Prolapse of internal genital organs ( genital prolapse ) - Causes, Symptoms and Treatment .MF .
prolapse of internal genital organs belong to the disease with which a doctor is common, but not always correctly and promptly decide on the treatment and rehabilitation of such patients.15% of gynecological operations produced just over this pathology.
prevalence of genital prolapse is striking: in India the disease is, one might say, the nature of the epidemic, and America, about 15 million women suffer from this disease.
There is general agreement that genital prolapse - a disease of older people.This is not the case, if we assume that 100 women under the age of 30 years, this pathology occurs in every tenth.At the age of 30 to 45 years, it occurs in 40 cases out of 100, and after 50 years diagnosed every second woman.
The disease often begins in the reproductive age and is always progressive in nature.Moreover, with the development and deepening of the process functional disorders that often cause not only physical pain, but also make these patients partially or completely disabled.
For ease of understanding, prolapse of internal genital organs should be regarded as a "hernia", which is formed when the closing device - pelvic floor - lost its ability to contract so that individual organs or parts thereof do not fall within the projection of the support apparatus.
accepted that in the normal position of the uterus is located on the wire axis of the pelvis.This body of the uterus is tilted forward, the bottom of it does not protrude above the plane of the entrance to the pelvis, the cervix is at the interspinous line.The angle between the body of the uterus and cervix greater direct and open front.The second angle between the neck and the vagina is also facing anteriorly and is 70-100 °.Normally, the uterus and its appendages maintain certain physiological mobility, which contributes to creating conditions for their normal operation, as well as the conservation of architectonics of the pelvic organs.
to the causes of the disease, clinical manifestations and treatment options for genital prolapse you are familiar, flipped through the pages of our site.In the "Make" is widely and clearly presented techniques of plastic surgery, carried out with the descent and prolapse of internal genital organs.
Causes of genital prolapse
prolapse gentaly - polyetiology disease and its development are important physical, genetic and psychological factors.
of the reasons affecting the state of the pelvic floor and ligaments uterine device can particularly identify the following: age, heredity, childbirth, birth injuries, heavy physical work and increasing intraperitoneal pressure, scars after previous inflammatory diseases and surgical interventions, changes in productionsex steroids affecting the response of smooth muscle, striated muscle failure to ensure the usefulness of the pelvic floor, etc.Always present factor in the development of this pathology is to increase intra-abdominal pressure and the failure of the pelvic floor muscles, which occurs can be identified 4 main reasons, although it is possible, and a combination thereof.
- Post-traumatic damage to the pelvic floor (most commonly occurs during childbirth).
- failure of connective tissue structures in the form of a "systemic" failure (which manifests itself by the presence of hernias at other sites, the omission of other internal organs).
- Violation of the synthesis of steroid hormones.
- Chronic diseases accompanied by metabolic disturbances, microcirculation.
Under the influence of one or more of these factors comes the functional failure of ligament apparatus of internal genitals and pelvic floor muscles.With increasing pressure intraperitoneal organs begin to be squeezed out of the pelvic floor.If any body is entirely within the extremely enlarged pelvic floor, he, deprived of any support, is forced through the pelvic floor.If the part of the body lying inside, and some - is hernial ring, the first part of it is squeezed, the other pressed to the supporting base.Thus, part of which lies further outside the hernial ring, keeps the displacement of the other - and the more, the more intra-abdominal pressure.
The close anatomical connection between the bladder and the vagina wall contribute to the fact that in the context of pathological changes of the pelvic diaphragm, including, of course, and genitourinary, omission occurs anterior vaginal wall, which entails the bladder wall.The latter becomes the contents of the hernia sac, forming a cystocele.
Cystocele increases under the influence of its own internal pressure of the bubble, thereby forming a vicious cycle.Similarly, the forms and rectocele.However, if the omission of the front wall of the vagina is almost always accompanied by cystocele, expressed in varying degrees, the rectocele may be absent even on a roll of the vaginal walls, which is caused by a loose connective tissue bond between the wall of the vagina and the rectum.
