduced pressure on the diaphragm (shortness of breath disappears, breathing becomes easier);
• relief of digestive discomfort;
• the appearance of pain in the lower pelvis;
• increased urge to urinate;
• worsening constipation;
• changes in abdominal contours;
• difficulty walking;
• sleep disorders.

If prolapse of the uterine fundus is observed immediately before the onset of labor, or approximately 3 weeks before delivery, such a situation can be considered within the normal range and not be a threat to termination of pregnancy.

Prolapse before the 36th week is dangerous: there may be a risk of early termination of the pregnancy. In such cases, the woman is usually hospitalized for measures to preserve the pregnancy.

Degrees of uterine prolapse

The course of the uterine prolapse process can be divided into three stages:

• the displacement occurs downwards, but the cervix is localized in the inner part of the vaginal cavity. This degree is often detected only during a gynecological examination;
• the uterus descends into the vaginal cavity, while the cervix can already be seen at the entrance to the vagina (in such cases, we can already talk about an incomplete moment of prolapse);
• the uterus, together with the vaginal walls turned outward, is found below the level of the external reproductive organs (severe prolapse of the uterus, or complete prolapse).

As the process progresses, protrusions of the anterior and posterior vaginal vault may form, in which intestinal loops, the rectum, and the urinary bladder are found. In this state, they can be palpated through the vaginal wall.

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Diagnosis of uterine prolapse

How to determine uterine prolapse? Actually, diagnostic measures for uterine prolapse and prolapse, as a rule, do not present difficulties and are carried out during examination by a specialist on a gynecological chair. In order to determine the degree of the process, the doctor may ask the woman to strain, after which, using the method of vaginal or rectal examination, he checks the change in the location of the vaginal walls, as well as the urinary organs and rectum.

Patients with disorders of the localization of reproductive organs are usually subject to medical examination. A mandatory condition for this is the performance of a colposcopy.

If the level of uterine prolapse suggests organ-preserving plastic surgery, then the range of diagnostic measures becomes more extensive. The following are used:

• method of hysterosalpingoscopy and diagnostic curettage of the uterine cavity;
• Ultrasound of the pelvic organs;
• bacterioscopic examination of the vagina, identification of atypical structures;
• bacterial examination of urine for infectious lesions of the urinary organs;
• excretory urography method that excludes obstructive changes in the urinary ducts;
• computer tomography of the pelvic organs.

Women diagnosed with uterine prolapse are consulted in the proctology and urology departments, where the condition of the intestines and urinary system is assessed.

Signs of prolapse and prolapse of the uterine organ must be differentiated from vaginal cysts, newborn myomatous formations and inversion of the uterus.

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Prevention of uterine prolapse

In order to prevent the occurrence of uterine prolapse, it is necessary to take care of this from childhood. Girls and women should not be allowed to have heavy physical labor, as well as lifting weights over 10 kg.

During pregnancy and labor, the risk of changes in the position of the uterus increases. However, it is important to know that in the formation of prolapse pathology, the determining role is played not so much by the number and frequency of births, but by qualified medical management of the pregnant woman, as well as the labor and postpartum period. Competent actions of the obstetrician, measures to protect the perineum, prevention of prolonged labor, correct manipulations during childbirth are the main factors in the prevention of prolapse.

After childbirth, especially difficult and complicated ones, it is recommended to follow all the doctor’s advice on the restoration and preservation of perineal tissues.

In the postpartum period, simple physical exercises and gymnastics are recommended to strengthen the muscular corset of the uterus. Heavy physical exertion should be avoided.

An important element of prevention is a balanced diet, preventing constipation. To do this, you should eat enough fiber (fruits and vegetables), and also follow a drinking regime - at least 1.5 liters of clean water per day.

Prognosis of uterine prolapse

The prognosis for uterine prolapse can be favorable. To do this, it is necessary to undergo full qualified treatment, follow all the doctor's recommendations and prescriptions, and in the future not to overload the pelvic organs with excessive physical activity.

Remember that you are a woman and you need to take special care of yourself. After all, you are the protection for your children and family, so you must maintain your health. This is especially true for the health of the reproductive system.

Uterine prolapse is an unpleasant and serious disease, but if you take better care of yourself, this problem will definitely pass you by.

Sports for prolapsed uterus

Many women wonder whether it is possible to play sports with prolapse of the uterus? Of course, physical activity helps to strengthen the muscular system, including the pelvic area. It is recommended to do gymnastic exercises, fitness or yoga. However, during exercise, you should avoid carrying heavy objects, excessive loads, jumping and falling.

Running is not contraindicated when the uterus is prolapsed, but jogging should not be intense and unhurried, without excessive activity and taking hurdles.

Strength training is prohibited if the uterus is prolapsed.

Sex with prolapsed uterus

A disease associated with uterine prolapse can create many problems in a woman's intimate life. Sexual intercourse with prolapse becomes unpleasant and painful over time, and a feeling of discomfort in the vagina haunts the patient everywhere. What can be advised? Of course, treat the pathology. Sexual intercourse with uterine prolapse should be suspended for the entire period of treatment.

• The pathology of prolapse only worsens and accelerates with active sexual intercourse.
• Pain during sexual intercourse should alert a woman and urge her to seek help from a specialist: the initial stage of the disease is much easier to treat.
• The advanced process of uterine prolapse entails the appearance of unbearable pain and discomfort during sexual intercourse, which reduces the frequency of sex to almost zero.
• At some stages of the process, sexual contact can cause eversion of the vagina with subsequent prolapse of the uterus.
• Even after the end of treatment, sex should be gentle and not rough.

There is an opinion that having sex is a good preventative measure against prolapse. Most likely, this is true. However, when the problem already exists, it is better to temporarily exclude sexual intercourse.