What happens to the vagina after childbirth: stages of recovery, possible complications and their treatment. How female genital organs change after childbirth View of the perineum after childbirth

During pregnancy, the entire female body is rebuilt, and, naturally, this happens most strongly during the birth of the baby. The biggest transformations occur with the genitals: they change their shape and size. This is a normal natural process through which a baby is born. After the birth of a child, the vagina is restored to its size, but this does not always happen as quickly as we would like. Let's take a closer look at what changes are happening and how the view of the vagina after childbirth.

Vagina before and after childbirth differs in its size. When a baby walks along the tracks, they are greatly stretched, which causes microtraumas and even ruptures. As a result of this, most likely. This usually goes away 3-4 days after the woman gives birth, and everything is completely restored within 6-8 weeks. Special exercises aimed at strengthening the vaginal muscles, which we will talk about a little later, will help speed up recovery.

Before a woman gives birth, her body prepares for the birth of a new life. The walls of the vagina loosen, the muscles become more elastic, and new cells begin to appear in the connective tissues, helping to stretch them better. During resolution, a special lubricant is released to make it easier for the baby to be born. But, despite all this, injuries can occur, capillaries can be damaged, which is why the genital slit acquires a bluish tint. In fact, this is how it should be, this is normal. If there is no significant damage, the color will soon return to normal light pink.

Low activity of the genital muscles and disturbances in the functioning of the nervous system lead to a decrease in their sensitivity.

The Kegel complex will help improve the situation.

Decreased estrogen levels (especially in mothers who are breastfeeding) can cause dryness woman's vagina. However, the itching that occurs as a result of dryness disappears after hormonal levels are restored. To get rid of it, it is recommended to use special lubricants that moisturize the paths.

Vagina immediately after childbirth stretches because the relief of the inner surface of the walls of this organ changes. In women who have already given birth, the relief decreases, becomes less pronounced, smoothed out.

Such smoothness gives the illusion of stretch, but often this does not correspond to reality.

Genitals after childbirth will recover on their own in a fairly short period.

Let us now consider the complications that may arise.

Consequences

Itching

Naturally, such a complex procedure as the birth of a new life will not just happen without leaving consequences. The most common complication among women in labor is itching. It occurs both as a result of hormonal changes, as already mentioned, and because of pathologies.

If the itching does not go away over time, or even worsens, contact your gynecologist to determine the probable disease and further treatment.

If surgery has been performed, scabies may be caused by an allergy to the suture threads or the antiseptic drugs used in their treatment. But if the itching is accompanied by an unpleasant odor, this is a symptom of organ inflammation, for example, inflammation of the uterus or rotting of the suture.

Prolapse of the pubis

Weakened by the birth of a new life, the pelvic muscles are often unable to hold the female womb, which is why, after the birth of a new person, it sinks down.

There are 3 degrees of severity:

• partial lowering of one wall of the vagina, not extending beyond the entrance to it;
• drooping of both walls outward from the entrance to the womb;
• complete prolapse of the reproductive system, often accompanied by prolapse of the uterus.

The last degree is the most difficult and requires immediate surgical intervention. To prevent such pathology, it is recommended to perform a Kegel complex, which is convenient to do at any time of the day. By the way, the first degree is easily corrected thanks to this complex if you do the exercise every day.

Discharge

Keep a close eye on any discharge from the labia. This is normal for the first two months. At first they are abundant, with bloody dark clots, but gradually become colorless and decrease in volume. And at the end of the second month they stop altogether.

But if after 8 weeks the discharge has not gone away, is still profuse, with an unpleasant odor and itching, immediately contact a qualified specialist. It is worth paying attention if the discharge stops very quickly, or if there are still blood clots in it throughout the entire period.

Reducing sensitivity

For a while, the lady will most likely lose sensitivity, since it takes time for the organs to recover. But don’t worry too much about this, as everything will soon return to normal.

Pain

Very often mothers experience such discomfort, and it hurts differently for everyone. This occurs due to perineal tears and sprains that require stitches. The genital tract itself cannot hurt, but when sutures are applied, the nerve endings are affected. With healing, the pain goes away, but if the pain is accompanied by scabies and an unpleasant odor, this is the first symptom of the inflammatory process.

Kegel exercises

Let's take a closer look at the Kegel complex. It is prescribed by doctors to strengthen and tone the pelvic floor muscles. At the same time, it is very easy to do and takes only a few minutes a day. Exercise improves blood flow to tissues and helps make muscles elastic and firm.

Let's get started. For 10-20 seconds we strain the perineum and vagina, as if we are trying to stop urination. We relax the muscles for about the same time. We do it 2-4 more times, and gradually increase the number of approaches.

This complex is convenient because it can be performed anywhere: at home, on the street, at work, sitting in front of the TV and in public transport, immediately after sleep or before bed.

At first it will be difficult to maintain constant muscle tension, but if you train regularly, you will get better and better each time. But if you think about increasing the strength of muscle tissue during pregnancy, you can avoid many pathologies that arise after the birth of a child. It is enough to devote just a few minutes a day to your loved one.