Hernial sac, in certain cases, with broad rectouterine or vesico-uterine space may include a loop and intestines.
Classification of the vagina and uterus displacement
- vagina offset downward:
- omission of the anterior vaginal wall, the back or both together;in all cases, the walls do not extend beyond the entrance to the vagina;
- partial loss of anterior vaginal wall and part of the bladder, and the rear part of the front wall of the rectum, or a combination of both deposition;wall face outwards from the vaginal entrance;
- complete prolapse of the vagina, often accompanied by loss and uterus.
- uterine displacement downwards:
- uterine prolapse or cervix - the cervix is lowered to the entrance level of the vagina;
- partial (starting) prolapsed uterus or cervix;cervix straining extends beyond gender gap, with similar starting uterine prolapse is most often seen on exertion and increase intra-abdominal pressure (potuzhivanie, coughing, sneezing, lifting weights, etc.);
- incomplete uterine prolapse: is gender gap is determined not only the cervix, uterus and part of the body;
- complete uterine prolapse: is gender gap (between the walls dropped out of the vagina) is determined by the entire uterus, thus it is possible to reduce the index and middle fingers of both hands on the bottom of the uterus.
Symptoms of genital prolapse
Current descent and prolapse of the vagina and the internal reproductive organs is characterized by a slow progression of the process, although there may be a relatively quick for him.Recently, there has been some "rejuvenation" of patients.
In almost all cases there are functional disorders of almost all of the pelvic organs, which necessarily requires the detection and treatment.
with lowered sexual organs often develops a symptom, which, along with violations of the sexual organ functions to the fore urology, proctology complications that cause patients and in some cases, seek the help of physicians related specialties (urologists, proctologist).But the main symptom of prolapse or cervix, vaginal wall and adjacent organs is detected most painful education, protrudes from the genital slit.
surface of the prolapsed genitals becomes matt-shiny, dry skin with cracks, abrasions, and then in a number of patients have deep ulceration (bedsores).This is due to a permanent injury, which is exposed when walking prolapsed vaginal wall.
the presence of trophic ulcers may adjacent tissue infection with its consequences.By moving the uterus is broken down normal blood circulation in small pelvis, there are congestion, and then develop pain, feeling of pressure in the abdomen, discomfort, pain in the lower back, sacrum, worse during and after walking.Stagnation characterized by a change in color of the mucous membrane until cyanosis, edema of the underlying tissues.
characteristic is the change of menstrual function (algomenorrhea, giperpolimenoreya), and hormonal disorders.Often these patients suffer from infertility, although pregnancy is considered to be feasible.
At loss of the genitals sexual life is possible only after reduction fallen body.
extreme diversity is related urological disorders, which cover almost all types of urinary disorders.When expressed degrees of prolapse of genitals to produce the most characteristic cystocele is difficulty urinating, the presence of residual urine, urinary stagnation in the system and, as a consequence - lower infection first, and with the progression of the process - the top of its departments.Continuously there is a complete loss of internal genital organs can be the cause of ureteral obstruction, hydronephrosis, hydroureter.A special place is the development of stress urinary incontinence.More often develop secondarily, pyelonephritis, cystitis, urolithiasis and others. Urologic complications occur almost every second patient.
Quite often, the disease manifests itself proctological complications that occur in every third patient.The most common of them - the constipation and in some cases they are the cause of the disease, in other - a consequence and manifestation of the disease.The characteristic symptoms are disorders of the colon functions mainly on the type of colitis.Painful manifestation of the disease is urinary and fecal gases that occur or as a result of traumatic tissue damage perineum, rectal wall and its sphincter, or as a result of deep functional disorders of the pelvic floor.
In this group of patients is common varicose veins, especially of the lower extremities, which can be explained, on the one hand, the violation of the venous outflow from changes in the architectonics of a small basin, on the other - nestatochnostyu connective tissue formations which manifests itself as a "systemic" failure.
More often than other gynecological diseases observed pathology of respiratory, endocrine disorders that can be treated as a predisposing background.
