Appearance and other features of the vagina after childbirth, restoration of the perineum of a woman who has given birth. What changes occur to the female organs after childbirth and how to avoid complications Type of female organs after childbirth

It is impossible to bear and give birth to a child without changes in the woman’s body and its individual organs.

The vagina, from which, in fact, the stage of conception and the subsequent birth of a baby begins, is no exception. It participates in many actions of the physiological process that completes pregnancy, so it inevitably transforms.

However, the special structure of the vagina does not allow it to change its shape; it undergoes changes of a different nature. A young parent feels undesirable changes in her general well-being and intimate life.

Rehabilitation is different for every woman. It is necessary to familiarize yourself with all the nuances so that the woman’s internal reproductive organ is restored as quickly as possible.

What changes are happening

The vagina is a muscular-elastic tubular formation located in the woman’s pelvis. It has different lengths for each specific situation.

In a normal state, its size rarely exceeds 10 cm, and in a state of sexual arousal - about 15 cm. As it became clear, nature has taken everything into account. The average size the male genital organ fully complies with these parameters.

Many "experts" internal structure And morphological characteristics female body They claim that the size of the vagina is determined by the woman’s height. The taller the female, the longer her genitals will be.

This is a legend, unconfirmed scientifically. The parameters of the vagina depend entirely on the location and structure of the organs abdominal cavity. According to statistics, there are often cases when a woman of short stature was the owner of a deep vagina or vice versa.

Most men are inclined to believe that before the birth of the child, the vagina of their significant other was small and tight, and after pregnancy its size became wider. This is far from true.

The vagina does not change its size after childbirth. The outline and shape of the surface of its walls undergo changes. Thus, there is no reason for concern, since all transformations that occur with a woman’s elastic genital organ return to normal over time.

Let's look at possible reversible complications in more detail.

Stretching

As the fetus passes through it, the relief of the vaginal walls becomes smoother, and the layer of longitudinal and transverse muscles is stretched. Under such circumstances, this is considered a normal and natural process.

Over the course of two months, the elasticity of muscle structures returns to normal due to contraction.

Edema

Swelling does not cause discomfort in a woman and goes away without medicinal assistance in 3-4 days.

Cracks and abrasions

This consequence occurs after every second birth. If a physiological specialist assumes that the walls of the vagina may be ruptured, then in the process of uncontrolled contractions of the uterus, an episiotomy is performed - a surgical incision of the perineum.

This will allow you to control the stages of tissue structure divergence. The birth process opens the vagina wide, its walls are injured, as a result of which they become a thick bloody color with a bluish tint.

The surface of the walls is covered with cracks and shallow wounds. It will take no more than two weeks to restore such damage.

The swelling will disappear, the cracks will undergo fibroplasia (healing phase), and the walls will acquire a pink-peach hue.

Changing the relief of the walls

The relief of the walls of the woman's genital organ changes. It is for this reason that men have an opinion about increasing the size of the vagina.

A nulliparous woman has a pronounced relief of the walls, and in new mothers it is evened out and smoothed out. Therefore, during sexual intercourse, men feel the expansion of the woman’s muscular channel, which causes some discomfort and incomplete satisfaction. The problem is solved by selecting a suitable pose.

Such changes in the structure of the organ affect absolutely all women in labor. The only difference is the rehabilitation period, some disorders and a number of uncomfortable sensations that can develop as a result of the aggravating consequences of the movement of the fetus and placenta.

Under such circumstances, the slightest delay can result in serious complications, so consult a doctor and promptly medication assistance- the right decision on the path to rapid recovery.

Learn more about myths and prejudices about the vagina after childbirth in the video.

Deviations from the norm

Unpleasant and uncomfortable sensations in the vaginal area after birth process, unfortunately, not uncommon.

In some cases, they turn into serious problems for women that require proper treatment. To avoid this, the parent must know how to quickly eliminate negative manifestations.

Pain

Painful sensations After childbirth, women often experience. In some they have a pronounced character, in others pain syndrome develops less intensively.

This symptom is caused by a rupture of the walls or perineum, which was subsequently stitched up. The pain is concentrated in the area where the suture material passes, since it is almost impossible to apply it without affecting the nerve endings.

After 14 days, the bundles of nerve fibers adapt and return to normal, and discomfort in the genital area ceases to cause concern.

Rotten smell

Rotting of sutures, inflammatory processes in the genital hollow organ can cause unpleasant putrid smell from the vagina.

In this case, you should not self-medicate. A specialist examination and long-term drug therapy are required.

Decreased sensitivity

After childbirth, many women note a loss of sensitivity or a slight decrease in it.

Given undesirable consequence occurs due to laxity of the vaginal walls and destruction of nerve endings. It will take some time for the nerve fibers to fully recover.

In this case, there is no need to panic; you need to be patient, and the woman will again be able to react to a certain external influence.

Omission

In some cases, the muscle structures of the pelvic diaphragm become severely weakened. This makes it impossible for them to retain organs.

