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Congenital malformations of the birth canal, ie, absence or obstruction of the vaginal canal, double uterus or vagina, missing vagina and uterus (Rokitansky, Kuster, Hauser, Meyer syndrome).
Cystocele
A protrusion of the front wall of the vagina above which is a sagging bladder. This condition is a form of pelvic hernia. It is frequently associated with urinary incontinence.
Enterocele
A form of pelvic herniation where the upper part of the vagina is pushed down by the pressure of the loops of the intestines.
Fistulas
Abnormal connections from one organ to another. For example, an abnormal tract between the bladder and the vagina, resulting in uncontrolled loss of urine from the vagina or a tract between the rectum and vagina, causing passage of gas, or fecal material, in an uncontrolled manner, from the vagina.
Fibroid tumors
Fibroids, or leiomyomas, are solid tumor growths arising from the walls of the uterus. They may be very small and unrecognizable on physical examination, or extremely large and may fill the whole abdomen, becoming larger that a uterus at full term. They are usually benign and are stimulated to grow under the influence of estrogen. They rarely occur before the age of 20, and will tend to reduce in size after the menopause. The symptoms of fibroids may produce pelvic pain, from pressure on adjacent organs, excessive bleeding because of proximity of the fibroid underneath the uterine lining. Fibroids are the single largest indication for the performance of hysterectomy.
Injuries of the birth canal, following surgical procedures or vaginal deliveries resulting in protusions, bladder or rectal dysfunction.
Minimally invasive surgical techniques, with shorter operating times, shorter time in the hospital, and shorter convalescence. In some cases vaginal operations may be appropriately done in place of more extensive abdominal procedures.
Pelvic Organ Prolapse
(Uterine prolapse, cystocele, dropped bladder, rectocele, enterocele)
The above terms refer to pelvic hernias through the opening of the vagina. As with other hernias from the abdominal wall, as inguinal or umbilical, these conditions present with bulges , or protrusions, from the vaginal opening that are easily recognized by the individual, are usually painless, and associated with discomfort, change in urinary, bladder or bowel, or sexual function. While these conditions occur more commonly in older women who have had multiple vaginal births, they are seen also in younger women recently delivered. These conditions in mild cases may be treated with muscle exercises and precautions regarding lifting or certain forms of exercise. Modifications of bowel functions and preventions of chronic constipation may be useful.
In some pregnant women, or those severely physically debilitated, a ring, or pessary may be introduced into the vagina to restore the vaginal walls to their more normal position, while the woman is erect. As these conditions do not improve with time, except for those women who delivered during the past 3-6 months, surgical treatments offer the best chance for a permanent cure and restoration of normal pelvic functions.
A variety of operative approaches are available, from above through the abdominal wall, or below through the vagina, with or without laparoscopic assistance, and with or without the placement of synthetic materials. As with all procedures for hernia repairs, claims of 100% success are unrealistic. Yet, published figures from the gynecologic literature stating that 1/3rd of women having surgery will require another operation during their lifetime for the correction of recurrences are in our experience overstated. Ten to 15% may be a more realistic estimate of recurrences requiring re-operation.
It has been our practice, in the majority of cases, to repair these conditions by a vaginal approach, taking approximately 1 to 2 and a half hours. Either general or spinal/epidural anesthesia is required. Complications include bleeding requiring transfusion, infections requiring additional antibiotics beyond the routinely given dose during surgery, or injury to bladder, bowel, or major blood vessels. These complications are not expected to happen routinely, and occur in less than 1% of cases. The need for blood transfusion may be as high as 3 percent.
Prolapse of uterus
Descent of the uterus from its normal position in the vagina, producing a sensation of pelvic discomfort, aggravated by being in the upright position.
Rectocele
This condition reflects a protrusion, or bulge from the vagina of the back wall of the vagina, behind which is the rectum. This protrusion usually develops from a weakness of the tissues between the rectum and vagina. It may occur with difficulties with defecation.
Sexual dysfunction
Infrequently may be amenable to medical or surgical methods.
Stress Incontinence
Involuntary loss, or leakage, of urine to the point of embarrassment or social disability is an increasingly common condition among seniors. Coughing, sneezing, lifting heavy objects, jogging, or certain exercises that induce sudden bursts of increasing pressure within the abdominal cavity result in a downward displacement of the bladder and urethra, preventing efficient retention of urine.
Urinary incontinence
Urinary incontinence is a symptom of a variety of conditions, related by the occurrence of involuntary leaked of urine to a degree imposing restrictions on social, working, and personal activities.
Leakage of urine may be caused by an irritation of the bladder musculature from an infection in the urinary tract. This conditions results in frequency of urination, in excess of 8 times per day, also associated frequently with burning and pain on urination. A strong urge to urinate, in association with urinary leakage also may be caused by urinary infection or an irritation of the urinary bladder from an excess of certain dietary or chemical stimulants, or an irritation of the bladder from a descent or protrusion into the vagina.
When portions of the bladder or urethra descend from their normal positions the urinary leakage may occur with sudden increases in intra abdominal pressure, changing positions, running, or doing exercises.
Urogynecologist
A Urogynecologist is an Obstetrician/Gynecologist who has specialized in the care of women with pelvic floor dysfunction. The pelvic floor consists of the muscles, ligaments, connective tissue, and nerves that help support and control the rectum, uterus, vagina, and bladder.
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