Relaxed vaginal outlet occurs when the tissues that separate the vagina from the rectum become weak or damaged, causing the pelvic organs—such as the bladder, urethra, uterus, rectum, and small intestines—to slip into, or protrude out from, the vagina. The condition can also cause variety of additional issues, outlined below.
What Causes Relaxed Vaginal Outlet?
A number of factors increase a woman's risk of the condition. These include:
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Pregnancy — During later stages of pregnancy, a woman's expanding uterus places excessive weight on the pelvic diagram and pelvic floor. This can weaken or tear the muscles, causing relaxed vaginal outlet and pelvic organ prolapse.
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Childbirth — Labor and medical procedures done during the process (such as when surgical instruments widen the vaginal canal), can strain the pelvic floor muscles and loosen the vaginal walls.
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Age and menopause — As women age, their estrogen levels decline. The decline causes the vaginal walls to weaken and thin (a condition called vaginal atrophy), something that can lead to inflammation and tears.
Additional factors that increase risk of relaxed vaginal outlet include connective tissue abnormalities, neurogenic dysfunction of the pelvic floor, obesity, and strenuous physical activity.
Symptoms of Relaxed Vaginal Outlet
While some women experience no symptoms, in those who do the most common indication is constipation. Additional symptoms include:
- Strong, sudden urges to urinate
- Urine leakage while coughing, laughing, or exercising (stress incontinence)
- Involuntary urination
- Fecal incontinence
- Perineal discomfort
- Sexual dysfunction
Conditions Associated with Relaxed Vaginal Outlet
Damaged or weakened pelvic-support muscles and tissues can also lead to other problems, including:
- Cystocele — when the wall between the bladder and the vagina weakens, causing the bladder to drop into the vagina
- Rectocele — a tear in the rectovaginal fascia, the tissue that separates the rectum and vagina, which can cause the front wall of the rectum to slip into the back wall of the vagina
- Urethral hypermobility — when the bladder neck and urethra drop below the pelvic floor muscles
- Enterocele — when the small intestines and peritoneum (layer of tissue that lines the abdominal and pelvic cavities) protrude into the vagina
- Perineal relaxation — relaxed perineum muscles (located between the vagina and anus) can change the vaginal angle
- Uterine prolapse — when the uterus and cervix descend into the vagina
Diagnosis of Relaxed Vaginal Outlet
A physical exam is the best method to diagnose relaxed vaginal outlet and its related conditions. During this exam, in which a physician inspects the vaginal muscles, a patient must have a moderately full bladder and strain the bladder muscles forcefully. This increased pressure forces any prolapsed organs forward, allowing the doctor to diagnose and assess the condition's severity.
MRI and other imaging studies are not typically needed to diagnose pelvic prolapse. But if symptoms persist despite a negative physical exam, imaging studies can sometimes pick up on something that a physical exam can't.
Relaxed Vaginal Outlet Treatment
Treatment for relaxed vaginal outlet depends upon the condition's severity, and include medical therapy and surgery.
References
Abet E, Lehur P, Wong M, Rigaud J, Darnis E, & Meurette G. (2012). Sexual function and laparoscopic ventral rectopexy for complex rectocoele. Colorectal Disease;14(10):e721-e726.
Cespedes, RD. (2011). The Treatment of Posterior Compartment Vaginal Defects. Urologic Clinics of North America; 38(1): 17-23.
Shull BL. (1993). Clinical evaluation of women with pelvic support defects. Clin Obstet Gynecol;36(4):939-51.
