Women have a problem and are very ashamed. They don’t even tell the doctor

Vaginal prolapse, uterine depression and urinary incontinence are still taboo. Women who observe disturbing symptoms of these ailments are ashamed and rarely talk about it, even in a doctor’s office. Meanwhile, disorders of the statics of female organs can be effectively treated. However, it is important to diagnose them accurately and know exactly which parts of the system they apply to. The drug explains what the correct therapeutic procedure looks like. med. Dorota Niewęgłowska, specialist in gynecology and obstetrics from SCM clinic in Krakow.

1. Degradation and prolapse of the reproductive organs is a problem that affects many women
2. These ailments are so embarrassing that many ladies prefer to remain silent rather than tell their doctor about them
3. The declining statics of organs can be effectively combated. There is one condition: the gynecologist must know about her
4. More current information can be found on the Onet homepage.

Disorders of the statics of the reproductive organ is a syndrome of dysfunction resulting from the weakening of the muscles and structures of the pelvic floor. As a consequence, the organs are not as well supported and gradually decline, and in extreme cases they fall out. The ailments may concern both the vagina and the uterus, but also the bladder and small intestine. The problem is rarely mentioned, while it affects up to 30 percent. women, and the risk of having surgery for this reason reaches approx. 7%. on the life scale of each of them. So we are talking about a common disease that requires attention. Especially that as a result of this type of disorders, the quality of life deteriorates significantly.

Despite this, this topic is still a social taboo, as the drug says. Dorota Niewęgłowska, a specialist in gynecology and obstetrics from SCM clinic in Krakow, unfortunately translates into poor knowledge about the methods of prevention and treatment of this type of ailments.

– Talking to patients at gynecological visits, I notice that many of them do not know what preventive measures they should take. What’s more, many of them are unaware that they can help themselves in any way. They think that it must be so. Meanwhile, it is very important to react as early as possible, because prevention introduced at an early stage may prevent the development of this type of dysfunction. So if a woman can sense even subtle changes in these parts of the body and sees that something is bothering her and it is not exactly as it used to be, I urge you to raise this topic during a gynecological visit – explains the expert.

Symptoms of dysfunction in the pelvic floor

Women who suffer from disorders of the statics of the genital organs complain of recurrent feeling of discomfort in the intimate areas and significantly reduced satisfaction with sex life, and even pain during intercourse. Although, as the drug explains. Dorota Niewęgłowska, specific symptoms really depend on which part of the reproductive organ falls and the degree of advancement of this pathology.

– When lowering the anterior vaginal wall together with the bladder, patients most often complain of the inability to fully urinate in one position. In addition, urinary incontinence may occur when you cough, sneeze, run, jump or reposition your body. If the dysfunction affects the back wall of the vagina along with the rectum, it results in impaired bowel movements. The pathologies of the middle compartment, i.e. lowering the top of the vagina, cervix and uterus, may manifest themselves with pain in the lower abdomen and the lower back, or with a feeling of gravity in this part of the body. There are also so-called vaginal gas. The vaginal mucosa becomes dry and rubs easily, which can lead to frequent infections. At higher stages of advancement, women also begin to feel a lump coming out of the vagina. In extreme stages, these elements fall out and are visible before entering the vagina – describes the doctor.

The reasons for the lowering of organs

The main causes of disorders of the statics of the reproductive organ are multiple pregnancies, natural births in children with high birth weight and an incorrect lifestyle. Increased BMI together with obesity puts the structures inside the pelvis under strain. Also, heavy physical work can significantly weaken the suspension structures. Hormonal disorders and the decrease in estrogen during menopause are also important.

Problem awareness and prevention

It is very important to raise awareness of this issue in all women who should conduct appropriate prophylaxis from their youth.

– Make sure you stay hydrated and urinate frequently. It is also important to avoid constipation. All women should learn how to properly tone their pelvic floor muscles and then exercise them regularly. The help of urogynecological physiotherapists is also valuable, as they pay attention to and correct important body posture and instruct patients on how to strengthen these structures through appropriate training. In addition, estrogen therapy is also worth considering prophylactically. It should be used by both women after childbirth and those who are breastfeeding, have irregular menstruation, non-ovulatory cycles, or are in the pre- and perimenopausal period. In the event of deficiencies, we have the opportunity to use, for example, vaginal preparations that improve the quality of the vaginal mucosa and this is also where we should start counteracting. It is worth implementing these simple measures on a permanent basis, as they can significantly prevent static dysfunctions of the reproductive organ, explains the SCM clinic specialist.

When the problem arises

At low stages of dysfunction, many short-term, non-invasive methods can be used. These include special everyday tampons that reduce the symptoms of stress urinary incontinence. Pessaries that support internal structures can be of other help. Properly applied and selected, they are imperceptible and give a sense of comfort in everyday functioning. However, it should be remembered that these types of measures do not solve the problem, but only reduce the discomfort associated with lowering the elements of the pelvic floor.

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Correct diagnosis

The basis for the implementation of therapeutic procedures is diagnostics. It begins with an in-depth interview with the patient, which allows for a preliminary identification of the problem. Then a gynecological examination is performed in the specula. Transperineal ultrasound (performed twice – with a full and empty bladder) is also necessary.

