Pelvic Relaxation
What is pelvic relaxation?
The supports for the uterus and bladder can be weakened by the effects of childbearing, age, smoking, obesity, and other factors. Sometimes only the uterus comes down, and other times the bladder and the top of the vagina come with it. These changes can cause feelings of pressure in the pelvis, discomfort during sex, and a noticeable bulge of tissue at the opening of the vagina.When the supports for the bladder and bladder stem (urethra) are weakened due to childbirth, the bladder often leaks urine when a person is coughing or laughing. Some women notice that they leak urine during or following sexual intercourse, a problem they are often too embarrassed to mention to anyone, including their doctor. Sometimes bladder infection, irritation or irritability can cause the problem, in which case medications are often helpful.
In other situations, control of urine can only be restored by reparative surgery to support the bladder and bladder neck.The first step in treating these problems is a good history and physical examination, including assessment of pelvic supports, and instruction on how to contract and relax the pelvic floor muscles. In many cases, exercises done at home to strengthen the pelvic floor muscles will help a great deal, and for others, pelvic floor biofeedback may help as well. When these fail, or when the examination findings are not clear-cut, then special testing of the bladder may add new information about the causes of the leakage.When only the uterus has come down, then it can be returned to a normal position using laparoscopic techniques for uterine suspension.
These are most appropriate for women who still wish to have more pregnancies. The long-term success of these suspension procedures is less well understood. If child bearing is complete, then the best results are often accomplished by removing the uterus vaginally and suspending the top of the vagina with additional sutures. Alternatively, the uterus can be removed laparoscopically, with or without removing the cervix as well. (See supracervical hysterectomy).
When surgery is needed to correct dropping of the bladder, there are several different ways to accomplish this. We have particular experience in laparoscopic approaches, which have shorter recovery times than “open” surgeries done through large incisions.If you would like to better understand how these approaches might help you, consider making an appointment for examination and consultation.
Retroverted “tipped” uterus
In most women (about 8 out of 10), the top of the uterus leans toward the front of the body. In the remainder, it may lean more toward the back. In some women whose uterus is in this leaning back or “tipped” position, menstrual pain may be increased, and there may be more discomfort deep inside during sexual intercourse. Aside from these concerns, the uterus being in the “tipped” position is not an illness. By itself, it does not decrease fertility or make the appearance of any of the gynecologic diseases more likely.
In many cases, the discomforts experienced during sex can be avoided by adjusting body position during sex. We often recommend the “cross-wise” position as the most likely to be comfortable.