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Delicate matter

Delicate matter

For the sake of fairness, it must be said that the problem to be discussed is also embarrassing to discuss. After all, it manifests itself more or less tangible discomfort in the perineum (for example, a feeling that there is something inside), drawing pain in the lower abdomen; frequent inflammations in the vagina (colpitis, vaginitis, “thrush”), which are difficult to cure, and then begin again; annoying “surprises” – involuntary urine leaks when coughing, sneezing and at that moment when you need to lift something heavy. The cause of all these events in the language of doctors called prolapse – a violation of the normal position of the pelvic organs, which is manifested by the prolapse of the walls of the vagina and uterus.

Neighboring organs may also be involved in this process: the bladder and the rectum. And in some cases, the disease also changes the sex life of women, causing a feeling of dissatisfaction on both sides.

It is explained by the flaccidity of the vaginal muscles and its expansion, and if, in addition to the omission of the vaginal walls, the process also affects the uterus, our heroine feels that there is some annoying noise inside.

Many women face such problems, although most of them prefer to keep silent about it, considering them to be common after childbirth, and later – natural “companions” of aging. According to statistics, in Russia, 60% of women have an omission of the vaginal walls and uterus, and half of them are young or future mothers!

Most women believe that the reason for the omission of the walls of the vagina and uterus is natural childbirth. Indeed, the birth of a child, especially a larger one, as well as trauma to the perineum in the process can provoke a problem, but do not cause it. For the development of the disease, it is important whether a woman has a hereditary predisposition to prolapse, how old she is (lack of hormones in the menopausal period increases the chance of developing the disease), whether she has experienced heavy physical exertion and, finally, whether there are any something special, in other words, “weakness”.

The latter circumstance will be decisive in the occurrence of the disease in young women, because such tissue can simply not cope with the task of supporting organs.

The discomfort that appeared shortly after the birth of the baby, small “surprises” that the body suddenly began to present. This is not a reason to consult a doctor – perhaps then to find out that everything is in order!

There was a time when neither the doctors nor the women themselves paid enough attention to these problems, because the omission of the vaginal walls and urinary incontinence do not pose any danger to life. Fortunately, the image of a woman has changed, and our contemporaries are active, goal-oriented, demanding personalities who devote maximum attention to their health and beauty. And the concept of “quality of life” in recent years has been confidently setting us an ever higher bar.

All the more important is the idea that, apart from the aesthetic, the problem of prolapses has a medical side. The constant gaping of the genital slit, which occurs when the walls of the vagina are omitted, disrupts the composition of the normal microflora in it and causes infinite inflammation.

Oleg Shalaev, MD, Professor of the Department of Obstetrics and Gynecology, RUDN, Deputy. Chief Physician of the Perinatal Medical Center: In the late 1980s, prolapses and incontinence were mentioned in passing in the gynecology textbook for students. In our tradition, it was believed that in women who gave birth these phenomena were almost the norm, especially since they did not pose any danger to life. This is how they were treated, so when the patient went to the doctor with her complaints, it often turned out that the doctor had the same problems as well as her mother and her friend.

The attitude to the problem changed 10–15 years ago and, alas, mostly not by our forces, but thanks to the information of our Western colleagues and the efforts of foreign pharmaceutical companies that offered means and methods for the treatment of prolapses and incontinence. From their presentation, the notion “quality of life” came into our everyday life, and since then the question “life or death?” Has become not the only one for Russian doctors. We began to think about how a person with these or other violations lives.

And it turned out that there are problems that do not kill, but steal life. The discomfort, and sometimes severe, that a woman experiences because of the omission of the walls of the vagina and the uterus, the leakage of urine, is just one of them.

O.Sh. There are more of them, but due to the fact that more and more women are aware of their condition as a disease.

Now a lot is said about the possibility of treatment of prolapses and incontinence.

O.Sh. It will be easier for Muscovites to get help: there are specialists in the capital who are well aware of the problem, and the equipment of gynecological hospitals is at an excellent level. In other cities of Russia, especially small ones, it will be more difficult to find such a doctor and a good clinic.

Those whose problems are not solved “on the spot” should try to contact the large center.

