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VAGINAL RELAXATION AND RELATED FUNCTIONAL PROBLEMS

Millions of women suffer from symptoms of vaginal relaxation and stress urinary incontinence. Many women have difficulty controlling their urine in certain situations or 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, ageing or a combination of both. Grouped together these problems are referred to as pelvic relaxation. Appropriate diagnosis and treatment will often restore patients to a life free of the aggravations and discomforts associated with pelvic relaxation.

The goal of this section is to acquaint you with the various forms of pelvic relaxation as well as their causes, symptoms and treatment. 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 for various reasons, 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:

Cystocoele.
Urethrocoele (most of the time the cystocoele and urethrocoele occur in combination - cystourethrocoele).
Rectocoele.
Enterocoele.
Uterine prolapse.

A cystocoele occurs when the bladder falls or descends from its normal position. The most common symptom associated with cystocoele is difficulty in completely emptying the bladder. This can be associated with bladder infections. Large cystocoeles can cause the bladder to overfill and allow small amounts of urine to leak. Leakage is most common during activity such as walking or bouts of coughing.

A urethrocoele usually occurs in conjunction with a cystocoele. Both of these conditions result in, among other things, involuntary loss of urine, particularly when there is increased pressure in the abdomen, caused by walking, jumping, coughing, sneezing, laughing, or sudden movements.

Rectocoeles occur when the rectum bulges into or out of the vagina. They usually occur as a result of injuries sustained during childbirth. With a weakened or bulging rectum, bowel movements become more difficult.

An enterocoele 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 felling of heaviness and fullness, or a sense that the uterus is falling out.

The diagnosis of these problems includes a through history and physical examination. Other tests depending on the circumstances include a "Q-tip" test, urodynamic study (a painless 15-20 minute computerised bladder and urethra functional study), urethrocystoscopy (instrument used to evaluate the inside of the bladder and urethra), and X-rays of the urinary system.