Lowering of the reproductive organs

Lowering of the reproductive organs (descensus genitalis) is a change in the position of the uterus and vagina as a result of muscle stretch, but not only! It is also a lowering of the urinary tract, small intestine or rectum, and sexual dysfunction. Not always all the listed changes occur at the same time, sometimes you may not even notice them or suspect other conditions. For this reason, it's worth learning more about it, consulting a specialist and getting help, because not every change of this type requires plastic surgery.

We asked Natalia Stopa-Harasiuk, M.D., a urogynecological therapist accredited by the Polish Urogynecological Society, about the problem of lowering the reproductive organs.

Causes of lowering of the reproductive organs

There are a number of factors contributing to abnormalities in the statics of the reproductive organs. Among the most common causes that cause these anatomical abnormalities is damage to the muscular, fascial and nerve structures within the pelvis. This damage can be a consequence of mechanical damage, such as childbirth, but also surgery within the pelvic floor. Decreases can also be caused by aging processes of the body, caused by hormone deficiency (estrogen, androgen), which results in disorders of the structure and function of proteins responsible for the mechanical strength of the pelvic floor tissues.

You may simply be predisposed to lowering of the reproductive organs. It can be favored by specific anatomy, congenital disorders of collagen synthesis, and promoting factors: chronic cough, obesity, performing heavy physical labor now or in the past. According to available epidemiological data, 50% of multiparous women have abnormal statics of the reproductive organs, but only 10% require surgical intervention.

Symptoms of static disorders of the pelvic floor

One of the most troublesome symptoms of lowering of the reproductive organs is discomfort during urination: frequent urination, urgency, a feeling of incomplete emptying of the bladder, difficulty in starting to urinate.

Defecation disorders are equally troublesome : constipation, a feeling of incomplete defecation, discomfort during defecation, a feeling of pushing against the stool.

Other symptoms reported by patients include a feeling of heaviness, pain in the lower abdomen, perineum or sacral region of the spine, abdominal discomfort, a palpable spherical foreign body in the vagina. These, too, may be consequences of lowering of the reproductive organs, which you may not even connect with this problem.

What are the types of lowering of the reproductive organs

Based on the degree of downgrading, we distinguish:

Stage I - the progenital part of the lowering does not exceed the vaginal vestibule
Stage II - the lowering of the uterus or vagina reaches the vaginal vestibule
Stage III - the progenital part of the lowering exceeds the vaginal vestibule and becomes visible externally (partial or complete prolapse of the reproductive organ)

Based on the type of defect, we distinguish:

• urethrocele - damage to the ligamentous structures supporting the urethra
• cystocele - damage to the bladder-vaginal fascia
• enterocele - is damage to the sacroiliac ligaments
• Rectocele - is an injury to the rectovaginal fascia
• In addition to the above, defects include lowering of the uterus and vagina

Disorders of the statics of the reproductive organs require specialized diagnosis and an appropriate therapeutic approach. Health awareness and the desire to preserve the quality of life of women is increasing, so more and more ladies who struggle with the above problem are seeking specialized help. In this case, making a proper diagnosis requires knowing the exact reason for a given dysfunction, which is why the examination and therapy is carried out by a specialist in urogynecological physiotherapy.

This is a field whose main task is to restore normal tensions, especially in the pelvic area. And the whole process should be based on the assumption that a woman's pelvis is made up of interrelated structures and that there is a close relationship between its structure and function.

Lowering of the reproductive organs - treatment

The most important thing is to correctly identify the type and stage of the disease. Secondly, the age of the patient is taken into account. For 1st and 2nd degree (IIa) lowers, conservative treatment consisting of pessary therapy and therapy with a urogynecological physiotherapist is recommended. Key to treatment is the introduction of pelvic floor exercises and education on how to change daily habits.

In postmenopausal patients, topical estrogen therapy is used. In the presence of urgency, bladder conditioning, pelvic floor exercises are indicated.

When conservative treatment is not possible, depending on the severity of the lowering of the reproductive organ, bladder or rectum, appropriately selected surgical methods are used. Operations are performed from vaginal, laparoscopic or abdominal access.

After undergoing surgery, it is worthwhile to take advantage of post-operative physiotherapy consultation. The basis of proper recovery is to educate the patient on how not to engage the abdominal compression, how to perform daily activities in a way that does not strain the pelvic floor muscles in order to learn to activate these muscles.

Source:

1. Intersdisciplinary guidelines of the Polish Society of Urogynecology for the diagnosis and treatment of pelvic lowering; https://ptug.pl/
2. Interdisciplinary guidelines of the Polish Society of Urogynecology on physiotherapeutic management of functional disorders of the pelvic organs; https://ptug.pl/
3. Etiology and risk factors for female reproductive organ static disorders and urinary incontinence Curr Gynecol Oncol 2019, 17(2), p. 69-77
4. Risk factors for pelvic floor defects in women qualified for reconstructive surgery - a Polish multicenter study; Gynecol. Pol. 2010, 81, 821-827