Prevention

In addition to this complex, there are several more recommendations for the prevention of the above diseases. For the first 2 months, you should follow the following rules:

• Abstinence from sex. Under no circumstances resume intimate life before the due date. Otherwise, this will lead to infection inside the uterus, which can develop into a serious illness. . Its treatment can prohibit breastfeeding and also provoke infertility.
• Charger. Let us repeat, this is the most effective way not only to raise the genital cleft, but also to prevent its prolapse, urinary incontinence and displacement of organs. You just need to understand which muscles need training. A simple test will help. When urinating, try to hold it and resume. These muscles need to be trained. Regular practice will quickly restore vaginal size after childbirth.
• Strong physical exertion can cause prolapse of the walls of the pubis. In pursuit of a beautiful, slender body, do not overdo it, giving your body excessive stress. Recovery should take place gradually, without severe stress and tension.

• When you resume your intimate life, monitor your microflora. Use special lubricants for dryness and discomfort. Lubricants must be without any additives or flavors. After normal functioning of the endocrine system is restored, the microflora will restore itself and the unpleasant sensations will go away.

Myths

Many people are often confused about what does the vagina look like after childbirth? Let's dispel a few myths:

1. It is believed that vaginal size after childbirth changes forever. But this is not true, since the vagina is a muscle that contracts, but does not change its size in any way. Only the relief of the walls changes, which creates the illusion of elongation.
2. Mom is misled by pain in the womb, but the womb itself cannot hurt, because there are very few nerve endings there. Painful sensations occur when the skin is irritated mechanically or chemically, or when muscles contract.
3. It is also a myth that dryness and discomfort are not normal. The statement is true only if the dryness does not go away after stopping breastfeeding, i.e. after restoring normal hormonal levels.

If you don't like it, what does the vagina look like after childbirth, it is better to contact your doctor once again to make sure that everything is in order, or to prevent the development of the disease.

Your life and the life of your child depend on your physical and mental state. Remember to take time for yourself to take care of your health.

What does the vagina look like after childbirth? This is a question young women often ask themselves during their first pregnancy. Anxiety is usually associated with a possible increase in vaginal volume, which inevitably occurs after childbirth. But women are more worried about their sex life - what if such changes affect their own feelings.

Transformations of the vagina begin from the moment of pregnancy, and end only a few months after childbirth. This is a normal physiological process that ends with complete restoration of the shape and volume of the organ. It occurs insufficiently only in women who have given birth to many children (more than three).

There are also pathological conditions in which the vagina does not recover sufficiently after childbirth. These include birth injuries to the mother - ruptures of the vagina or perineum. But even after them, complete recovery is possible - with competent and timely assistance from obstetricians.

To fully understand the changes occurring in a woman's genital organs, it is necessary to learn about their anatomy and functions.

Normal structure and functions

The vagina consists of two parts - external and internal. The first is the vestibule - skin formations that delimit the organ from the external environment. They include the labia, clitoris and Bartholin glands. Their role is to protect the soft and delicate mucous membrane from injury and infection.

The internal part of a woman's genital organs is shaped like a tube, which consists of several layers. Since it contains muscle tissue, with its normal tone the vagina resembles a slit from the inside.

It contains the anterior and posterior walls, which cover the cervix from above. This structure allows you to quickly rebuild these organs at the time of birth, creating a channel convenient for the passage of the child.

• The labia majora are located on the sides of the vaginal opening and look like two folds of skin that tuck inward.
• Between them are the labia minora, which are the border between the inner and outer parts.
• Bartholin's glands secrete a special lubricant - it moisturizes the vaginal mucosa and has an antibacterial effect.
• The mucous surface has many folds located in the longitudinal direction. This feature allows you to significantly increase the volume of the vagina during pregnancy and childbirth.
• In the muscle layer, the fibers are directed mainly longitudinally and are connected to a similar layer of the uterine wall. Therefore, in a relaxed state, they can stretch well and expand the lumen of the genital organs.

A woman's genitals contain beneficial bacteria - lactobacilli. They create lactic acid, which creates conditions favorable for sperm movement. It also has an antibacterial effect - many microorganisms die in an acidic environment.

Changes in the vagina during pregnancy and childbirth

The main role in preparing a woman’s reproductive tract for childbirth is played by the hormone progesterone. It is secreted from a special gland (corpus luteum), which develops on the ovaries after ovulation. It reaches its maximum size in the first months of pregnancy, and then gradually decreases.

The action of the hormone is associated with a strong effect on smooth muscle tissue and blood vessels. It causes muscle relaxation and dilation of the lumen of blood vessels. Due to the decrease in tone and blood stagnation, the tissues become softer and more elastic.

1. Due to the dilation of blood vessels, the vaginal muscles fill with blood and soften. Longitudinal muscle fibers gradually increase in size, but by the time of birth their tone is minimal. This allows the child to move forward unhindered, stretching them.


2. The mucous membrane becomes darker and more moist, which is associated with improved blood circulation. A large number of folds straighten out during childbirth, moving along with the muscles.
3. Progesterone affects the properties of connective tissue, reducing the amount of dense collagen fibers in it. Thanks to this, the anterior and posterior commissures of the vagina (the junction of the labia) become softer and more elastic. This protects them from rupture when the child passes through the vestibule of the genital tract.

