Pelvic Relaxation

Definition

Pelvic relaxation is a weakening of the supportive muscles and ligaments of the pelvic floor. This condition, which affects women and is usually caused by childbirth, aging, and problems with support, causes the pelvic floor to sag and press into the wall of the vagina.

Description

The pelvic floor normally holds the uterus and the bladder in position above the vagina. When the pelvic floor becomes stretched and damaged, these organs can sag into the vagina, sometimes bulging out through the vaginal opening. A sagging uterus is referred to as a uterine prolapse, pelvic floor hernia, or pudendal hernia. A sagging bladder is referred to as a bladder prolapse, or cystocele. Other organs, such as the rectum and intestine, can also sag into the vagina as a result of a weakened pelvic floor.

Causes and symptoms

Childbirth increases the risk of pelvic relaxation. Other causes include constipation, a chronic cough, obesity, and heavy lifting. Some women develop the condition after menopause, when the body loses the estrogen that helps maintain muscle tone. Mild pelvic relaxation may cause no symptoms. More severe pelvic relaxation can cause the following symptoms:

• an aching sensation in the vagina, lower abdomen, groin or lower back
• heaviness or pressure in the vaginal area, as if something is about to "fall out" of the vagina
• bladder control problems that worsen with heavy lifting, coughing, or sneezing
• frequent urinary tract infections
• difficulty having a bowel movement

Diagnosis

A thorough pelvic exam can help diagnose pelvic relaxation, as can tests of bladder function.

Treatment

Exercises called Kegel exercises can strengthen pelvic floor muscles and lessen the symptoms of pelvic relaxation. These exercises involve squeezing the muscles that stop the flow of urine. The pelvic floor can also be strengthened by estrogen supplements. Physicians sometimes prescribe the insertion of a supportive ring-shaped device called a pessary into the vagina, to prevent the uterus and bladder from pressing into the vagina. Sometimes surgery is recommended to repair a sagging bladder or uterus, and sometimes surgical removal of the uterus (hysterectomy ) is recommended. Patients are often advised to adhere to a high-fiber diet to reduce the strain of bowel movements, maintain a moderate weight, and avoid activities that strain the pelvic floor. They are sometimes prescribed medications to help control urination and prevent leakage.

Prognosis

Mild cases of pelvic relaxation can sometimes be reversed through Kegel exercises, while severe cases usually do not respond to exercise or estrogen therapy, but usually require pessary support or surgery.

Prevention

To limit stress on the pelvic support system, women are advised to maintain a normal body weight, limit heavy lifting, and avoid unnecessary straining to have bowel movements.

KEY TERMS

Cystocele— Bulging of the bladder into the vagina.

Cystourethrocele— Bulging of the bladder neck into the vagina.

Enterocele— Bulging of the intestine into the upper part of the vagina.

Kegel exercises— Pelvic muscle exercises that strengthen bladder and bowel control.

Pessary— A device inserted into the vagina to support sagging organs.

Rectocele— Bulging of the rectum into the vaginal wall.

Uterine prolapse— Bulging of the uterus into the vagina.

Vaginal prolapse— Bulging of the top of the vagina into the lower vagina or outside the opening of the vagina.

Resources

ORGANIZATIONS

American College of Obstetricians and Gynecologists. 409 12th St., S.W., P.O. Box 96920, Washington, DC 20090-6920. 〈http://www.acog.org〉.

American Foundation for Urologic Disease. 1128 North Charles Street, Baltimore, MD 21201. (800) 242-2383. 〈http://www.afud.org〉.

National Association For Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER. 〈http://www.nafc.org〉.

National Kidney and Urologic Diseases Information Clearinghouse. 3 Information Way, Bethesda, MD, 20892. NIH Publication No. 97-4195. (800) 891-5390. 〈http://www.niddk.nih.gov/health/kidney/nkudic.htm〉.