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Rectocele
In gynecology, a rectocele ( ) or posterior vaginal wall prolapse results when the rectum bulges ( herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of pelvic organ prolapse, such as enterocele, sigmoidocele and cystocele. Although the term applies most often to this condition in females, males can also develop it. Rectoceles in men are uncommon, and associated with prostatectomy. Signs and symptoms Mild cases may simply produce a sense of pressure or protrusion within the vagina, and the occasional feeling that the rectum has not been completely emptied after a bowel movement. Moderate cases may involve difficulty passing stool (because the attempt to evacuate pushes the stool into the rectocele instead of out through the anus), discomfort or pain during evacuation or intercourse, constipation, and a general sensation that something is "falling down" or "falling out" within the p ...
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Obstructed Defecation
Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of the rectum with or without an actual reduction in the number of bowel movements per week. Normal definitions of functional constipation include infrequent bowel movements and hard stools. In contrast, ODS may occur with frequent bowel movements and even with soft stools, and the colonic transit time may be normal (unlike slow transit constipation), but delayed in the rectum and sigmoid colon. Definitions and terminology Definition and classification of constipation Constipation is usually divided into two groups: primary and secondary. Primary constipation is caused by disrupted regulation of neuromuscular function of in the colon and the rectum, and also disruption of brain–gut neuroenteric function. Secondary constipation is c ...
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Vagina
In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vaginal opening and hymen, vaginal introitus is normally partly covered by a thin layer of mucous membrane, mucosal tissue called the hymen. The vagina allows for Copulation (zoology), copulation and birth. It also channels Menstruation (mammal), menstrual flow, which occurs in humans and closely related primates as part of the menstrual cycle. To accommodate smoother penetration of the vagina during sexual intercourse or other sexual activity, vaginal moisture increases during sexual arousal in human females and other female mammals. This increase in moisture provides vaginal lubrication, which reduces friction. The texture of the vaginal walls creates friction for the penis during sexual intercourse and stimulates it toward ejaculation, en ...
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Enterocele
An enterocele is a herniation of a peritoneum-lined sac containing small intestine through the pelvic floor, between the rectum and the vagina (in females). Enterocele is significantly more common in females, especially after hysterectomy. It has been suggested that the terms enterocele and sigmoidocele are inaccurate, since hernias are usually named according to location and not according to contents. However, the terms are in widespread use. As such, enterocele, peritoneocele, sigmoidocele, and omentocele could be considered as types of cul-de-sac hernia. Classification * Posterior enterocele (develops in the rectovaginal space, also termed the pouch of Douglas or the cul-de-sac). * Anterior enterocele (develops in the vesicovaginal space). ** Retains the full thickness of the anterior vaginal wall. ** Lacks vaginal wall (or very thin and ulcerated vaginal wall). Anterior enterocele is rare. It may occur after cystectomy or hysterectomy. In these cases, the anterior wall of ...
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Sigmoidocele
Sigmoidocele (also known as pouch of Douglas descent) is a medical condition in which a herniation of peritoneum containing loops of redundant sigmoid colon descends (prolapses) into the rectouterine pouch (in females), between the rectum and the vagina. This can obstruct the rectum and cause obstructed defecation syndrome. Classification Sigmoidocele may be internal if it is only detectable on defecography, or external if it detectable without imaging and associated with a rectocele or rectal prolapse. It is a type of posterior compartment prolapse. Sigmoidocele may be classified according to size relative to the pubococcygeal line.The "pubococcygeal line" (PCL) is a reference line which may be drawn on defecography. It extends from the inferior (lower) border of the pubic symphysis to the last coccygeal joint. See Bordeianou ''et al.'' 2018. * Small: less than 3 cm between pubococcygeal line and the most inferior (lowest) point of the hernial sac. * Moderate: 3–6  ...
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Pelvic Organ Prolapse
Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions into the vagina. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. Injury incurred to fascia membranes and other connective structures can result in cystocele, rectocele or both. Treatment can involve dietary and lifestyle changes, physical therapy, or surgery. Types * Anterior vaginal wall prolapse ** Cystocele (bladder into vagina) ** Urethrocele (urethra into vagina) ** Cystourethrocele (both bladder and urethra) * Posterior vaginal wall prolapse ** Enterocele (small intestine into vagina) ** Rectocele (rectum into vagina) ** Sigmoidocele * Apical vaginal prolapse ** Uterine prolapse (uterus into vagina) ** Vaginal vault prolapse (descent of the roof of vagina) – after surgical removal of the uterus hysterectomy Grading Pelvic organ prolapses are graded either via the Baden–Walker ...