Progesterone also has a beneficial effect on the vaginal microflora - lactobacilli. During childbirth, they fall on the child, then populating his intestines. They protect his skin from dangerous bacteria, and also allow him to digest mother's milk from the first days.

Vagina after childbirth is normal

With normal management of pregnancy (in the antenatal clinic) and childbirth, complications occur extremely rarely. Their main reason is the discrepancy between the size of the child and the woman’s reproductive tract. Normally, minor damage to the mucous membrane is possible - cracks, abrasions, bruises.

Thanks to changes in hormonal levels at the end of pregnancy and after childbirth, normal muscle tone and blood circulation are restored. There comes a period of release of a new hormone - prolactin. It has the opposite effect of progesterone and is aimed at stimulating milk production in the mother.

All recovery processes take no more than three months, and much depends on the individual capabilities of the mother - on the age and number of previous births. If the girl is no more than 25 years old and is giving birth for the first time, then the vagina will take on a normal shape within two weeks.

Changes

The main transformations during pregnancy concern the uterus - it takes the longest to recover and requires careful medical supervision of this process. In the external genitalia this occurs unnoticeably from the outside. But with the return to sexual activity, partners note a change in sensations.

1. Women usually complain of decreased sensitivity and weakened libido. And men note an increase in the size of a woman’s organs and a decrease in her elasticity. Often these problems are associated with an early return to intimacy, while vaginal restoration has not yet been completed.
2. After childbirth, the vagina changes its shape somewhat - this occurs due to stretching of the muscles and mucous membrane. Unlike injuries, the muscle layer does not rupture, but its fibers stretch slightly and diverge in the transverse direction.


3. The most noticeable changes appear after the first pregnancy - the mucous membrane stretches significantly and then forms many folds. The vagina changes from a slit-like shape to a spindle-shaped one (wide in the center, narrowed at the edges). In multiparous women, it gradually takes on the shape of a cylinder, which is associated with stretching of the ligamentous apparatus.
4. Minor abrasions, cracks and hemorrhages heal within the first day after birth. This is facilitated by changes in hormonal levels, which enhance the ability of the mucous membrane to recover.
5. During the first week, spotting mucous discharge from the vagina is possible. They are associated with increased activity of the glands of the genital tract and a sharp decrease in the size of the uterus.
6. The muscles and skin of the perineum recover the fastest - after two weeks their tone returns to normal. It is these formations that play the main role in maintaining normal shape. If you train them after pregnancy, you can achieve the previous shape of the genitals.

Prolactin also affects the emotional state of a woman, directing her attention to the care and protection of the child. With this dominant, it inhibits sexual desire, while simultaneously suppressing ovulation in a woman. Therefore, while the young mother is in the feeding period, she will have no desire to have sex.

Recovery methods

The vagina after childbirth takes on its previous shape quite quickly - defects in the mucosa and muscles are eliminated during the first week. Therefore, the main measures are aimed at strengthening the perineum. Gymnastics and physical therapy, as well as vitamin therapy, are used.

1. During the first week, when it is still difficult for a woman to perform any exercises, dosed walks can be used. Half an hour of quiet walking a day is enough to improve blood circulation in the perineal area. Normal blood flow ensures an increase in the tone of the perineal muscles, which strengthens the walls of the vagina. It will be much healthier to walk in the fresh air.
2. Gymnastics can be started depending on how you feel, but no later than two weeks. The exercise is one and extremely simple - alternately tensing and relaxing the muscles of the perineum is performed. The woman puts her feet shoulder-width apart and makes such movements with her buttocks. On the day of such procedures, you need from 3 to 5 (at least twenty squeezing and unclenching in each).
3. Physical therapy begins two weeks after birth. It includes a set of various exercises for the muscles of the lower extremities. They start with stretching - it will strengthen the ligaments and increase the tone of the perineum.
4. Swimming will be useful - it evenly develops the muscles of the body. Unlike other types of stress, it does not cause an increase in pressure on the pelvic organs. Two workouts a week are enough to get the desired effect.
5. Vitamin E and ascorbic acid are antioxidants and are good for vaginal recovery after childbirth. They improve metabolic processes in connective tissue, which makes it possible to quickly eliminate small defects in the walls of the genital organs.

The main problem of women in the postpartum period is overestimation of their condition. Therefore, instead of worrying, it is better to direct your energy to eliminating these small shortcomings.

Damage to the genital organs during childbirth

Since all soft tissues of the perineum are subject to significant pressure, ruptures occur if they are insufficiently elastic. They are typical for those giving birth for the first time - women are often not prepared for childbirth mentally and physically. On average, every sixth birth is accompanied by soft tissue injuries.

Responsibility for ruptures always lies with doctors, since timely assistance was not provided. The reason is always a discrepancy between the size of the birth canal and the child moving through it. Minor injuries are not dangerous and heal on their own within the first week after birth.

Severe ruptures are accompanied by simultaneous damage to neighboring organs - the urethra and rectum. Such injuries require immediate surgery, as they directly threaten the life of the mother. After them, repeated births through natural means are rarely feasible, as their scar deformation occurs.

