The face of female pelvic organ bulge

  Female pelvic organ bulges, also known as pelvic floor defects or pelvic floor support tissue laxity, are a series of disorders caused by weakness of the pelvic floor support structures and consequent displacement of the pelvic organs due to various etiologies. These problems occur because of damage to the musculofascial of the female pelvic floor. In the female pelvis, there are organs such as the bladder and urethra, the reproductive system, and the rectum, which are soft tissues and open downward, in order from front to back.  And the abdominal cavity has a certain pressure, what to carry these organs, control their opening and closing? They are like a hammock, relying on good elasticity and contraction to maintain normal function. If they lose their elasticity and contraction ability, the normal position of pelvic organs, the pleasure of sex and normal defecation and urination will become difficult to maintain. Specifically, the vagina and uterus tend to prolapse, and the bladder, urethra or rectum may also bulge. Patients often feel a sensation of falling in the pubic area and back pain. Vaginal prolapse combined with bladder bulge can cause urinary tract infection and stress urinary incontinence, and combined with rectal bulge, it can cause difficulty in defecation, which brings a lot of inconvenience to life. With age and obesity, the condition will get worse.  Pelvic organ prolapse is very common in middle-aged and elderly women, with a prevalence rate of about 40%. The factors that influence this include age, childbirth, alcohol consumption, waist circumference, constipation, chronic pelvic pain, history of respiratory diseases, history of gynecological diseases, history of pelvic surgery and menstrual status, etc. The most important risk factors are childbirth and age. The effect of childbirth is that the damage to the pelvic floor musculofascia caused by pregnancy and childbirth is not well recovered after childbirth. During pregnancy, as the weight of the uterus continues to increase, the pressure from the pelvic and abdominal cavity becomes greater and gradually points vertically to the pelvic floor muscles and lasts longer, which tends to cause relaxation of the pelvic floor muscles. The pelvic floor ligaments also become lax during late pregnancy due to increased collagen lysis as a result of the physiological changes of pregnancy.  During childbirth, perineal laceration and lateral perineal incision cause more direct damage to the pelvic floor tissues. The meshwork of pelvic floor muscle fibers and fascia is torn, and the pelvic floor nerves are also damaged to some extent. If you don’t take proper care of your pelvic floor muscles after childbirth and increase abdominal pressure before they recover, such as constipation, heavy work and heavy lifting, you will easily suffer from pelvic floor dysfunction. The influence of the age factor is mainly manifested in women as they age, the level of estrogen in the blood decreases, the collagen content and composition of the pelvic floor muscles, fascia and uterine ligament tissues will lead to significant changes, these factors lead to older women pelvic floor muscles, fascia and uterine ligament tension is reduced.  Although pelvic floor dysfunction in women is not “life-threatening”, it seriously affects the quality of life and health. With the improvement of living standard, people pay more and more attention to the quality of life, and the consultation rate of pelvic floor dysfunction gradually increases. However, there are still some patients who are embarrassed to seek medical attention and suffer from it, and some of them mistakenly believe that it is a temporary reaction, which makes many conditions that can be cured or controlled delayed.  First of all this disease can be prevented, such as postpartum intervention is the best time to prevent pelvic floor dysfunction. Once it occurs, with reasonable treatment, such as a humane, individualized, and comprehensive treatment plan based on the patient’s degree of symptoms, the majority of patients can have their symptoms effectively improved. Those with mild or no symptoms, mainly manifesting as vaginal laxity and affecting the quality of sexual life, can be treated by means of pelvic floor muscle exercises. Like other health exercises, pelvic floor exercises can be divided into two types: freehand and apparatus. Manual training is to instruct the patient to do contraction and relaxation exercises of pelvic floor muscles in a conscious and rhythmic manner to strengthen the pelvic floor muscles. Apparatus training involves tightening the vagina with a small “dumbbell”-like apparatus to prevent its prolapse.  For severe symptoms, surgery may be used if conservative treatment is not effective. In the past, these diseases were treated by traditional anterior and posterior vaginal wall repair and cervical hysterectomy, but the recent results of traditional vaginal wall repair are 30-60% and the recurrence rate is high, while cervical hysterectomy is cruel to young women, who lose their precious uterus. Once recurrence occurs, there is no good way to treat it. Recently, the new technology, the basic point of treatment is to achieve functional recovery with anatomical recovery, considering connective tissue, muscles, nerves, etc. as an overall dynamic system, and repairing the damage to muscles and ligaments with correct surgery, slings, patches, etc., to achieve anatomical and functional reconstruction, and to make the patient suffer less, recover faster, eliminate symptoms and restore function as soon as possible.  For example, a mid-urethral sling is used to treat stress urinary incontinence caused by increased abdominal pressure such as coughing, sneezing, running and jumping; the pelvic floor suspension (PROLIFT procedure) uses a specially made mesh made of polypropylene and is butterfly-shaped and implanted in the anterior and posterior vaginal walls. The procedure is simple and makes up for the shortcomings of traditional surgical methods, with short operation time, minimal trauma, quick recovery, low chance of recurrence, no need to remove stitches after surgery, long-lasting results, preservation of vaginal function, restoration of satisfactory sexual life, and few complications. For patients with pelvic floor organ prolapse combined with stress urinary incontinence, a mesh can be used to solve the problem in one operation. It is very effective and economical. For young patients who desire to preserve their uterus, this procedure can treat their pelvic floor organ prolapse and stress urinary incontinence while satisfying their desire to preserve their uterus.