| Abstract: |
The pelvic floor, including pelvic floor muscles, ligaments and other structures that support the uterus, bladder, vagina, and rectal area, often changes after pregnancy. This article discusses conditions that women may experience (called 'pelvic relaxation disorders') and strategies to rebuild the pelvic floor to help prevent future complications. The disorders include cystocele, a protrusion of the bladder behind the wall of the vagina; rectocele, a protrusion of the rectum that bulges into the vagina; enterocele, when the small intestine bulges into the top and upper back portion of the vaginal wall; and uterine prolapse, when the pelvic muscles and ligaments are stretched or weakened and the uterus descends partway or all of the way into the vaginal canal. Pregnancy is not the only cause of these conditions; normal aging, including diminishing levels of the female hormone estrogen, can also be a cause. Other risk factors include being overweight, repeated heavy lifting, or straining with bowel movements. Diagnosis can include patient history, physical exam, a defecating proctogram (x ray monitoring of defecation), and dynamic magnetic resonance imaging (MRI). Treatments can include Kegel exercise (to strengthen the pelvic floor muscles), reducing the strain on pelvic organs, a vaginal pessary to hold the uterus in place, and surgical repairs. Surgery must be individually tailored, taking into consideration all the pelvic organs that may be affected. One sidebar explains how to do Kegel exercises. 2 figures. |