Treatment of ruptures is usually surgical - immediately after birth, large defects are sutured under local anesthesia. Vaginal injuries are the most cosmetic - the stitch will not be visible externally, since the scars on the mucous membrane are dissolving. If there was an injury to the skin of the perineum, then in any case there will be a scar that will become invisible over time.

To prevent ruptures, a woman in labor must learn to push and relax correctly. For this purpose, breathing exercises are used - this allows you to regulate the pressure on the perineum.

As you know, NEN is a publication that is not ashamed. We do not hesitate to raise sensitive topics and talk about what everyone really always wants to know about, but is afraid to discuss with doctors. We have already told you about the first trip to the toilet after childbirth, and now we decided to talk to you about the female genital organs after childbirth. Spoiler: yes, they will never be the same.

Changes begin already during pregnancy - some women may notice that the color of the labia and perineum (but not all expectant mothers think about it) has become darker. This is explained by the action of hormones that stimulate the production of melanin, a substance responsible, among other things, for pigmentation.

After childbirth, when hormones return to normal, the color of the genitals will change again and become more familiar. So you shouldn’t be afraid of this darkening - it is temporary. During pregnancy, many things change color - freckles may become brighter, and scars may become more noticeable.

Yes, about the scars. Many are afraid that during childbirth they will “tear” the British flag. But firstly, this is far from necessary, and secondly, in many cases, tears and cracks are minimal and do not even require suturing. In addition, it is important to remember that self-confidence, correct behavior during contractions and the care of medical personnel help to avoid injury - but here it depends on your luck, unfortunately.

Natural ruptures often occur due to a combination of factors - for example, they can appear during rapid labor (when a woman’s body does not have time to react to what is happening and is unprepared for the speed at which a child rushes through the birth canal), which takes place in an inconvenient for the woman pose. Unfortunately, ruptures occur mainly when lying on your back, since the pressure on the perineum in this position increases.

The appearance of ruptures or a forced incision - episiotomy - will, of course, affect both the appearance of the genital organs and the sensations after childbirth. The quality of the work of the surgeon who will suture the wound has a big impact on postpartum life - the more delicately the work is done, the higher the chances that you will look and feel down there, almost the same as before giving birth.

And remember that you will not form any “bucket” - these are all urban legends. The vagina is an organ that has an innate talent for stretching and shrinking back. During childbirth, the hormone relaxin helps him with this, making everything more elastic, mobile and soft. It is he who allows a miracle to happen - to bring a whole person through a hole that seems tiny at first glance.

How quickly your vagina will recover from childbirth depends on many factors: your health, fitness level, genetics, and even whether you have the opportunity to give your body time to recover. Of course, the stronger your pelvic floor muscles, the sooner they will return to normal. It will take six to ten weeks for the vagina to return to approximately the same size and shape as before giving birth.

But keep in mind that it is now the era of a new normal for your genitals. They will never be exactly the same as before giving birth. But the good news is that you most likely won't even notice.

The vagina (vagina/colpos) refers to the internal female genital organs; it is a tube about ten centimeters long that connects the external genitalia and the cervix, forming four vaults. Its wall has three layers - mucous, smooth muscle, connective tissue. Together they are about four millimeters thick. Throughout life, the organ undergoes physiological changes. What happens to the vagina after natural childbirth? What is considered normal, how does pathology manifest itself?

The mucous membrane of the genital tract is covered with stratified squamous epithelium, which does not have glands. During puberty, transverse folds form on it, the number of which decreases in proportion to the increase in the number of births. The smooth muscle layer has a medial location and is highly extensible. External - consists of connective tissue, located adjacent to the bladder, urethra, and rectum.

The perineum, especially the inner layer of the pelvic floor, is of greatest importance in maintaining the position of the vagina. It is compressed by the pubic part of the levator ani muscle, which is quite often injured during the passage of the fetal head. The condition of the vagina after childbirth depends on the quality of restoration of the integrity of this levator muscle.

What is the function of the vagina?

The genital tract constantly interacts with the external environment; the likelihood of pathogenic microbial flora entering is high. An obstacle to the colonization of pathogenic bacteria is the physiological tone of the perineal muscles and the self-cleaning of the vagina due to cyclic hormonal changes throughout the menstrual cycle.

The mucous membrane undergoes restructuring within a month - its layer grows in the first phase of the cycle and is rejected in the second. In addition, it produces protective immunoglobulin A, maintains a stable environment for the proliferation of beneficial bacteria (lactobacillus) and is uncomfortable for pathogens.

Lactic acid fermentation rods form a protective film on the walls of the vagina and produce antibiotic-like substances. A decrease in levels during pregnancy leads to a decrease in the amount of nutrients necessary for the normal functioning of lactobacilli. Against this background, the likelihood of colonization of pathogenic microbes and viruses increases.

Recovery stages

During pregnancy and childbirth, the vagina/colpos undergoes restructuring, returning to its original state within three weeks. How does the vagina change during this period?

• tapers;
• becomes shorter;
• redness and swelling of the walls disappear;
• the mucous membrane is restored.

