Omission of a uterus
Omission of a uterus – the wrong position of a uterus, shift of a bottom and a neck of a uterus is lower than anatomo-physiological border owing to weakening of muscles of a pelvic bottom and ligaments of a uterus. At most of patients omission and loss of a uterus usually is followed by shift of a vagina from top to bottom. Omission of a uterus is shown by feeling of pressure, discomfort, nagging pains in the bottom of a stomach and in a vagina, frustration of an urination (difficulty, increase of an urination, an urine incontience), pathological allocations from a vagina. Can be complicated by partial or full loss of a uterus. Omission of a uterus is diagnosed during gynecologic survey. Depending on extent of omission of a uterus medical tactics can be conservative or surgical.
Omission of a uterus
Omission of a uterus – the wrong position of a uterus, shift of a bottom and a neck of a uterus is lower than anatomo-physiological border owing to weakening of muscles of a pelvic bottom and ligaments of a uterus. It is shown by feeling of pressure, discomfort, nagging pains in the bottom of a stomach and in a vagina, frustration of an urination (difficulty, increase of an urination, an urine incontience), pathological allocations from a vagina. Can be complicated by partial or full loss of a uterus.
The most frequent options of the wrong arrangement of internal genitals of the woman are omission of a uterus and its loss (uterotsela). At omission of a uterus there is a shift of her neck and a bottom below anatomic border, but the neck of a uterus is not shown from a sexual crack even at a natuzhivaniye. The Vykhozhdeny uterus out of limits of a sexual crack it is regarded as loss. Uterus shift precedes its partial or full loss from top to bottom. At most of patients omission and loss of a uterus usually is followed by shift of a vagina from top to bottom.
Omission of a uterus is quite frequent pathology which is found at women of all age: it is diagnosed for 10% of women up to 30 years, at the age of 30-40 years comes to light at 40% of women, and aged after 50 years occurs at a half. 15% of all operations on genitals are carried out concerning omission or loss of a uterus.
Omission of a uterus is most often connected with weakening of the copular device of a uterus, and also muscles and fastion of a pelvic bottom and quite often lead to rectum shift (rektotsela) and a bladder (tsistotsela), the followed disorder of functions of these bodies. Quite often omission of a uterus begins to develop in childbearing age and always carries the progressing current. In process of omission of a uterus become vyrazhenny and the accompanying functional frustration that the physical and moral suffering brings to the woman and quite often leads to partial or full disability.
Normal position of a uterus its arrangement in a small basin, equally spaced from its walls, between a rectum and a bladder is considered. The uterus has the kpereda body tilt forming an obtuse angle between a neck and a body. The neck of a uterus is rejected kzad, forms in relation to a vagina the corner equal 70-100 °, her external pharynx prilezhit to a back wall of a vagina. The uterus has sufficient physiological mobility and can change the situation depending on filling of a rectum and a bladder.
The typical, normal arrangement of a uterus in a cavity of a basin is promoted by its own tone, interposition with adjacent bodies, copular and muscular the device of a uterus and a pelvic bottom. Any violations of very tectonics of the device of a uterus promotes omission of a uterus or its loss.
Classification of omission and loss of a uterus
Distinguish the following stages of omission and loss of a uterus:
- omission of a body and neck of a uterus – a neck of a uterus is defined over the level of an entrance to a vagina, but does not support limits of a sexual crack;
- partial loss of a uterus – a neck of a uterus is shown from a sexual crack at a natuzhivaniye, physical tension, sneezing, cough, a raising of weights;
- incomplete as loss of a body and a bottom of a uterus – from a sexual crack the neck and partially a uterus body acts;
- full loss of a body and bottom of a uterus – a uterus exit out of limits of a sexual crack.
Reasons of omission and loss of a uterus
Out of limits of its normal physiological borders lead the anatomic defects of a pelvic bottom developing as a result to omission of a uterus:
- injuries of muscles of a pelvic bottom;
- patrimonial injuries – during the imposing of obstetric nippers, a vakuumekstraktion of a fruit or extraction of a fruit buttocks;
- the undergone surgeries on genitals (a radical vulvektomiya);
- deep ruptures of a crotch;
- violations of an innervation of an urinogenital diaphragm;
- congenital defects of pelvic area;
- the deficiency of estrogen developing in a menopause;
- dysplasia of connecting fabric, etc.
As risk factors in development of omission of a uterus and its subsequent loss serves numerous childbirth in the anamnesis, hard physical work and heavy lifting, advanced and senile age, heredity, the increased intra belly pressure caused by obesity, tumors of an abdominal cavity, chronic locks, cough.
