Prolapse does not pose a threat to life, however, it can significantly reduce its quality, so this disease should not be considered a manifestation of the natural aging process. This disease can and should be treated. Proper treatment will allow you to return to a fulfilling life and feel healthy again.
Genital prolapse – This is a disease in which the prolapse or prolapse of the pelvic organs through the vagina occurs. If the ligaments and muscles of the small pelvis are weakened or damaged, then under the influence of gravity and with an increase in intra-abdominal pressure, a descent first occurs, and then a complete prolapse of one or another organ through the vagina.
A condition in which the bladder prolapses through the anterior wall of the vagina is called a cystocele. This is the most common type of prolapse. Prolapse of the uterus is also quite common. If the uterus has been removed, then the dome of the vaginal stump may droop. The descent of the rectum through the posterior wall of the vagina is called rectocele, the prolapse of loops of the small intestine through the posterior fornix of the vagina enterocele. This type of prolapse is relatively rare. Prolapse of the genitals can be either isolated or combined, when several organs prolapse, for example, cystorectocele – prolapse of the bladder and rectum. The severity of prolapse can also be different – from the minimum degree of omission to complete loss.
Several classifications of genital prolapse have been proposed, the most common of which is the POP-Q (Pelvic Organ Prolapse Quantification System) classification.
Causes of genital prolapse
Among the causes of genital prolapse, leading to disruption of the muscles and ligaments of the pelvis, pregnancy and childbirth are most often mentioned. The age of the mother, the weight of the fetus, the number and duration of childbirth play an important role. Accordingly, the more a woman gave birth through the natural birth canal, the larger the fetus was and the longer the birth was, the higher the risk of developing genital prolapse. In this case, prolapse can manifest itself both after a relatively short time after childbirth, and in a very remote period. & nbsp; The natural aging process and associated age-related deficiency of sex hormones can also lead to weakening of supporting structures, so genital prolapse is more common in older women.
The cause of prolapse can be a number of diseases, which are characterized by a periodic increase in intra-abdominal pressure. These include chronic bronchitis, chronic constipation, bronchial asthma and a number of other diseases. Increased intra-abdominal pressure is transmitted to the pelvic floor muscles and ligaments, which over time leads to their weakening and the development of prolapse. In addition, a number of hereditary diseases and syndromes have been described that are characterized by a congenital defect in the connective tissue that makes up all the ligaments in the human body. Such patients are characterized by the appearance of prolapse at a fairly young age, as well as the presence of concomitant diseases, also associated with weakness of the connective tissue.
Symptoms of genital prolapse
The most common complaint with genital prolapse is the sensation of a foreign body ("ball") in the vagina. Difficulty urinating, a feeling of incomplete emptying of the bladder, frequent urination, and an urgent urge to urinate may also be of concern. These complaints are characteristic of bladder prolapse. With prolapse of the rectum, there may be complaints about the difficult act of defecation, the need for manual assistance for its implementation. Discomfort during intercourse is possible. There may also be a feeling of heaviness, pressure and discomfort in the lower abdomen.
Methods of treatment of genital prolapse
Before describing the various treatments, it should be noted that genital prolapse is fortunately not a life-threatening condition. A certain danger is represented by extreme degrees of prolapse, in which the normal outflow of urine from the kidneys may be disturbed due to partial compression of the ureters, but such situations are rare. Many women have a minimal degree of prolapse that does not bother them. In such cases, you can limit yourself to observation. The need for treatment, especially surgery, arises only when the prolapse causes significant discomfort and anxiety. All methods of treatment of genital prolapse can be divided into 2 groups: surgical and conservative.
Conservative treatment of genital prolapse
Conservative treatments include pelvic floor strengthening exercises and the use of a pessary (which is explained below). Exercises for the pelvic floor muscles can slow down the progression of prolapse. They are especially effective in young patients with minimal prolapse. To achieve noticeable positive results, these exercises must be performed for a sufficiently long time (at least 6 months), follow the regimen and technique of their implementation. In addition, heavy lifting should be avoided. It is also recommended to bring your weight back to normal if there is an excess of it.
With a significant degree of prolapse, as well as in elderly patients, the effectiveness of exercise is almost zero. If it is necessary to delay surgical treatment, for example, in case of a planned pregnancy or there are contraindications to surgery in somatically burdened patients, a pessary may be used.
