What is female genital prolapse?
• It is the progressive downward displacement of the vagina and uterus, accompanied by the displacement of adjacent pelvic viscera, for relaxation of the perineal muscles perineal fibrous ring and of the suspension means.
Causes of genital prolapse - The factors driving genital prolapse include:
• A congenital weakness of the suspension means of the pelvic organs.
• A spontaneous labor, fetal macrosomia (large baby).
• Or, more often an operative delivery, especially after application of the forceps, resulting in laceration of the perineum, levator ani muscle and ligaments.
Symptoms of genital prolapse - The symptoms, sometimes very low, is generally characterized by:
• Feelings of heaviness in the lower abdomen and external genitalia.
• fatigue and urinary symptoms (frequency, partial incontinence).
• Sometimes, the patient herself, in the absence of specific symptoms, says the emphasis of the volume of a “package” which can be seen in the external genitalia after exercise, or after having been too long standing.
During the pelvic exam, the doctor can easily diagnose issue, inviting the patient to perform pressure of the abdominal walls, as in the act of defecation: this maneuver can appreciate the nature of prolapse, and therefore apply most appropriate therapy.
Degrees of genital prolapse - Schematically distinguish various degrees of prolapse:
• In the first degree prolapse, the cervix is ??still in the birth canal.
• In second degree prolapse, the cervix at the edge surfaces vulvar, without protruding outside.
• In the third degree prolapse, the cervix and vagina come entirely from the vulvar orifice.
Degrees of downward displacement of the uterus and vagina, in a middle section of the pelvis.
1) First-degree prolapse: the anterior vaginal wall (1) is directed toward the vulva (2), also dragging the back of the bladder (3) down (cystocele), cervix (4) drops in the pelvic cavity.
2) second degree prolapse: the vagina is almost completely extroflexionada and uterus (5) markedly decreased, until the point where the neck of the flat surfaces by the vulva. The anterior wall of the rectum (6) is pulled down and forward (rectocele), the Douglas cavity (7) has been displaced downward by the descent of the bodies that surround it.
3) Third-degree prolapse: the vagina is completely inverted to the outside of the uterus and leaves the perineal plane, dragging the back wall of the bladder and anterior rectal wall. In the Douglas cavity hernias may even occur if the bowel loops (8), sliding along the parietal peritoneum (9), enter it, being strangled between the body of the uterus and the anterior wall of the rectum.
It is relatively easy to get the prolapsed organs back to their normal position, but is also likely to surface again.
The treatment is surgical and uses various operative methods. The choice of technique to adopt is made taking into account the patient’s age, the quality of the tissues, the existence of sex and desire for children.
Typically, young women applying a previous colpotomy, concistopexia and colporrhaphy, and colpoperineoplasty.
In women who are past menopause and marked prolapse is usually followed by vaginal hysterectomy, followed by cystopexy and colpoperineoplasty.
In older women with low resistance can be applied surgical intervention colpocleisis. The use of the pessary is indicated in exceptional cases for very old women, or affected by diseases that do not allow surgery.