What is left out and why
The pelvic organs are held in place by the pelvic floor muscles, ligaments and fascia. If this support system weakens, the organs are pushed downward by intra-abdominal pressure.
- Cystocele - prolapse of the anterior vaginal wall along with the bladder
- Rectocele - prolapse of the posterior wall of the vagina with the rectum
- Prolapse and prolapse of the uterus
- Elongation of the cervix - its lengthening
- Vaginal dome prolapse after hysterectomy
- Enterocele - prolapse of intestinal loops
- Often there is a combination of several options
The degrees are determined by how much the organ moves relative to the entrance to the vagina: from a slight prolapse within the vagina to complete prolapse outside of it.
Risk factors
- Natural birth, especially multiple births, with a large fetus, with ruptures and forceps
- Age and estrogen deficiency in menopause
- Heavy physical labor and heavy lifting
- Chronic constipation and constant straining
- Chronic cough, including smoker's cough
- Obesity
- Congenital weakness of connective tissue
- Hereditary predisposition
- Previous operations on the pelvic organs, including removal of the uterus
- Professional weightlifting
Symptoms
- Sensation of a foreign body, pressure, or “prolapse” in the vagina
- Heaviness and nagging pain in the lower abdomen and lower back, intensifying in the evening
- Palpable or visible formation in the genital area
- Urinary incontinence when coughing, sneezing, exertion
- Difficulty urinating, the need to reduce the protrusion to empty the bladder
- Feeling of incomplete emptying of the bladder
- Recurrent cystitis
- Constipation, need to help with defecation
- Discomfort or pain during intercourse
- Bloody discharge due to injury to prolapsed tissue
- Increased symptoms after exercise and towards the end of the day
Diagnostics
- Examination by a gynecologist at rest and with straining, in a lying and standing position
- Determination of the degree of prolapse according to the accepted classification
- Assessment of pelvic floor muscle tone
- Ultrasound of the pelvic organs
- Ultrasound of the bladder with determination of residual urine
- Urodynamic study for incontinence or difficulty urinating
- Cough test
- General analysis and urine culture
- Ultrasound of the kidneys in case of severe prolapse - to exclude a violation of the outflow of urine
- PAP test and assessment of mucosal condition
- Consultation with a urologist and proctologist for relevant complaints
Conservative treatment
At initial stages and with contraindications to surgery, the possibilities of conservative treatment are quite large, and they are often underestimated.
- Pelvic floor muscle training - Kegel exercises; with the correct technique and regularity, they give noticeable results in the early stages
- Classes with a pelvic floor specialist, biofeedback
- A pessary is a silicone device that supports organs; a good alternative to surgery, especially in older women and with contraindications
- Local estrogens - improve the condition of tissues during menopause and increase the effectiveness of other methods
- Weight loss
- Treatment of constipation and chronic cough
- Limiting heavy lifting
- Quitting smoking
- Bandages and support garments
Surgical treatment
- Anterior vaginal plastic surgery with bladder reposition - for cystocele
- Posterior vaginal plastic surgery - for rectocele
- Antero-posterior plastic surgery - with combined prolapse
- Laparoscopic ventrofixation of the uterus - suspension of the uterus during its prolapse while preserving the organ
- Removal of cervical elongation
- Vaginal hysterectomy with vaginal plastic surgery - for severe prolapse
- Sling operations for concomitant urinary incontinence
- Use of mesh implants - according to strict indications and after discussion with the patient
- Obliterating operations - in elderly women who are not sexually active
Prevention
- Pelvic floor muscle training, starting after childbirth
- Proper management of childbirth and timely repair of ruptures
- Limiting heavy lifting, especially during the postpartum period
- Maintaining normal body weight
- Prevention and treatment of constipation
- Treatment of chronic cough, smoking cessation
- Local estrogens in menopause as prescribed by a doctor
- Correct technique when exercising: do not hold your breath or strain
- See a doctor at the first signs, and not at complete loss
Where is treatment in Tashkent
An examination by a gynecologist to assess the degree of prolapse, a urological examination for urinary disorders, and a surgical service proficient in vaginal and laparoscopic plastic surgery are required.
In Tashkent, examination and surgical treatment of pelvic organ prolapse is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Don’t delay your visit because of embarrassment: in the early stages, exercises and a pessary help, but in case of complete loss, the only option is surgery. This is the case when early treatment really changes the scope of treatment. Clinic contacts are below.
