Pelvic relaxation is a common condition in which there is weakness of  the suporting structures of the female pelvis, thereby allowing descent (prolapse) of one or more of the pelvic organs through the “ potential space” of the vagina. These organs include the following: urethra,  bladder, rectum, small intestine, uterus, and vagina (vaginal vault) itself.

The urethra and bladder are anatomically situated above the  “roof” or top wall of the vagina, the cervix and uterus at the very deepest part of the vagina (the apex), and the rectum below the “floor” or bottom wall of the vagina.  Thus, when prolapse develops,  one or more of the following may occur: the urethra and bladder may descend into the vaginal roof, the cervix and uterus may descend down the vaginal canal, and the rectum may ascend into the vaginal  floor. Pelvic relaxation can vary from minimal descent—causing few, if any, symptoms—to major descent—in which one or more of the pelvic organs literally prolapse outside the vagina at all times and cause significant symptoms. The degree of descent often varies with position and activity level, increasing with the assumption of the upright position and with exertional activities, and decreasing with lying down and resting.

Pelvic relaxation usually results from a combination of factors  including multiple pregnancies and vaginal deliveries (especially deliveries of large babies), menopause, hysteretomy, aging, weight gain, and any condition associated with chronic increases in abdominal pressure,  such as asthma and bronchitis (chronic wheezing and coughing), seasonal allergies (chronic sneezing), or constipation (chronic straining). Vaginal birth is probably the single most important factor in the development of prolapse. Passage of the large human head through the female pelvis causes tissue trauma, separation or weakness of connective tissue attachments, and alterations in the geometry of the pelvis . It is  unusual for women who have not had children or who have delivered by caesarian section to develop significant pelvic relaxation.

Because the female genital tract and urinary tract are intimately  related (due to their anatomic proximity as well as a common embryological origin), pelvic relaxation can cause significant changes in normal urinary function.  These range from stress urinary incontinence ( a spurt-like leakage of urine from the urethra associated with an increase in abdominal pressure such as occurs with sneezing, coughing, etc.), to an inability to empty the bladder unless one manually pushes back the  prolapsed bladder.   It is important to know that such symptomatic pelvic relaxation can be surgically corrected. The goal of this pelvic reconstructive surgery is to restore normal anatomy and function,  Non-operative treatment of pelvic relaxation is used when symptoms are minimal or when surgery cannot be performed because of infirmity and frailty. Such conservative treatment options include change of activities,  management of constipation and other circumstances that increase abdominal pressure, pelvic floor exercises, hormone replacement, and pessaries.   Pessaries  are mechanical devices that are  inserted into the vagina to act as a “strut” to help provide pelvic support. The side effects of pessaries are vaginitis (vaginal infection and discharge), extrusion (the inability to retain the pessary in proper position),and the “unmasking” of stress incontinence.


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