Vaginal relaxation syndromes – cystoceles, urethroceles, enteroceles, and rectoceles

Pelvic relaxation syndromes cover cystoceles, urethroceles, enteroceles and rectoceles, which are forms of prolapse whereby an organ protrudes into the vaginal canal. These prolapses often occur together. Organs ‘fall out’ of the vagina (prolapse) when the connective tissue (fascia) is weak (due to connective tissue disorders or age), damaged due to gravity, or with increased abdominal pressure, for example during childbirth. The ring at the top of the vagina is weakened.

Prolapses feel worse later in the day after activities, and are better after lying down all night, first thing in the morning. Early signs include stress urinary incontinence (peeing when you laugh or cough or lift something heavy), changes in bowel habits (having to sit on a different angle to get it out), or being able to touch your cervix. More obvious signs are your insides coming out your vagina, pain, and bulging.

There are six types of pelvic relaxation syndromes, with each specific to an area, which occur due to laxity of the ligaments, muscles and fascia that support the organs. This includes the pelvic floor muscles. It is estimated that almost 10 per cent of women with a pelvic relaxation syndrome require surgery to correct it.

These pelvic relaxation syndromes can occur due to trauma, like childbirth, obesity, ageing, pelvic surgery, injury, connective tissue disorders, collagen disorders, or straining for long periods of time. There could also be anatomical abnormalities or malformations of tissue, pressure coming down from the abdomen due to respiratory or abdominal organ problems, sacral nerve disorders, and connective/collagen tissue problems.

Often prolapse is in more than one area.

     Types of pelvic relaxation syndromes

  1. Prolapse (vaginal, uterine)
  2. Cystocele
  3. Urethrocele
  4. Enterocele
  5. Rectocele

Learn how to strengthen your pelvic floor muscles

     Types of prolapse

  1. Cystoceles – bladder – pubocervical fascia weakness (often associated with uterine prolapse, either due to a tear or weak connective tissue), where the bladder prolapses down
  2. Urethroceles – urethra (almost always accompanied by a cystocele, called a cystourethrocele) – pubocervical fascia weakness, where the urethra also prolapses
  3. Enteroceles – small intestine and peritoneum – pubocervical fascia and rectovaginal fascia weakness, tissue between uterus and rectum, or the bladder and rectum after hysterectomy (often found with rectoceles), where part of the small intestine pushes down into the perineal area
  4. Rectoceles – the rectum – problems with the levator ani muscles between the rectum and vagina, particularly during childbirth (often found with enteroceles), the rectum pushes into the perineal area, creating a sack

     Degrees of prolapse

1st Degree – entry into the upper vagina
2nd Degree – to the vaginal entrance (introitus)
3rd Degree – organs come out of the vaginal entrance

     Symptoms of prolapse

  • Feeling of pelvic or vaginal fullness or pressure
  • Sensation of organs falling out
  • Organs may bulge out of the vagina, possibly all the time, or just during coughing or sneezing
  • Painful sex (dyspareunia)
  • Leaking urine when coughing or sneezing (stress urinary incontinence)
  • Frequent bladder/urinary tract infections

     Why prolapse happens

Cystourethrocele most commonly occurs due to the pubocervical fascia – the stuff that holds us in place – is weakened for some reason. Enteroceles most often occur after a hysterectomy. The fascia that holds the contents of our abdomen becomes weak in a certain area, or all over, and organs fall into the vagina.

     What is fascia?

If you have ever cooked with raw chicken, you would have seen the veins of white tissue that run between muscles. This is fascia. It is a 3-D netting of fibrous tissue that holds our whole body in place, to a greater or lesser degree. When it gets stretched out or weakened, the tissue it holds in place falls, since it is not strong enough.

Additionally, if you have ever had a ‘Chinese burn’ (where you grab someone’s wrist with both hands, and twist the skin in opposite directions, mostly kids do this!), that burning feeling is caused by the stretching of your fascia. It can get quite tight, but it can also get loose.

     Treatment for prolapse

The usual treatment may include pessaries, pelvic muscle exercises and possibly surgery. Mesh has also become popular, as a support structure, but other surgeries may involve closing gaps in connective tissue.

Another possible treatment might be use of painless, surgery-free laser or radiofrequency treatments to boost the natural support structures of the body. (You would need a doctor who operates a ThermiVa radiofrequency device, or the Juliet or Mona Lisa laser.)