– Ultrasound is invaluable, but unfortunately often overlooked. It makes it possible to visualize all elements of the pelvic floor. During such an examination, the patient should be asked, for example, to cough. We can then see exactly what the problem is related to, which part is falling, check the muscle tension and from the appropriate relations between the structures of the pelvic floor, we can draw conclusions and propose treatment adequate to the disorder – surgical or non-surgical. Such accurate diagnosis is extremely important, because without it, the therapy performed “blindly” will not give satisfactory results – explains Niewęgłowska.

Minimally invasive methods

At low stages of disease advancement, we can use minimally invasive methods, including laser therapy. It is a procedure performed during a gynecological visit, revitalizing the vaginal mucosa and suspension structures at a shallow depth. It gives the opportunity to increase vaginal tension, and thus sexual satisfaction, as well as self-nourish the vaginal mucosa and improve its condition. This type of method is not uncomfortable and usually needs to be repeated.

Selection of the operational method

In the case of more advanced disorders of the statics of the reproductive organ, there is still an operation that, although more invasive, will eliminate the problem. According to the gynecologist Dorota Niewęgłowska, the selection of the procedure should be adjusted to the degree of organ deterioration and loss, and the specific site of damage (you need to know exactly which part of the system is affected), as well as whether the patient has been operated on earlier for this reason.

– Each of these issues will be crucial in selecting the best surgical method and different procedures should be performed in each case. Therefore, the diagnosis and performance of transperineal ultrasound, which has been described earlier, is of key importance. Problems may overlap and then the operational methods should be combined. Therefore, a good treatment plan is very important, based on the knowledge of the broadly understood problem of disorders of the statics of the reproductive organ and all possible methods of treatment. At SCM clinic, we have started cooperation with an outstanding specialist in this field – dr. Jerzy Fabian, who has been dealing with the subject of lowering and prolapse of the pelvic organs in Germany for 40 years. Working under his supervision allows us to introduce modern surgical procedures – adds the specialist.

Therefore, let us look at the most modern surgical methods of dealing with the problem of statics of the reproductive organ.

Lowering the front wall of the vagina and bladder

When the problem concerns the anterior compartment, the urinary bladder is lowered, the urethra folds and the anterior vaginal walls fall out. If a woman has not been operated on before, she should have an anterior vaginoplasty with bladder lifting.

– This type of procedure can reveal the second disease in the form of latent stress urinary incontinence. When the urethra is straightened as a result of the surgery, the funnel may become visible and then the patient may start to lose urine after coughing and sneezing. In this case, in the second step, it is proposed to put on the undercoat tape. Depending on the construction, TOT or TVT tape should be used. Appropriate qualification of the patient for the procedure with their use is crucial. – explains the expert.

These tapes differ in the way of mounting – the place of attachment, the way they are led in the pelvis, the angles of the coil and the degree of the possibility of its pull-up. The TOT tape is placed flatter and passes through the curtain openings. The TVT is guided up past the pubic bone.

– So far, most patients have been wearing TOT tapes due to their theoretically lower invasiveness and possible complications after this procedure. Meanwhile, this is a good solution only if the woman has low vaginal vaults and a highly movable urethra. Then her coil rests on the tape. But if it has high vaginal vaults, after a few years such a tape, constantly rubbing against the vaginal wall, can lead to erosion, i.e. damage. As a result, it will cause pain during intercourse, pulling, infections, etc. A woman with high vaginal vaults (which is what the vast majority of patients are) should have TVT tape on – explains the expert.

When there are varicose veins in the area of ​​the urethra, surgery cannot be performed. The only salvation is non-invasive methods.

Prolapse of the vagina, cervix and uterus

If the middle compartment is lowered and prolapsed, i.e. the vaginal apex, cervix, uterus, it is necessary to attach the lowering element to the permanent structures of the body. It turns out that the best solution for a woman is to cut off the uterine body and pull the cervix up with a special tape. According to the doctor, the gold standard should be the attachment of the cervix to the promontorium, i.e. a fragment of the sacrum..

– Unfortunately, classically, it is still very often attached to the fascia of the abdominal muscles or laterally to the pelvic bones, which changes the angle of the vagina. This is a mistake that prevents the woman from having comfortable intercourse later. It is worth adding that the tapes used in the procedures are performed retroperitoneally, which minimizes possible complications. Tapes must be used because the own tissues cannot sufficiently support the sagging structures.

Lowering the back wall of the vagina, rectum and intestine

The last kind of problem concerns the rear compartment. In his case, there may be two different pathologies. There may be the so-called rectocele, i.e. the bulging of the large intestine and the lowering of the back wall of the vagina along with the rectum. If the patient has not been operated on, she is offered posterior vaginoplasty with possible perineoplasty.

The operation is different when the problem is enterocele, i.e. a situation in which the small intestine lowers, presses between the uterus and the vagina, and it highlights the lump visible on the outside. In this case, it is not possible to recreate the division between the small intestine and the vagina with your own tissues. In this case, a mesh supporting the intestine should be placed, also with fastening to the permanent elements of the pelvis.

The doctor warns that these two problems can be confused without good diagnostics.

– Without a transperineal ultrasound, we will not see a descending small intestine. If vaginoplasty is performed and the problem is actually a lowered small intestine, the procedure will not give the expected results.

The expert adds that in the procedure, doctors try to avoid using artificial materials, but in some cases, there is no other option to help.

– Intra- and postoperative examination is also very important. After the insertion of the urethral tape directly during the procedure, the patient performs a cough test, which allows to set the optimal tape tension reducing urinary incontinence. In the postoperative period, in the ultrasound examination, we locate the tape in three planes, determining its distance from the urethra and its correct position.

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