Omission of the uterus: symptoms, causes and treatment, photo

Omission of the uterus is a condition in which the pelvic organs are displaced beyond the pelvic cavity in the vagina or even lower.

According to statistical data, approximately 15-28% of women suffer from this pathology.

In addition, up to 15% in the structure of large gynecological surgeries is done about this.

Classification of

Classification of ovulation of the uterus is based on determining the position of this organ relative to the vulvar ring, since this structure is relatively easy to determine.

1. At the first degree of ovulation of the uterus, the most distant point of this organ is located 1c above the vulva.
   
2. At the second degree - this point is already at the level of the vulvar ring.
   
3. At the third degree, it drops below it by 1 cm. At the fourth degree, there is a complete prolapse of the uterus.

It should be noted that to determine the omission of the uterus, it is necessary to ask the woman to strain. If at this time there is no protrusion of the walls of the vagina, then a satisfactory condition of the muscles of the pelvic floor is established.

Causes of ovulation and prolapse of the uterus

Omission of the uterus as a kind of prolapse of pelvic organs, usually always begins with a reproductive age, while steadily progressing.

The underlying cause of this pathological process is increased intra-abdominal pressure, which can increase in the results of either external or internal causes. It is always combined with the incompetence of the muscles of the pelvic floor.

Four main groups of causative factors leading to genital descent have been identified:

• inadequate synthesis of sex hormones.
  
• connective tissue dysplasia, which leads to its inferiority.
  
• injuries of the pelvic floor muscles, which are observed with prolonged labor, surgical obstetrics, delivery of a large fetus.
  
• chronic extragenital diseases, which are accompanied by a violation of microcirculation, increased pressure inside the abdominal cavity( chronic bronchitis, bronchial asthma, constipation as a consequence of diseases of the gastrointestinal tract).

What happens when the uterus descends? The basis of this pathological process is the formation of a pelvic hernia. As the hernia gates, there is a sexual gap that does not close properly.

As a result of the inconsistency of the pelvic floor muscles and the disturbed normal topographic anatomy of the pelvic organs, they protrude outward, since there is no normal support for them( the longitudinal axis changes).It turns out that the force with which the organs press on the pelvic floor, is directed downward, namely into the lumen of the vagina. Vaginal walls become the basis of the hernial sac.

The displacement of the uterus from behind is a predisposing factor for the omission of the uterus, since its bottom presses the longitudinal axis of the vagina. Thus, the uterus protrudes into its lumen. The muscle that raises the anus( levator) does not counteract this pressure, and therefore the uterus descends.

Morphologically one can find out that with the lowered uterus there are always discontinuities of the pelvic fascia. That is, it does not fulfill the support function assigned to it. From the anatomical point of view, it is principally possible to distinguish three main groups of defects of the pelvic fascia:

• anterior, which leads to prolapse of the bladder simultaneously with the uterus in the luminal cavity;
  
• average - there is a prolapse of the uterus and vagina;
  
• posterior - the intestine, including the rectum, falls out.

Thus, the basis of omission is always the inconsistency of the pelvic floor as a supporting apparatus, while in the body there are no violations. In addition to this classification, practicing gynecologists can also use the classification of Malinovsky, according to which three main degrees of uterine ovulation are identified.

1. At the first - the cervix reaches the entrance to the vagina, but does not fall below this level.
   
2. At the second degree - the neck is lowered below the entrance to the vagina, but the body of the uterus is above this level.
   
3. With the third degree - falls both the cervix and her body.

Symptoms of omission of the uterus

A long time of ovulation can not show itself. However, sometimes there are symptoms of the following nature that support this diagnosis:

• in the perineal region, a woman may feel a foreign body or a feeling of heaviness;
  
• slight soreness in the lower abdomen;
  
• pain arising during intercourse;
  
• difficulty in intercourse;
  
• when the posterior wall of the vagina is lowered, the woman does not always hold the gases, there are constipation;
  
• omission of the front wall is fraught with urinary incontinence.

Diagnosis

Diagnosis of uterine dysfunction in the first stage involves conducting a routine gynecological examination. After it, it is recommended to strain to determine the maximum degree of abnormal arrangement of the organ.

Carrying out a rectal examination allows you to assess the condition of the pelvic floor muscles, to identify possible bowel descent. The doctor determines the loops of the small intestine by the presence of peristalsis in them.

In addition to these studies, additional tests may be required, which include:

• ultrasound;
  
• urodynamic study;
  
• electromyography, which directly assesses the condition of the pelvic muscles;
  
• and magnetic resonance imaging.

Treatment of ovulation of the uterus

The main place in the treatment of uterine prolapse is given to operative correction. However, conservative methods can be used in the initial stages or as an addition to the operation. These include:

• normalization of lifestyle;
  
• reception of hormone replacement therapy if a woman is in menopause and the level of sex hormones is significantly reduced;
  
• use of pessaries for the vagina, which is a temporary measure;
  
• exercises for training the pelvic floor muscles.

Operative treatment in the presence of omission of the uterus is carried out in the following cases:

• the patient's desire to have her appropriate complaints;
  
• presence of violations from other organs of the small pelvis;
  
• significant anatomical deficiencies.

Operative treatment has specific goals. These include:

• restoring the normal integrity of the pelvic fascia and closing its defects;
  
• the formation of a hole from the levator, which has normal dimensions;
  
• giving the uterus a normal position relative to other pelvic organs, while maintaining normal mobility of organs;
  
• the formation of the vagina, which has a normal length and elasticity, a normal ratio between him and the leftists;
  
• reinforcement with ligaments, if necessary.

From operative accesses can be applied either vaginal or transabdominal. In most cases, there is a need to use synthetic prostheses. This occurs when there is a lack of connective tissue formations of the pelvic organs and ligamentous apparatus. As a rule, the clinical manifestation of this condition is the presence of recurrences of uterine prolapse or severe forms.

The main types of surgery performed for the omission of the uterus are:

1. 1) Anterior colprafia, at which the plastic reconstruction of the anterior wall of the vagina;
   
2. 2) Colpoperineolevatoroplasty, or restoration of the normal anatomical ratio of the posterior wall of the vagina;
   
3. 3) Hysterectomy, or removal of the uterus.this operation is performed at the menopausal wife, or at an earlier age, if there are strict indications for this( uterine myoma, precancerous endometrium conditions, etc.);
   
4. 4) Colposia - an operation in which the fixation of the vaginal canopy occurs, if the uterus has been removed before;
   
5. 5) Sacrogisteropexy, in which the uterus is fixed to the walls of the pelvis. This operation is usually performed when it is necessary to preserve the childbearing function.

Exercises for the omission of the uterus

There is a whole set of exercises that are aimed at training the muscles of the pelvic floor. They allow them to be strengthened.

The simplest of them is the squeezing and unclenching of the anus. For one approach, it is recommended that 10-15 such cycles be performed. During the day, the charge is repeated several times. Another type of exercise to strengthen the pelvic muscles - is the squeezing of books or pins knees. In this case, there is a tension in the anal sphincter and other muscles involved in the formation of the pelvic diaphragm.

Prevention

Preventive measures for the prevention of uterine prolapse are as follows:

• restriction of lifting weights;
  
• elimination of constipation by stool normalization;
  
• prevention of ruptures in childbirth;
  
• the normal duration of the generic act;
  
• prophylaxis of large fetuses;
  
• performance of special gymnastics, which is aimed at training the muscles of the pelvic floor.

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