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Thirty million American women suffer from symptoms
of vaginal relaxation and stress urinary incontinence.
Many women have difficulty controlling their urine in certain
situations like walking or coughing or they may notice changes
in their bowel habits. These two symptoms may be related to
a common set of problems that may occur as a result of childbirth,
aging, sagging, or a combination of all three. Grouped together
these problems are referred to as pelvic relaxation.
Many women suffer unnecessarily from conditions involving
pelvic relaxation. Appropriate diagnosis and treatment will
often restore patients to a life free of the aggravations
and discomforts associated with pelvic relaxation.
Various forms of pelvic relaxation require treatment that
is usually covered by insurance. The pelvic organs include
the vagina, uterus, bladder, and rectum. These organs are
held in position by three types of supports: 1) muscles, 2)
sheets of tissue called fascia 3) and ligaments. When these
supports become damaged, one or more of the pelvic organs
may sag and occasionally even protrude outside the vagina.
These are called pelvic support defects.
During childbirth as the baby passes through the birth canal,
the muscles, fascia, and ligaments separate and may be weakened.
This weakening gradually worsens and, in later years, may
cause the pelvic organs to drop from their normal positions.
Occasionally, this weakening of the muscles and tissue may
occur in women who have never had children. In these women,
the cause may be:
Inherited weakness of the supporting tissues
- Unusual strain placed on the supporting tissues by a chronic
cough
- Unusual increases in abdominal pressure
- Obesity
The general symptoms associated with pelvic
relaxation depend on which organs are affected. Often there
is a feeling of heaviness or fullness. Small or moderate amounts
of urine may be lost with normal physical activities such
as laughing, coughing, walking, or running. In more advanced
and rare cases a mass may actually protrude from the vaginal
opening. Based on the organ or organs involved, pelvic support
defects can be defined more specifically as:
- Cystocele
- Urethrocele (most of the time the cystocele and urethrocele
occur in combination - cystourethrocele)
- Rectocele
- Enterocele
- Uterine prolapse
A cystocele occurs when the bladder falls or descends
from its normal position. The most common symptom associated
with cystocele is difficulty in completely emptying the bladder.
This can be associated with bladder infections. Large cystoceles
can cause the bladder to overfill and allow small amounts
of urine to leak. Leakage is most common during walking or
coughing.
A urethrocele usually occurs in conjunction with
a cystocele. Both of these conditions result in involuntary
loss of urine, particularly when there is increased pressure
in the abdomen caused by walking, jumping, coughing, sneezing,
laughing, or sudden movements.
Rectoceles happen when the rectum bulges into or
out of the vagina. Rectoceles usually occur as a result of
injuries sustained during childbirth. With a weakened or bulging
rectum, bowel movements become more difficult.
An enterocele is the bulging of small intestines
into the back wall of the vagina.
Uterine prolapse occurs when the uterus falls or
is displaced from its normal position. There are varying degrees
of severity depending on the descent. This produces a general
feeling of heaviness and fullness.
The diagnosis of these problems includes a thorough history
and physical examination. Other test depending on the circumstances
include a "Q-tip" test, urodynamic studies (painless
fifteen to twenty minute computerized bladder and urethra
functional studies), urethrocystoscopy (instrument used to
evaluate the inside of the bladder and urethra), X-rays of
the urinary system.
For all practical purposes, definitive treatment
is surgical correction of the specific defects.
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