LOSS OF UTERINE

LOSS OF UTERINE - displacement of the uterus and vagina beyond the limits of the sexual slit. The prolapse of the uterus, as a rule, is accompanied by the descent or prolapse of the walls of the vagina. There are incomplete and complete loss of the uterus and vagina. When incomplete, only the cervix and partially the vaginal wall drop out, with the full - from the genital slit comes out the vagina, inside which is the uterus. From the prolapse of the uterus should be distinguished from the omission of the uterus, when the outer cervix is ​​below the spinal plane of the small pelvis passing through the sciatic forearms, but the uterus does not exit from the genital slit.

It is observed with weakness of the muscles of the pelvic floor, which developed as a result of birth trauma, with increased intra-abdominal pressure, insufficiency of the ligamentous apparatus of the uterus, weakness of the abdominal muscles, and also in the elderly and senile age. In nulliparous women, this pathology is extremely rare; Is usually associated with impaired innervation of the pelvic floor muscles.

The prolapse of the uterus and vagina develops slowly. In the initial stages is manifested only with increased intra-abdominal pressure (natuzhivanii). As the pathological process develops, prolapse occurs without prior strain. Patients complain of low back pain, lower abdomen, especially after physical exertion, on discharge (often bloody) from the vagina, sensation of the foreign body in the perineal region, impaired urination, until its delay. The fallen uterus is edematic, cyanotic, often with multiple superficial ulceration.

Treatment depends on the degree of displacement of the uterus and vagina, as well as the general condition of the woman. With the omission of the uterus, treatment is carried out on an outpatient basis. Apply general strengthening measures, therapeutic exercise, which helps to strengthen the muscles of the pelvic floor and ligament apparatus, water procedures. It is necessary to exclude heavy physical activity. When complete and incomplete fallout is shown surgical treatment: vaginal extirpation of the uterus, ventrofixation (lining the uterus to the abdominal wall), in some cases - amputation of the cervix with the suture of the cardinal ligament of the uterus. For the restoration of the pelvic floor, plastic surgery is used: colporaphy - excision of excess tissue of the vaginal walls with their subsequent cross-linking, colpoperereoraphy (colpopereneoplasty) - suturing the posterior vaginal wall and perineal muscles.

With contraindications to surgical treatment in women of elderly and senile age, it is justified to use uterine rings that help to keep the uterus and vagina in the right position. However, it should be remembered that with prolonged use, ulcers and bedsores can form.

Prevention consists in the rational management of labor, the timely and thorough suturing of vaginal and perineal ruptures, early retirement after childbirth, observance of personal hygiene, hygienic gymnastics, sports, the appointment of special exercises that help strengthen the abdominal muscles, pelvic floor, ligament during pregnancy And after childbirth.