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Fecal Incontinence
Fecal incontinence (FI), or in some forms, encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents—including flatus (gas), liquid stool elements and mucus, or solid feces. FI is a sign or a symptom, not a diagnosis. Incontinence can result from different causes and might occur with either constipation or diarrhea. Continence is maintained by several interrelated factors, including the anal sampling mechanism, and incontinence usually results from a deficiency of multiple mechanisms. The most common causes are thought to be immediate or delayed damage from childbirth, complications from prior anorectal surgery (especially involving the anal sphincters or hemorrhoidal vascular cushions), altered bowel habits (e.g., caused by irritable bowel syndrome, Crohn's disease, ulcerative colitis, food intolerance, or constipation with overflow incontinence). Reported prevalence figures vary: an estimated 2.2% of community-dwelling adult ...
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Cystocele
A cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complications may include recurrent urinary tract infections and urinary retention. Cystocele and a prolapsed urethra often occur together and is called a cystourethrocele. Cystocele can negatively affect quality of life. Causes include childbirth, constipation, chronic cough, heavy lifting, hysterectomy, genetics, and being overweight. The underlying mechanism involves weakening of muscles and connective tissue between the bladder and vagina. Diagnosis is often based on symptoms and examination. If the cystocele causes few symptoms, avoiding heavy lifting or straining may be all that is recommended. In those with more significant symptoms a vaginal pessary, pelvic muscle exercises, or surgery may be recommended. The type of surgery typical ...
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Gynecology
Gynaecology or gynecology (see American and British English spelling differences) is the area of medicine concerned with conditions affecting the Female reproductive system, female reproductive system. It is often paired with the field of obstetrics, which focuses on pregnancy and childbirth, thereby forming the combined area of obstetrics and gynaecology (OB-GYN). Gynaecology encompasses both Primary care, primary and Preventive healthcare, preventative care of issues related to female reproduction and sexual health, such as the uterus, vagina, fallopian tubes, ovaries, and breasts; subspecialties include family planning; minimally invasive surgery; pediatric and adolescent gynecology; and pelvic medicine and reconstructive surgery. While gynaecology has traditionally centered on Cisgender, cisgender women, it increasingly encompasses anyone with female organs, including transgender, intersex, and Non-binary gender, nonbinary individuals; however, many non-cis women face acce ...
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Pelvic Examination
A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, discharge, urinary incontinence, or trauma (e.g. sexual assault). It can also be used to assess a woman's anatomy in preparation for procedures. The exam can be done awake in the clinic and emergency department, or under anesthesia in the operating room. The most commonly performed components of the exam are 1) the external exam, to evaluate the vulva 2) the internal exam with palpation (commonly called the ''bimanual exam'') to examine the uterus, ovaries, and structures adjacent to the uterus (adnexae) and 3) the internal exam using a speculum to visualize the vaginal walls and cervix. During the pelvic exam, sample of cells and fluids may be collected to screen for sexually transmitted infections or cancer (the Pap test). Some clinici ...
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Pelvic Floor
The pelvic floor or pelvic diaphragm is an anatomical location in the human body which has an important role in urinary and anal continence, sexual function, and support of the pelvic organs. The pelvic floor includes muscles, both skeletal and smooth, ligaments, and fascia and separates between the pelvic cavity from above, and the perineum from below. It is formed by the levator ani, levator ani muscle and coccygeus muscle, and associated connective tissue. The pelvic floor has two hiatus (anatomy), hiatuses (gaps): (anteriorly) the urogenital hiatus through which urethra and vagina pass, and (posteriorly) the rectal hiatus through which the anal canal passes. Structure Definition Some sources do not consider "pelvic floor" and "pelvic diaphragm" to be identical, with the "diaphragm" consisting of only the levator ani and coccygeus, while the "floor" also includes the perineal membrane and deep perineal pouch. However, other sources include the fascia as part of the diap ...
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Rectal Prolapse
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved. Rectal prolapse may occur without any symptoms, but depending upon the nature of the prolapse there may be mucous discharge (mucus coming from the anus), rectal bleeding, degrees of fecal incontinence, and obstructed defecation symptoms. Rectal prolapse is generally more common in elderly women, although it may occur at any age and in either sex. It is very rarely life-threatening, but the symptoms can be debilitating if left untreated. Most external prolapse cases can be treated successfully, often with a surgical procedure. Internal prolapses are traditionally harder to treat and surgery may not b ...
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