Delicate matter

The prolapse of the genital organs is treated, regardless of the age of the patient. And do not think that this is possible only with the operation. A slight degree of omission, which does not give its owner any discomfort and does not affect her sex life, will not become an indication for intervention.

In addition, you need to understand that after any plastic surgery on the vagina, childbirth will naturally be unsafe and will send a woman to a cesarean section. Yes, and the pregnancy itself can sometimes affect the results of surgical treatment is not the best way.

Therefore, the “plasticity” is done mainly for patients who no longer plan to have children. All the rest are more suitable conservative methods of treatment, although they, unfortunately, give only a temporary effect.

Basically, this is a set of exercises to strengthen the muscles of the pelvic floor, and I must say that this method is more suitable for protection against the disease than for its treatment.

With regard to surgical methods, there are many ways – for each patient has his own. The most common procedure for omitting vaginal walls is the technique of excision of the “extra” vaginal mucosa (colporrhaphy), and for uterus prolapse, pulling it up and fixing it. This is also done at the expense of its own bundles.

Unfortunately, in those cases when the tissues of the patient’s body are too “weak”, it is not always possible to use them. Then additional materials will come to the aid of doctors, for example, synthetic nets to create a more reliable “frame” that supports organs and tissues.

Simultaneously with the correction of the omission, the patient may require assistance in the treatment of incontinence accompanying prolapse. And again you should not think that the operation will be the only possible solution: many forms of incontinence are well treated with drugs, and the surgeon’s help in such cases is simply not needed.

Omission and incontinence will pass over time by themselves.

Not true. These violations do not pass. Having arisen, they either stop at some stage, or, as happens in most cases, quickly or slowly progress.

And without treatment, this movement cannot be stopped!

Such problems are treated only with the help of surgery.

Not true. Not necessarily; in some mild cases, a woman will be prescribed a course of conservative treatment.

And even in a more serious situation, if the patient plans to have a future pregnancy, she will be advised to postpone the operation.

The cause of all troubles – childbirth, what else?

Not true. Natural childbirth provoke prolapse and incontinence rather than cause it.

These disturbances do not appear in all young mothers, but only in those women who either have a hereditary tendency towards them, or “weakness” of the connective tissue, which normally should keep the organs “in place”, or have already entered the age when the body produces less hormones and the tissues become flabby.

My grandmother had the same problems. Anywhere you will not get to – heredity.

True. The tendency to the development of prolapse and incontinence can be inherited, and this is just an excuse to be closer to yourself.

At the first sign of violations, without delay, consult a doctor.

During surgery, be sure to remove the uterus.

Not true. Prolapse in itself is not a reason for its removal.

Doctors go to this step only if there are problems in the uterus that are not related to prolapse, such as fibroids.

As already mentioned, prolapses are often combined with urinary incontinence, that is, urological problems. Therefore, before a woman, the question arises: to whom to go – to the urologist or gynecologist?

And where to find specialists who will help to cope with all this? There are no urogynecologists in Russia yet, although this specialty, which unites two adjacent areas, exists in many countries.

Nevertheless, doctors from some institutions work with such patients. At the same time, traditional operating methods (anterior and posterior colporrhaphy) are owned by almost all operating gynecologists.

As for the more complex operations using mesh implants, which are done through 3 small incisions on the abdomen (using laparoscopy) or through the vagina (vaginal access), and the simultaneous correction of urinary incontinence, by far not everyone owns these techniques. Such assistance can be obtained at the Center for Family Planning and Reproduction and the Perinatal Medical Center (Sevastopolsky Ave.), Moscow Regional Research Institute of Obstetrics and Gynecology, GKB № 50, GKB them.

S.P. Botkin and major treatment centers in other cities of Russia.

The patient goes to the hospital on the eve of the operation, stays there for 3-5 days, and the recovery time will not take more than a month.

How to avoid ptosis of the vagina after birth? To prevent prolapse and help the pelvic floor muscles to quickly recover from childbirth, you need to do special exercises, such as the Kegel complex.

You can start them on the 2-3rd day after birth. And those young mothers who were stitched to the crotch should wait 2 weeks.

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