It looks a little wider, with a slightly open entrance, and fewer transverse folds. After the second birth there are even fewer of them. The perineal muscles acquire normal tone by the end of the second week. From the first day for six weeks, lochia is released from the genital tract, which has a bloody appearance during the first three days, gradually turning into bloody and mucous discharge.

The postpartum period is called puerperia, during which time a woman’s body is at risk of infections. Immediately after childbirth, the surface of the uterus is a wide wound, the cervix and vagina are often injured. Remains of membranes and blood clots provide a favorable environment for the proliferation of microbes, tissue resistance and the number of lactobacilli are reduced.

Under such conditions, postpartum ulcers may develop. Predisposing factors are vaginal rupture, emptied, drained hematoma. If there are no complications, after three weeks the situation changes - the number of lactic acid fermentation rods returns to normal. In analyzes of discharge a month after birth, no differences are found; it corresponds to a smear of nulliparous healthy women.

The lumen of the vagina in primigravidas does not return to its original state, it becomes somewhat wider. The capacity of the organ is reduced, swelling, redness, and small abrasions gradually disappear over four days.

The normal course of the puerperal period involves recovery within a month. Why can the process be delayed, what are the reasons?

Manifestation of pathology

If there are deviations from the natural course of labor, the recovery period may take longer. Symptoms that accompany diseases of the genital area and obstetric complications cause anxiety. Women may be concerned about:

• vaginal dryness;
• pain;
• unpleasant odor;
• edema;
• drooping walls;
• copious discharge.

Dryness should not be a concern. This phenomenon can be explained by a temporary physiological decrease in estrogen levels. The sensations are more pronounced in women who are breastfeeding and go away on their own. Unpleasant discomfort during sexual activity is reduced with the help of special lubricants purchased at pharmacies.

Rectovaginal fistulas

An unpleasant odor from the vagina after childbirth can be caused by fistulas - pathological communications between organs that are not provided for by the normal anatomical structure. The cause of this condition may be grade III. The disease is manifested by involuntary discharge of gases and feces from the genital tract, burning, itching, and discharge.

If the sutures fail, it is accompanied by pain in the lower abdomen, perineum, and increased body temperature. Fistula openings are located on the posterior or lateral wall of the vagina, communicate with the lumen of the rectum, and can have a point size or be more than one centimeter in diameter.

The disease is diagnosed during a gynecological examination using speculum and sigmoidoscopy. There are conservative and surgical methods for treating fistulas. The choice of tactics depends on the location, size, condition of the surrounding tissues, pelvic floor muscles, and concomitant pathology. Ointment tampons, sanitation, strengthening therapy, enemas with herbal decoctions are used.

Genitourinary fistulas

Involuntary leakage of urine from the genital tract is a symptom of the disease. Pathology occurs as a result of obstetric trauma during emergency fetal extraction and prolonged standing of the head in one plane of the pelvis. In this situation, a three-tampon test, vaginography, cystoscopy, sonography of the kidneys and bladder, and a gynecological examination are used for diagnosis. In most cases, surgical treatment is performed.

Painful sensations

Pain in the vagina may occur after external and internal sutures are applied to the perineum. The sutured mucosa returns to normal - the swelling goes away in a few days, the suture material located in its thickness dissolves within a month. The tissues should grow together anatomically, without gross scar changes. This period does not always proceed smoothly - the stitches may come apart, the wound may become infected, which is accompanied by pain and discharge with an unpleasant odor.

Depending on the situation, drug treatment is carried out or secondary sutures are applied. Narrowing of the vagina after inadequate suturing leads to painful sexual intercourse.

Colpitis

Itching in the vagina in the postpartum period occurs due to inflammatory processes, allergic reactions, etc. Gynecologists can figure out the problem during an examination. These diseases are characterized by vaginal swelling, hyperemia, and pathological discharge from the genital tract. This symptom is a reason to consult a doctor and examine the discharge for flora and sensitivity to antibiotics.

Based on the examination data and test results, the gynecologist prescribes treatment. If the process is allergic, antihistamines are prescribed. Yeast colpitis is treated with antifungal agents, inflammation of bacterial etiology is treated with antibiotics.

Position anomalies

Pathological childbirth with a large fetus, twins, vaginal delivery operations, perineal ruptures can be complicated by prolapse of the vaginal walls, its prolapse. The causes of the anomaly are:

• excessive pressure on normal anatomical structures;
• muscle weakness even with normal force;
• the presence of defects in the connective tissue fascia - pubocervical and rectovaginal.

The location of the defect determines which walls will fall out. The disorder occupies 28% of the structure of gynecological diseases, appears during reproductive age, and progresses over time. Synonyms for anomalies are prolapse, prolapse. Risk factors are failure of the ligamentous apparatus due to congenital connective tissue dysplasia, hypoestrogenism, birth trauma, metabolic disorders, and age-related changes.

Development options:

1. Prolapse of the anterior wall leads to bladder prolapse, called cystocele.
2. The prolapse of the posterior wall is called a rectocele, since the anterior wall of the rectum (rectum) descends along with the vagina.
3. Posterior fornix prolapse – enterocele.