Often in development of omission of a uterus interaction of a number of factors under the influence of which there is a weakening of the copular and muscular device of internals and a pelvic bottom plays a role. At increase in intra belly pressure the uterus is forced out out of limits of a pelvic bottom. Omission of a uterus involves shift anatomic of closely related bodies - vaginas, a rectum (rektotsela) and a bladder (tsistotsela). To Rektotsele and a tsistotsela increases under the influence of internal pressure in a rectum and a bladder that causes a bigger omission of a uterus.
Symptoms of omission and loss of a uterus
In the absence of treatment omission of a uterus is characterized by gradual progressing of shift of bodies of a small pelvis. In initial stages omission of a uterus is shown by nagging pains and pressure in the bottom of a stomach, a sacrum, a waist, feeling of a foreign matter in a vagina, dispareuniy (painful sexual intercourse), emergence is more white or bloody allocations from a vagina. As characteristic manifestation of omission of a uterus serve changes in menstrual function as a giperpolimenorea and an algodismenorea. Quite often at omission of a uterus infertility is noted though also pregnancy approach is not excluded.
Further urological frustration which are observed at 50% of patients join symptoms of omission of a uterus: the complicated or speeded up urination, development of a symptom of residual urine, stagnation in urinary bodies and — infection of the lower, and then and top departments of an urinary path - develop further cystitis, pyelonephritis, an urolithic disease. The long course of omission and loss of a uterus conducts to restretching of mochetochnik and kidneys (gidronefroz). Often uterus shift is followed by an urine incontience from top to bottom.
Proktologichesky complications at omission and loss of a uterus meet in every third case. Locks, colitis, an incontience a calla and gases concern to them. Quite often burdensome urological and proktologichesky manifestations of omission of a uterus force patients to address adjacent experts – the urologist and the proctologist. When progressing omission of a uterus the education which is independently found by the woman acting from a sexual crack becomes the leading symptom.
The acting part of a uterus has an appearance of the brilliant, opaque, cracked, sadnenny surface. Further, as a result of a constant travmatization when walking, the vybukhayushchy surface izjyazvlyatsya quite often with formation of deep decubituses which can bleed and be infected. At omission of a uterus violation of blood circulation in a small basin, emergence of developments of stagnation, cyanosis of a mucous membrane of a uterus and hypostasis of adjacent fabrics develops.
It becomes frequent at uterus shift below physiological borders impossible sex life. At patients with omission of a uterus the varicose veins of veins, mainly lower extremities, owing to violation of venous outflow often develop. As complications of omission and loss of a uterus infringement of the dropped-out uterus, decubituses of walls of a vagina, infringement of loops of intestines can also serve.
Diagnostics of omission and loss of a uterus
Omission and loss of a uterus can be diagnosed on consultation of the gynecologist during gynecologic survey. For definition of extent of omission of a uterus the doctor asks the patient to be extinguished then at a vaginal and pryamokishechny research determines the shift of walls of a vagina, bladder and rectum. Women with the shift of genitals are put on the dispensary account. Without fail the patient with such pathology of a uterus carries out a kolposkopiya.
In the cases of omission and loss of a uterus demanding performing organ-preserving plastic surgeries and at associated diseases of a uterus the diagnostic complex joins additional methods of inspection:
- gisterosalpingoskopiya and diagnostic scraping of a cavity of a uterus;
- ultrasonic diagnostics of bodies of a small pelvis;
- capture of dabs on flora, degree of purity of a vagina, , and also for definition of atipichesky cages;
- urine for an exception of infections of urinary tract;
- excretory urography for an exception of obstruction of urinary tract;
- computer tomography for specification of a condition of bodies of a small pelvis.
Patients with omission of a uterus look round the proctologist and the urologist for existence definition the rektotsel and the tsistotsel. It carries out assessment of a condition of sphincters of a rectum and bladder for identification an incontience of gases and urine at a tension. Omission and loss of a uterus should be distinguished from an eversion of a uterus, a cyst of the vagina which was born miomatozny knot and to carry out differential diagnostics.
Treatment of omission and loss of a uterus
At the choice of tactics of treatment the following factors are considered:
- Extent of omission or loss of a uterus.
- Existence and the nature of the gynecologic diseases accompanying omission of a uterus.
- Need and possibility of restoration or preservation of menstrual and genital functions.
- Age of the patient.
- Nature of violations of functions of sphincters of a bladder and rectum, thick gut.
- Degree of anesteziologichesky and surgical risk in the presence of associated diseases.
Considering a data set of factors, treatment tactics which can be both conservative, and surgical is defined.
Conservative treatment of omission and loss of a uterus
At omission of a uterus when it does not reach a sexual crack and functions of adjacent bodies are not broken, conservative treatment which can include is used:
- the physiotherapy exercises directed to strengthening of muscles of a pelvic bottom and abdominal tension (gymnastics across Kegel, across Yunusov);
- gynecologic massage;
- the replacement therapy by estrogen strengthening the copular device;
- local introduction to a vagina of the ointments containing metabolites and estrogen;
- transfer of the woman to easier physical activity.