Doctors call this phenomenon prolapse of the vagina after labor, which has several degrees of severity:

• incomplete prolapse of the vaginal walls(there is no exit beyond its aisles);
• prolapse with protrusion outward;
• absolute(complete) loss.

Discharge

After the birth process, the vagina is restored by the release of characteristic discharge, which should not frighten the woman.

They look like lochia (specific mucus), which includes dead cells and tissue of the uterine endometrium, as well as blood fragments. Postpartum mucus comes out in stages, namely over the course of two months.

In the first phase recovery period lochia can be confused with the onset menstrual cycle. They come out in abundance and have a characteristic blood-purple color.

Over time, the mucus changes color to a yellowish color and comes out less intensely, gradually disappearing altogether.

If, after 8 weeks after the birth of the baby, lochia continues to come out, without medical care not enough. The doctor will determine the true cause of the pathology and prescribe proper treatment.

Dryness

The recovery period of a woman in labor is often accompanied by vaginal dryness, which causes a lot of discomfort.

This manifestation is due to a decrease in steroid hormones produced by the ovaries.

Most often, dryness is diagnosed during lactation. Over time, this undesirable consequence disappears on its own.

Itching

If a woman feels itching in the vagina, it is better to consult a doctor without delay. This symptom may be due to an allergy to synthetic sutures or an antiseptic used during the process of the fetus leaving the uterus.

Under any circumstances, solving the problem is the doctor's responsibility. He will conduct a certain series of studies and prescribe effective therapy.

More often, an undesirable manifestation is eliminated by douching. The situation becomes aggravated if the itching sensation is accompanied by a foul odor and lochia. This indicates that the inflammatory process has begun.

Recovery

The duration of vaginal recovery depends on many factors:

• did it take place purulent discharge, provoking the formation of scar tissue on the walls;
• did you perform future mom specially designed exercises that strengthen the muscular structures of the vagina;
• what condition the woman is in mentally and physically;
• fetal head size;
• quality of suture material;
• difficulty of childbirth.

If the birth took place quickly or for a long time, and the fetus was large, the number and depth of the tears increases.

If during the delivery process the obstetrician had to resort to sutures, especially in the perineal area, then the woman will experience discomfort for up to 12 weeks until the sutured nerve endings adapt.

The birth stretch of the vagina is restored within 2 months.

For a quick postpartum period, experts give several recommendations:

1. At the first stage of rehabilitation, the traditional form of intimate communication must be changed. The release of secretions through an open cervix can pose a risk of infection.
2. The perineum must be washed with running water using detergents. intimate hygiene after every visit to the restroom.
3. Change postpartum pads every 4-5 hours.
4. Replenish your diet with foods that have laxative properties. It is better to exclude flour products. If difficulties with emptying do arise, wax and glycerin will help solve the problem.
5. To ensure that the seams receive proper ventilation, underwear must be removed during the day.
6. Areas of tissue scarring need to be treated antiseptic at least twice a day.
7. As soon as sexual intercourse resumes, it is advisable to use moisturizing lubricants for a while so as not to injure the walls of the vagina.
8. During night sleep, it is necessary to free the body from the obligatory fabric elements that create favorable hygienic conditions (panties, bikini) and sleep on a sterile diaper.
9. After 4 weeks of rehabilitation, a set of Kegel exercises is recommended, which will help strengthen the muscle layers of the vagina.

Kegel exercises are performed as follows:

1. tense the vaginal muscles for 10-15 seconds;
2. relax the genital organ for the same time.
3. perform 3 passes for each manipulation.

The training is carried out daily. This will allow a woman’s body to return to normal, establish sexual relationships and fully experience the joy of motherhood.

If labor activity led to the use of a surgical incision of the perineum, a woman is prohibited from:

• lift heavy objects;
• walk quickly;
• sit down on a hard surface.

Only after two weeks is it allowed to sit on the buttock located opposite the incision. For a sitting position, it is better to use an elastic circle, this will promote adequate scarring.

Watch the video about exercises for the vagina after childbirth.

During pregnancy, the entire female body, 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 normal natural process, thanks to which the 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 dysfunction 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 gets worse, contact your gynecologist to determine probable illness 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. Do not renew under any circumstances intimate life ahead of schedule. Otherwise, this will lead to infection inside the uterus, which can develop into serious disease. . Its treatment can prohibit breastfeeding and also provoke infertility.
• Charger. We repeat, this is the most effective method not only raise the genital cleft, but also 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 operation is restored endocrine system the microflora will restore itself, and discomfort will leave.

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.

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

Let's start with the fact that change will actually happen. Nothing irreversible and nothing terrible, you just need to be prepared for the fact that some things will be unusual for you.

Refrain from sudden movements and jumping

Yes, you will have to sneeze while standing and wear pads for a while. This is what some women have to put up with after giving birth - stress urinary incontinence. This means that urine will leak during vigorous exercise. This does not mean that you will suffer from this disease for the rest of your life, but now you will have to pay more attention to your intimate muscles. Dr. Alyssa Dweck, a New York-based gynecologist and author of V is For Vagina, recommends Kegel exercises, which have proven effective in strengthening the pelvic floor muscles.