Prolapse can be felt in the form of a foreign body in the vagina, accompanied by urination disorders, bowel movements, and a feeling of heaviness in the lower abdomen. Upon examination, the mucous membrane of the genital tract looks swollen, with a bluish tint, and has a dry, thin appearance.

Hair loss treatment

Vaginal prolapse has three stages of development - partial prolapse without going beyond the genital slit, external protrusion, prolapse. For minor disorders, it is treated with special therapeutic exercises to strengthen the pelvic floor muscles, physical therapy, and wearing a pessary. In severe cases, surgical treatment is recommended.

During surgical correction, vaginal plastic surgery is performed - anterior colporrhaphy, colpoperineolevatoplasty, colpopexy, synthetic prostheses are used to completely restore the damaged pelvic fascia.

Anterior colporrhaphy is done when the anterior vaginal wall prolapses - a flap of excess tissue is cut out, followed by suturing of the defect. Its fascia is isolated and separate sutures are placed on it. The intervention helps reduce the size of the organ and strengthen the pelvic floor muscles.

During colpoperineolevatoplasty, excess tissue is removed from the posterior wall, and the muscular-connective tissue frame of the pelvic floor is restored. Particular attention is paid to isolating and stitching together the levators—the muscles that lift the anus.

Colpopexy involves fixing the vaginal dome. The operation is performed using vaginal or abdominal laparoscopic access. In this case, the dome is fixed to the sacrospinous or anterior longitudinal ligament of the sacrum, respectively.

The operation to install a synthetic prosthesis is called colpopexy, as well as TVM (transvaginal mesh). The essence of the method is to eliminate all anatomical defects of the pelvic floor using standard methods using mesh prostheses. Located under the connective tissue, the prosthesis duplicates the contour of the vagina, reliably eliminating prolapse without changing the anatomical location of the organ.

Therapeutic exercises

The role of physical therapy (PT) is important for rehabilitation in the postpartum period. It allows the body to recover faster and improve lactation. With its help, posture disturbed after pregnancy is corrected and the perineum is strengthened. The objectives of therapeutic gymnastics are:

• improving blood circulation in the pelvic organs to prevent the formation of blood clots;
• elimination of stagnation;
• stimulation of uterine contractions for proper involution;
• strengthening the muscles and ligaments of the abdominal wall, perineum to ensure the correct position of the internal organs and genital tract;
• activation of metabolism, tone;
• normalization of intestinal and bladder function.

In the normal course of labor, classes begin from the first day of the postpartum period. In the first days, it is recommended to pay attention to them for fifteen minutes, doing eight exercises, repeating each four times. First, they perform finger movements, stretching, rotation of the hands with simultaneous deviation of the feet, and rotation of the torso in bed. From the third day they switch to lifting the pelvis with support on the feet and shoulder blades. Exercises are performed in a horizontal position from the first to the seventh day.

After reducing the size of the uterus, they move to a vertical position, add circular movements of the pelvis, turns and bends of the torso, half-squats, and leg lifts. To achieve a stable positive result, the duration of the course should be up to three months of daily classes.

Prolapse of the genital organs is a problem that women often face after childbirth, because pregnancy is a serious “test” for the pelvic floor muscles. How to fight this disease, which causes significant discomfort to a young mother?

A little physiology

The problem of prolapse of the genital organs arises when the pelvic floor muscles have lost the ability to contract so much that individual organs or parts thereof do not fall into the projection of the supporting apparatus. The whole organ or any of its walls can be displaced.

The pelvic floor is a powerful muscular-fascial layer (fascia (lat. fascia - bandage, strip) - a connective tissue membrane covering organs, vessels, nerves and forming cases for human muscles), which covers the pelvic bones from below. The part of the pelvic floor located between the posterior commissure of the labia and the tailbone is called the perineum.

The pelvic floor provides support for the internal genital organs (uterus, vagina, ovaries and fallopian tubes, as well as the bladder, urethra and rectum), and helps maintain their normal position. The levator ani muscles are of particular importance. When these muscles contract, the genital fissure closes, narrowing the lumen of the rectum and vagina. Damage to the pelvic floor muscles leads to prolapse and prolapse of the genital organs.

The pelvic floor provides support not only for the genitals, but also for the internal organs. The pelvic floor muscles are involved in the regulation of intra-abdominal pressure together with the thoraco-abdominal barrier (diaphragm) and the muscles of the abdominal wall.

Symptoms of genital prolapse

Manifestations of genital organ prolapse (vaginal walls, cervix, uterine body) are varied. With complete prolapse of the uterus, women complain of a feeling of fullness or a foreign body in the vagina, nagging pain or a feeling of heaviness in the lumbar region. Symptoms usually disappear when lying down, are absent or less pronounced in the morning and increase during the day, especially if the patient spends a lot of time on her feet.

More often, symptoms of dysfunction of the bladder and/or rectum come to the fore. From the urinary system, there may be difficulty urinating, congestion in the urinary system with possible infection (initially - in the lower parts (urethra, bladder), and then, as the process progresses, in the upper parts - the kidneys). This phenomenon can serve as the beginning of the development of a disease such as pyelonephritis - inflammation of the kidneys. In this case, pyelonephritis often manifests itself as a sluggish course, accompanied by dull pain in the lumbar region, a slight increase in body temperature, weakness, fatigue, lack of appetite, nausea, vomiting, anemia, frequent, painful urination, changes in urine (urine becomes cloudy due to which contains bacteria, leukocytes).