At impossibility of performing expeditious treatment concerning omission or loss of a uterus at patients of advanced age application of vaginal tampons and , representing thick rubber rings of various diameter is shown. Inside the pessariya contains the air giving it elasticity and elasticity. After introduction to vaginas, a ring creates a support for the displaced uterus. At introduction to a vagina the ring rests against the arches of a vagina and fixes a uterus neck in a special opening. Pessary it is impossible to leave a long time in a vagina because of danger of development of decubituses. When using for treatment of omission of a uterus it is necessary to carry out daily vaginal syringing by camomile broth, solutions of Furacilin or permanganate of potassium, and twice a month to be shown to the gynecologist. Pessariya can leave in a vagina 3-4 weeks, doing then a break for 2 weeks.
Surgical treatment of omission and loss of a uterus
More effective radical method of treatment of omission or loss of a uterus is surgery to as which indications serve inefficiency of conservative therapy and considerable degree of shift of body. The modern operational gynecology at omission and loss of a uterus offers a set of types of surgeries which can be structured on the leading sign – anatomic education which is involved for correction and strengthening of position of bodies.
Vaginoplasty – the plastic surgeries directed to strengthening of muscles and fastion of a vagina, bladder and a pelvic bottom concerns to the first group of surgical interventions (for example, a kolpoperineolevatoroplastika, a forward kolporafiya). As muscles and fastion of a pelvic bottom are always involved in omission of a uterus, a kolpoperineolevatoroplastik to be carried out at all types of operations as the main or additional stage.
The second big group of operations provides shortening and strengthening of the round sheaves supporting a uterus and their fixing to a forward or back wall of a uterus. This group of operations is not so effective and gives the greatest number of a recurrence. It is explained by use for fixing of the round ligaments of uterus having ability to stretching.
The third group of operations for omission and loss of a uterus is used for strengthening of fixing of a uterus by sewing together of sheaves among themselves. Some operations of this group deprive further of patients of ability to a child-bearing. The fourth group of surgical interventions is made by operations with fixing of the displaced bodies to walls of a pelvic bottom (a sacral, pubic bone, to pelvic sheaves etc.).
To the fifth group of operations interventions treat with use of the alloplastichesky materials used for strengthening of sheaves and fixing of a uterus. Carry considerable number of a recurrence of omission of a uterus, rejection of an alloplast, development of fistulas to shortcomings of operations of this look. The sixth group of operations for this pathology includes the surgical interventions leading to partial narrowing of a gleam of a vagina. The last group of operations includes radical removal of a uterus – a hysterectomy when there is no need of preservation of genital function.
Preference at the present stage is given to the combined surgical treatment including at the same time both fixing of a uterus, and plasticity of a vagina, and strengthening of the copular and muscular device of a pelvic bottom one of ways. All types of the operations applied at treatment of omission or loss of a uterus are carried out by vaginal access or through a forward belly wall (band or laparoscopic access). After carrying out operation the course of conservative actions is necessary: physiotherapy exercises, a dietotherapy for elimination of locks, an exception of physical activities.
Prevention of omission and loss of a uterus
The most important preventive measures of omission and loss of a uterus is observance of the rational mode, since the girl's childhood. Further prevention of hard physical activity, rise and carrying of weights over 10 kg is necessary accurate compliance with the law in the field of protection of female labor.
During pregnancy and during childbirth the risk of shift of genitals increases. In development of omission of a uterus an important role is played by not only the number of childbirth, but also the correct conducting pregnancy, childbirth and the postnatal period. Competently rendered obstetric grant, protection of a crotch, prevention of long childbirth, the choice of the correct technique of a rodorazresheniye – will help to avoid further the troubles connected with omission of a uterus.
Important preventive measures in the postnatal period are careful comparison and restoration of tissues of crotch, prevention of septic complications. After the delivery for the purpose of prevention of omission of a uterus it is necessary to carry out the gymnastics strengthening muscles of a pelvic bottom, an abdominal tension, the copular device in cases of a traumatic course of childbirth to appoint laser therapy, electrostimulation of muscles of a pelvic bottom. In the early postnatal period heavy physical activities are contraindicated. At tendency to locks the diet directed to their prevention and also special remedial gymnastics is recommended to women.
The special attention to prevention of omission and loss of a uterus should be given during the premenopauzalny period: to limit excessive physical activities, to do treatment-and-prophylactic gymnastics and sport. An effective way of prevention of omission of a uterus in a menopause is purpose of the replacement hormonal therapy improving blood supply and strengthening the copular office of pelvic bodies.