Diagnostics descent and prolapse of internal genital organs
is mandatory colposcopy study.
cysto- determines the presence or rectocele.Make a preliminary assessment of the functional state of the sphincter of the bladder and the rectum (ie, whether there is urinary incontinence, at a voltage of gases, such as cough).
Research should include:
- urine culture;
- excretory urography;
patients with prolapse of internal genital organs shall be carried out rectal examination, while drawing attention to the presence or severity of rectocele, the state of the sphincter of the rectum.
In those cases, when it is intended to carry out organ-plastic surgery, as well as the presence of concomitant diseases of the uterus in the complex studies need to include special methods:
- hysteroscopy with diagnostic curettage,
- hormonal studies,
- smearto determine the flora and purity, as well as atypical cells,
- analysis of crop discharge from the vagina, etc.
prevention of genital prolapse
- rational mode of work and education, from childhood, especially puberty.
- Rational tactics of pregnancy and childbirth.It is known that not only the number of births, but their character has a decisive influence on the occurrence of prolapse of internal genital organs and stress urinary incontinence.At birth there are various intrapelvic damage to the lumbosacral plexus, causing paralysis of the obturator, femoral and sciatic nerves and, as a consequence, incontinence.It should seek to apply such methods of delivery, in which the muscles of the pelvic floor and its innervation would be protected from damage during delivery.We can not allow prolonged labor, especially II period.Anatomical and physiological justified timely production medio-lateral episiotomy, predominantly right-handed, that retains the integrity of the pudendal nerve and, therefore, are less disturbed innervation of the pelvic floor muscles.The second important point is to restore the integrity of the perineum with the correct juxtaposition of fabrics.
- Prevention of inflammatory complications and rehabilitation measures aimed at a more complete restoration of the functional state of the pelvic floor and pelvic organs in the postpartum period - special physical exercises, laser therapy, electrical stimulation of the pelvic floor muscles with the use of anal electrode.
Treatment descent and prolapse of internal genital organs
particular difficulty is the choice of treatment strategy, the definition of a rational way of operational benefits.It is determined by a number of factors:
- degree of prolapse of internal genital organs;
- anatomical and functional changes in organs of the reproductive system (the presence and character of concomitant gynecological pathology);
- opportunity and the need to preserve or restore fertility, menstrual function;
- features of dysfunction of the sphincter of the colon and rectum;
- age of patients;
- concomitant extragenital pathology and risk of surgery and anesthetic.
Conservative treatment descent and prolapse of internal genital organs
with lowered internal genitals, when the latter do not reach the vestibule and in the absence of abnormalities in the adjacent organs may conservative management of patients, including:
- Kegel exercises,
- exercise therapy forYunusov (voluntary contraction of the pelvic floor muscles during voiding of urine before the termination of the current),
- lubrication of the vaginal mucosa ointment containing estrogen metabolites,
- use of pessaries, medical bandage.
Surgery descent and prolapse of internal genital organs
In more severe degrees of descent and prolapse of internal genital organs method of treatment is surgical.It should be noted that under any other disease is not offered as many methods of surgical benefits as a given.They estimated a few hundred, and each has, along with certain advantages, disadvantages, mainly expressed in the recurrent disease.Recent usually occur within the first 3 years after the intervention, reaching 30-35%.
All treatments can be combined in groups of one main feature - which anatomical structures used and strengthened to remedy the situation of internal genital organs.
most common surgical options.
- I gruppa.Operatsii to strengthen tazogo dna- kolpoperineolevatoroplastika.Given that the muscles of the pelvic floor pathogenetically always involved in the process, the kolpoperineolevatoroplastiku should be carried out in all cases, surgical intervention, or as an additional main benefits.This may also include plastic surgery on the anterior vaginal wall to strengthen the vesicovaginal fascia.
- II group.Operation using various modifications of shortening and strengthening of the round ligament of the uterus and uterine fixation of using these structures.The most frequently used and typical shortening is round with uterine ligaments fixing them to the front surface of the uterus.