Another symptom of bladder dysfunction is stress urinary incontinence (during coughing, sneezing, loud laughter). From the intestinal side, complications include dysfunction of the colon in the form of the development of constipation and colitis (an inflammatory disease of the colon, characterized by abdominal pain of a cramping nature; diarrhea alternating with constipation; mucus secretion; weakness and loss of appetite). The most painful complication, which is extremely rare, is gas and fecal incontinence.

Prolapse of the genital organs can be manifested by weak sensations during intercourse, the inability of the vagina to tightly envelop the penis, the entry of air during intercourse and its release with characteristic sounds.

Menstrual function changes, which is characterized by the appearance of pain during menstruation (the uterus changes position, making the outflow of menstrual blood difficult) and an increase in the amount of menstrual blood. Often such women suffer from infertility, although pregnancy is considered quite possible.

It must be said that with slight prolapse of the vaginal walls, a woman may not have any complaints, but with age the prolapse can progress.

Thus, with prolapse and prolapse of the genital organs, the quality of life of a woman changes for the worse due to the involvement of the organs of the urinary system, intestines, and symptoms from the genital organs. In addition to changes in the quality of life, the likelihood of complications is also unpleasant.

Causes of genital prolapse

Functional failure of the ligamentous apparatus of the internal genital organs and the pelvic floor (muscular frame) occurs under the influence of one or more factors:

• Post-traumatic pelvic floor injury(most often occurring during childbirth). Severe perineal ruptures, as well as improperly sutured ruptures or infection of even a correctly sutured rupture in the postpartum period will contribute to vaginal prolapse. Small tears of the perineum, as well as episiotomies, do not lead to incompetence of the pelvic floor muscles, since there is no damage to the muscles themselves. Prolapse of the walls of the pelvic organs after normal childbirth is explained by stretching of the muscles or damage to the tissue of the perineum and, to a greater extent, is a consequence of a violation of the nervous regulation of the sphincter muscles - circular muscles that “lock” the urethra and anus, preventing the exit of urine and feces, respectively. The risk of prolapse increases with surgical delivery (using forceps) and with, since the incompetence of the ligamentous apparatus worsens with age. In addition, with repeated births, the weight of the fetus is usually greater. This is especially clearly seen in women who have given birth to large children, as well as in multiple pregnancies. If the passage of the head through the vulvar ring is difficult or ineffective, the doctor decides to perform an episiotomy - an incision in the perineum, since when the muscles of the perineum are excessively stretched by the fetal head, weakness of the pelvic floor muscles is formed.
• Failure of connective tissue structures, manifested by prolapse of other internal organs.
• Violation of the synthesis of steroid hormones, including sex hormones.
• Chronic diseases, accompanied by disruption of metabolic processes and microcirculation. Such diseases, for example, include diabetes mellitus, metabolic syndrome (a condition characterized by obesity, high blood pressure, impaired tissue perception of insulin), hereditary metabolic diseases and others.
• Hard physical labor.

Types of genital displacement

Here is a classification of downward displacement of the vagina and uterus according to severity.

1. Downward displacement of the vagina:

• prolapse of one of the vaginal walls or both; but the walls do not extend beyond the entrance to the vagina;
• the walls of the vagina extend outwards from the vaginal opening. The close anatomical connections between the bladder and the vaginal wall contribute to the fact that, against the background of pathological changes in the pelvic floor muscles, there is a prolapse (as if sagging into the vaginal lumen) of the anterior vaginal wall, which entails the wall of the bladder, forming a cystocele (bulging of the bladder in vaginal lumen). The cystocele also increases under the influence of its own pressure in the bladder, resulting in a vicious circle. A rectocele (bulging of the rectum into the vaginal lumen) is formed in a similar way;
• complete vaginal prolapse, often accompanied by uterine prolapse.

Downward displacement of the uterus:

• the cervix is ​​lowered to the level of the entrance to the vagina;
• with partial (beginning) prolapse of the uterus or its cervix, the latter, when straining, protrudes beyond the genital slit, and such incipient uterine prolapse most often manifests itself with physical stress and increased intra-abdominal pressure (straining, coughing, sneezing, lifting weights, etc.);
• incomplete uterine prolapse: not only the cervix, but also part of the body of the uterus is identified outside the genital slit;
• with complete prolapse of the uterus, the organ is completely identified outside the genital slit.

Treatment of prolapse and prolapse of internal genital organs

If the defects of the supporting structures are minor and the internal genital organs do not fall below the plane of the vaginal opening when straining (usually there are no complaints), treatment is not carried out. The exception is patients with stress urinary incontinence who are scheduled for surgical treatment. In other cases, the treatment tactics for prolapse and prolapse of the internal genital organs are determined individually. It can be conservative (use of uterine rings made of synthetic material) or surgical.

