Pelvic Floor Injury

Pressure from pregnancy, labor, and birth can cause your pelvic floor — the muscles, ligaments, and connective tissue of your pelvis that support your bladder, uterus, and rectum — to become weak or stretched out. This can cause prolapse, or dropping, of the organs and tissue in the pelvic area. Symptoms tend to occur when the woman is upright and to disappear when she is lying down. For some women, sexual intercourse is painful. Mild cases may not cause symptoms until a woman is older.

Conditions caused by a pelvic floor injury include:

  • Rectocele. This occurs when the rectum protrudes into the back wall of the vagina. It can make it difficult to have a bowel movement or cause a feeling of constipation. Some women need to apply perineal or vaginal pressure in order to have a bowel movement.

  • Enterocele. This happens when the small intestine and lining of the abdominal cavity sag down between the uterus and rectum and can cause a sense of fullness, pressure, or pain in the pelvis or lower back.

  • Cystocele. This occurs when the bladder protrudes into the front wall of the vagina and can cause stress incontinence (urine leakage during coughing, laughing, or sneezing), or it can cause you to leak urine if your bladder becomes too full. It can also be difficult to feel that your bladder is empty, and increases the chances that you'll develop a bladder infection.

  • Uterine prolapse. This is when the uterus sags down into the vagina. It can cause pain in the lower back or over the tailbone, or if the prolapse is severe, pain during walking, difficulty with urination or bowel movements, or bleeding sores on the cervix.

  • Prevention

    Kegel exercises help keep the pelvic floor strong and can help prevent or treat pelvic-floor injuries. Also, maintaining a healthy weight during and after pregnancy can reduce stress and strain on the pelvic floor and reduce the chances of this type of injury. During birth, fundal pressure, which is when a caregiver pushes on your uterus to move the baby down the birth canal; forceps or vacuum extraction; giving birth lying flat on your back; or coached pushing, as opposed to pushing when you feel the urge, can all increase the chances that you'll experience a pelvic-floor injury.

    Treatment

    Kegel. Kegel, Kegel. For severe injuries, a device called a pessary may be used to support the pelvic organs. Estrogen suppositories or cream are another potential treatment. In some cases, surgery may be needed, but usually this won't happen until you've decided not to have any more children.

    Essential

    Remember how to do a Kegel exercise? It's so important that the directions bear repeating: Gently tighten your perineal muscles as if you were trying to stop urinating. Slowly pull the muscles up as tightly as you can — it may help to visualize an elevator going up a shaft — hold for a few seconds, and slowly release. Repeat often.

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