There may be gaps

Birth injuries often occur during childbirth. If soft fabrics The perineum is not elastic enough and ruptures may occur. This most often occurs during the first birth, especially if the fetus is too large or labor lasts too long.

If the perineum has been damaged, sutures are placed - usually with absorbable suture material.

Popular

During childbirth, the vaginal vestibule and labia minora are most often injured. Bad news: Often such injuries are quite painful. A young mother should not sit down; she must adhere to a diet and change pads frequently. The good news is that the perineum is usually well supplied with blood, which means that healing also occurs quite quickly.

But the disease is easier to prevent than to treat. And here Kegel exercises and yoga classes for pregnant women will save you. Check if you have inflammation of the tissues of the vagina and vulva - they should be treated! Important role The psychological preparation of the young mother also plays a role.

Blood and bruises

Do not be afraid that bruises will appear there and there will be heavy bleeding comparable to intense menstruation. They can last for several weeks, and you need to be prepared for this: stock up on pads with maximum absorbency.

Dry as the desert

No matter how excited you are, you may still have problems with insufficient lubrication after birth. Your hormonal levels will not immediately return to their previous state, and if you are ready to return to the bedroom with your husband, do not forget to run to the nearest pharmacy and buy lubricant.

All the colors of the rainbow

Don't be alarmed if you find that your vulva has taken on a different color - this is normal. Usually the color of the external genitalia darkens, especially around the labia and the space between the vagina and anus. This is again related to hormonal levels, as soon as they return to normal, everything between your legs will also return to its usual shades.

Strange smell

Starting from the period immediately after childbirth and up to 6-8 weeks after, you may have discharge with a not very pleasant odor - the so-called “lochia”. There can be quite a lot of them. But if they are very unpleasant, run to the doctor, there may be an infection.

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 is not sufficiently restored after childbirth. These include birth injuries to the mother - ruptures of the vagina or perineum. But even after them it is possible full recovery– 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 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 distinguishes the anterior and back wall, 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 longitudinal direction. This feature allows you to significantly increase the volume of the vagina during pregnancy and childbirth.
• IN 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.

Women live in their genitals 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 the smooth muscle tissue and 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 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 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

During normal pregnancy (in antenatal clinic) and labor complications are extremely rare. 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 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 the restoration of the vagina 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 emotional condition women, 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 physiotherapy, as well as vitamin therapy.

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 complex various exercises on the muscles lower limbs. 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 exposed significant pressure, then if their elasticity is insufficient, ruptures occur. 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 size mismatch birth canal and a child moving along them. 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 ways are rarely feasible, as their cicatricial 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. Methods used for this breathing exercises– this allows you to regulate the pressure on the perineum.

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 supports the internal genital organs (uterus, vagina, ovaries and fallopian tubes, as well as the bladder, urethra and rectum), helps preserve them normal position. Of particular importance are the muscles that lift anus. 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 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, slight increase in body temperature, weakness, fatigue, lack of appetite, nausea, vomiting, anemia, frequent, painful urination, changes in urine (urine becomes cloudy due to the fact that it 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 quality of life, the likelihood of developing 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). Vaginal prolapse will be caused by severe perineal ruptures, as well as improperly sutured ruptures or infection of even a correctly sutured rupture in the postpartum period. 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. Drooping of the walls pelvic organs after a normal birth is explained by muscle strain or damage to the tissue of the perineum and is even more a consequence of a violation nervous regulation 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 a violation metabolic processes, microcirculation. Such diseases include, for example, diabetes, metabolic syndrome (a condition characterized by obesity, increased blood pressure, impaired tissue perception of insulin), hereditary diseases metabolism 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. Close anatomical connections between bladder and the vaginal wall contribute to the fact that against the background pathological changes 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 into the 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 loss 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, which is planned surgery. 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 from synthetic material) or surgical.

Uterine rings installed in the vagina if there are contraindications for surgical treatment (for example, concomitant somatic pathology various organs and systems - heart, lungs, kidneys, etc., elderly age sick). 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 long time eliminate all defects in 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 it is ineffective conservative treatment. The best treatment results are obtained by fixing the uterus to the anterior longitudinal ligament the sacrum, and the sacrouterine ligaments are sutured to the sacrum not directly, but with the help of 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 unpleasant symptom(urinary incontinence), but the prolapse of the vaginal walls is not eliminated. 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. Ribbon supports urethra and prevents involuntary urination with increased intra-abdominal pressure. 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 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. Pelvic floor muscle training helps with many dysfunctions genitourinary organs not only in women, but also in men (urinary incontinence, etc.), promotes the regulation of sexual functions (erection, ejaculation and orgasm) and the treatment of diseases of the rectum (fecal incontinence, 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, hypoplasia of the genital organs, lack of sensitivity during sexual activity, problems with pregnancy, . 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 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