Uterine rings are installed in the vagina if there are contraindications for surgical treatment (for example, concomitant somatic pathology of various organs and systems - heart, lungs, kidneys, etc., elderly patient). They can be silicone and remain in the vagina for several months. Other uterine rings, which are often made of rubber, should be removed by patients at night to prevent bedsores (death of tissue as a result of constant pressure of the ring on the vaginal walls). After selecting the uterine ring, the patient is taught to insert and remove it independently. The frequency of examination of such patients is determined individually, usually the first examination is carried out after a week, and then, in the absence of complaints, every 4-6 months.

If the defects of the supporting structures are minor, no treatment is performed.

A radical solution to the problem of genital prolapse is surgical treatment. The purpose of the operation is to permanently eliminate all defects in the supporting structures. Many operations have been developed to pursue this goal. Typically these operations are performed through the vagina.

Hysteropexy(fixation of the uterus to something) is performed for women planning to have children in the future, if conservative treatment is ineffective. The best treatment results are obtained by fixing the uterus to the anterior longitudinal ligament of the sacrum, and the uterosacral ligaments are sutured to the sacrum not directly, but using a synthetic mesh or a section of fascia.

If the vaginal walls prolapse, colporrhaphy and perineoplasty are performed - an operation that consists of excision of “excess tissue” and strengthening of the perineal muscles by suturing their legs. Women who have undergone colporrhaphy undergo a cesarean section in the event of a subsequent pregnancy.

If a woman has urinary incontinence, without genital prolapse, then a method such as plastic surgery with a free synthetic loop - TVT/TVT-O - can be used. The intervention eliminates an unpleasant symptom (urinary incontinence), but does not eliminate prolapse of the vaginal walls. The operation lasts 20-30 minutes under local anesthesia. During this operation, the doctor passes a special tape made of synthetic polypropylene material under the urethra through three small incisions in the suprapubic area. The tape supports the urethra and prevents involuntary urination when intra-abdominal pressure increases. The surgeon checks the effectiveness of the intervention directly during the operation. The patient is asked to perform several coughing movements, and if no urine leakage occurs, then the operation is completed. If necessary, the doctor changes the tension of the loop.

In cases of complete uterine prolapse in old age, vaginal hysterectomy is performed (i.e. complete removal of the uterus through the vagina). During this operation, anterior or posterior vaginal plastic surgery, correction of intestinal hernia, etc. can be performed simultaneously from the same access.

Prevention of genital prolapse

In the late 1940s, gynecologist Arnold Kegel developed a basic perineal muscle development program designed to treat women with urinary incontinence. Training the pelvic floor muscles helps with many dysfunctions of the genitourinary organs not only in women, but also in men (urinary incontinence, etc.), helps regulate sexual functions (erection, ejaculation and orgasm) and treat diseases of the rectum (, fecal incontinence and etc.). The exercises are isometric (contraction of a muscle without changing its length) contractions of the striated muscle fibers that make up the pelvic floor.

Even if you do not have signs of weakness in the pelvic floor muscles, their additional development improves blood supply to the pelvic organs and restores their anatomy. The development of this muscle group is the prevention and treatment of stagnation of venous blood, chronic inflammatory processes and prolapse of the vaginal walls, and therefore the prevention and treatment of pelvic pain, genital hypoplasia, lack of sensitivity during sexual activity, problems with pregnancy, etc. Similar exercises are used to prepare for childbirth and enhance self-control of orgasm.

A woman can identify the muscles of the perineum as follows: sit on the toilet, spread your legs. Try to stop the flow of urine without moving your legs. The muscles you use to do this are your perineal muscles.

Consists of three parts:

• Slow compressions. Tighten your muscles as you did to stop urination. Slowly count to three and relax.
• Abbreviations. Tighten and relax your muscles as quickly as possible,
• Pushing out. Push down moderately, as you would for bowel movements or childbirth. This exercise causes tension in the perineal and some abdominal muscles. You will also feel the anus tightening and relaxing. Start your workout with 10 slow squeezes, 10 contractions and 10 push-ups, 5 times a day. After a week, add 5 exercises to each, continuing to perform them five times a day. Add 5 exercises to each exercise every other week until you have 30. Then continue to do at least 5 sets of exercises per day to maintain tone. You can do the exercises almost anywhere: while walking, watching TV, sitting at your desk, lying in bed.

When you first start exercising, you may find that your muscles don't want to remain tense during slow contractions. You may not be able to perform the contractions quickly or rhythmically enough. This is because the muscles are still weak. Muscle control improves with practice. If your muscles get tired mid-exercise, rest for a few seconds and continue. While doing the exercises, remember to breathe naturally and evenly. Do one to two hundred compressions every day. This physical therapy allows you to:

• stimulate compensatory-adaptive reactions in damaged tissues of the closing apparatus of the bladder and urethra in order to normalize its activity;
• improve trophism (nutrition) of the pelvic organs, eliminate uncontrolled contractions of the detrusor - smooth muscles (not related to the perineal muscles) that close the bladder;
• strengthen the muscular-ligamentous apparatus of the pelvic floor, muscles of the urethra, pelvis, abdomen and back;
• promote the restoration of anatomical and topographic relationships of the pelvic organs;
• have a general strengthening effect on the body.

Irina Garyaeva, obstetrician-gynecologist, Kyiv