A pessary is a special device that is inserted into the vagina. It, having a certain shape and volume individually selected for each patient, restores or improves the anatomical relationships of the pelvic organs while it is in the vagina. In order to avoid traumatic effects on the walls of the vagina, it is necessary to periodically replace the pessary. It is also advisable to use estrogen-containing vaginal creams.
Surgical treatments
There are a number of surgical interventions aimed at eliminating pelvic organ prolapse. The choice of a particular operation depends on the type of prolapse, its severity and a number of other factors. Basically, they can be divided depending on the access used.
Operations performed by vaginal access. They can be performed both using the patient's own tissues, and using special synthetic meshes. Using own tissues, operations such as anterior and posterior colporrhaphy are performed. During these interventions, the anterior and / or posterior walls of the vagina are strengthened, respectively, with cystocele and rectocele. Using local tissues, sacrospinal fixation is also performed, in which the dome of the vaginal stump is fixed to the right sacrospinous ligament. Accordingly, this operation is used for prolapse of the vaginal stump.
Surgeries using local tissues are preferable for young patients in whom the condition of these tissues is good, and also with a small degree of prolapse. In elderly patients, especially with significant prolapse, it is preferable to use synthetic meshes, because. when using own tissues, the probability of recurrence is high. The synthetic grid consists of specially developed material – polypropylene, which is not absorbed in the tissues of the body and does not cause an inflammatory reaction. The mesh is also placed through the vagina. Modern synthetic prostheses make it possible to perform plastic surgery when the anterior and posterior walls of the vagina are lowered, as well as when the uterus is lowered. Elderly patients with significant prolapse may be offered colpocleisis – stitching the anterior and posterior walls of the vagina. The obvious disadvantage of this operation is the impossibility of sexual activity due to the shortening of the vagina. On the other hand, this intervention is extremely effective and is performed relatively quickly from the vaginal access.
Operations performed by laparoscopic access. These operations are performed with special instruments that have a very small diameter (3-5 mm) and are carried out through small punctures into the abdominal cavity. This group of operations includes the previously mentioned sacrospinal fixation, as well as sacrovaginopexy. When performing sacrovaginopexy, the vagina and cervix are fixed to the presacral ligament of the sacrum. This operation is also performed using a synthetic mesh. Sacrovaginopexy is preferred for isolated uterine prolapse.
Complications of surgical treatment
Unfortunately, like any other surgery, surgical treatment of prolapse can be accompanied by various complications. First of all, it is the possibility of recurrence of prolapse. Even with the correct choice of the method of the operation and the observance of the technique of its implementation, the possibility of relapse cannot be completely excluded. In this regard, it is extremely important to follow the recommendations given by the doctor after the operation: limiting physical activity and a ban on sexual activity for 1 month. after intervention.
After the operation, especially if plastic surgery of the anterior wall of the vagina was performed, various urination disorders may occur. First of all, this concerns urinary incontinence during stress, manifested during physical exertion, coughing, sneezing. It occurs in approximately 20-25% of cases. You don't need to get upset. Today, there are effective methods of surgical treatment of urinary incontinence using synthetic loops. This operation can be performed after 3 months. after surgical treatment of prolapse.
Another possible complication may be difficulty urinating. When it occurs, the appointment of stimulating therapy (coenzymes, physiotherapy sessions aimed at stimulating the contractile activity of the bladder, etc.) is required, which in most cases allows you to restore the normal act of urination.
Another urinary disorder that develops after surgery may be overactive bladder syndrome. It is characterized by sudden, hard-to-control urge to urinate, frequent daytime and nighttime urination. This condition requires the appointment of drug therapy, against the background of which it is possible to eliminate most of the symptoms.
The use of synthetic vaginal meshes may cause pain during intercourse. This condition is called "dyspareunia" and is quite rare. However, it is considered that women who are sexually active should avoid implanting mesh prostheses whenever possible to avoid these complications, as they are difficult to treat. The development of modern medical technologies allows us to provide highly effective care in the treatment of almost any genital prolapse.
According to www.rmj.ru
Unfortunately, many people are not even aware that their sexual problems – this is not a matter of whispering with a friend or discussing with a sex therapist, but a reason to go to an aesthetic medicine clinic and without much difficulty – and most importantly, quickly and forever – get rid of these problems. Modern medicine has many different opportunities to improve the intimate health of patients, to make their sex life brighter and richer. One of them is thread plastic surgery of the vagina:
Share:
Add a comment