CAUSES OF GENITAL PROLAPSE

Аннотация

Genital prolapse is a general name for disorders in the ligamentous apparatus of the vagina and uterus, which cause the prolapse of the internal genital organs or their descent, for example, prolapse of the uterus, prolapse of the uterus, prolapse of the vagina, prolapse of the vagina. The frequency of certain types of prolapse of the pelvic organs in women under fifty years of age in Russia varies and ranges from 15 to 30%. And by the age of fifty, this figure increases to 40%. Among older women, prolapse and prolapse of the pelvic organs are even more common. Their frequency reaches 50-60%. Key words: genital prolapse, hypoestrogenism, menopause, vitamin D, surgical interventions. Genital prolapse, or prolapse and drooping of the internal genital organs, is a polyetiological disease, in the development of which physical, genetic and psychological factors play a role. Analysis of statistical data shows that in the Republic of Uzbekistan, every fifth patient who consults a gynecologist presents complaints related to prolapse and drooping of the internal genital organs. As the pathological process develops, functional disorders of the bladder and rectum worsen, leading not only to physical and moral suffering, partial or complete loss of ability to work, but in some cases making the lives of these women socially difficult [1, 13]. For many years, there has been a lively debate about the causes of prolapse and pelvic hernia. Despite the efforts of many generations of gynecologists, surgeons, anatomists and doctors of other specialties, there is still no consensus on the etiology and pathogenesis of this condition. A number of authors believe that prolapse and pelvic hernia develops due to insufficiency of the pelvic floor muscles and should be considered as a type of pelvic hernia. Insufficiency of the pelvic floor muscles is caused by a decrease in the tone of the muscular-fascial structures or their defects, which can be traumatic and non-traumatic (functional) [3, 9, 22]. Factors of traumatic pelvic floor muscle insufficiency: Pregnancy and childbirth (injuries to the soft birth canal, rapid and rapid labor, use of various obstetric aids during childbirth, large fetus). About a third of all women examined indicate birth trauma as the cause of pelvic floor insufficiency symptoms. 324 Aprel, 2025-Yil There is an opinion about the influence of the duration of the second stage of labor on the risk of pelvic floor muscle insufficiency in the future. According to some data, any pregnancy lasting more than 20 weeks, regardless of the method of delivery, increases the risk of pelvic floor pathology [10]. Chronic increase in intra-abdominal pressure (constipation, heavy physical labor, prolonged static position, presence of abdominal tumors). Women with a more pronounced degree of prolapse are 3 times more likely than patients with minimal manifestations of the disease to note this as the main etiologic factor. heavy physical labor [11, 19]. Mechanical trauma to the muscular-fascial structures of the pelvis, not associated with pregnancy and childbirth (surgical interventions for gynecological pathology) [21]. Traumatic damage to the centers and pathways of the nervous system responsible for regulating the muscular-fascial structures of the pelvic floor and pelvic organs [21]. Risk factors non-traumatic insufficiency pelvic: Connective tissue dysplasia (varicose veins, hernias of various localizations, etc.). Recently, there have been increasing reports of prolapse of the genitals of young women after vaginal delivery, after cesarean section, and even in nulliparous women. These facts suggest that, first of all, pathological changes in the connective tissue, and only then childbirth and obstetric trauma to the pelvic floor contribute to the occurrence of pelvic organ prolapse in young women. The theory of systemic connective tissue dysplasia as the leading cause of prolapse is becoming increasingly widespread. In this case, childbirth and trauma are considered as provoking factors against the background of widespread undifferentiated forms of connective tissue dysplasia. Prolapse of the genitals in women of reproductive age after a single physiological birth and with a preserved hormonal background in the absence of factors contributing to an increase in intra-abdominal pressure is a frequent manifestation of generalized dysplasia of the connective tissue fabrics. [2, 11]. Hypoestrogenism (menopause, castration). It has been established that insufficient concentration of sex steroids potentiates prolapse of the pelvic organs, since the perineal tissues contain a high content of receptors to estrogens and progesterone. In addition, hypoestrogenism, leading to impaired blood circulation and microcirculation of the pelvic floor tissues, aggravates the development of this pathology [21]. Damage to the centers and pathways of the central nervous system responsible for regulating the muscular-fascial structures of the pe