Relaxed Vaginal Outlet - Causes, Symptoms, and Treatment

What Is a Relaxed Vaginal Outlet?

The relaxed vaginal outlet is a condition of vaginal prolapse where the wall between the vagina and the rectum becomes weak or damaged. As a result, the vaginal opening becomes large, causing the pelvic organs (such as the urinary bladder, uterus, urethra, rectum, and small intestines) to protrude from the vagina. A relaxed vaginal outlet is not a life-threatening condition. The woman with a relaxed vaginal outlet may complain that her vaginal opening feels enlarged and a bulge is coming out of her vagina. Other medical terms used for a relaxed vaginal outlet are- “genital hiatus” or “enlarged vaginal introitus.”

What Causes a Relaxed Vaginal Outlet?

Various factors that increase the risk for a relaxed vaginal outlet are-

• Pregnancy- In the final months of pregnancy, the large size of the uterus and excessive weight can tear or weaken the muscles resulting in pelvic organ prolapse (POP) or relaxed vaginal outlet. Multiple pregnancies can also account for a relaxed vaginal outlet.

• Childbirth- Surgical procedures during vaginal childbirth and labor can damage or loosen the vaginal walls. Large babies can also cause tears and damage to vaginal walls and surrounding structures.

• Age and Menopause- With increasing age, when women reach menopause, estrogen levels decrease. This causes the weakening of the vaginal walls. It can also lead to vaginal atrophy (thinning of vaginal walls), inflammation, and tear.

• Hysterectomy- Removal of the uterus leads to decreased support for surrounding structures.

• Other Risk Factors- Obesity, neurogenic dysfunction of the pelvic floor, connective tissue abnormalities, prior pelvic surgery, or strenuous physical activity.

What Are the Symptoms of a Relaxed Vaginal Outlet?

• Some women might experience no symptoms at all.

• Enlarged vaginal opening.

• A bulge of tissues protrudes out from the vagina.

• Painful urination.

• Constipation.

• Frequent and sudden urge to urinate.

• Involuntary urination.

• Stress incontinence- Urine leakage on physical exertion (sneezing, coughing, or lifting heavy items).

• Fecal incontinence.

• Discomfort during sexual intercourse or lack of sexual pleasure.

• Perineal discomfort and pain.

• Severe cases may lead to other problems as-

  • Rectocele- It is the posterior vaginal prolapse where the wall between the vagina and the rectum is weakened.

  • Cystocele- Wall between the bladder and vagina is weakened, resulting in the bladder bulging into the vagina.

  • Enterocele- It is the anterior vaginal prolapse. The small intestines and peritoneum structures bulge into the vagina.

  • Urethral Hypermobility- Movement of the urethra due to weak pelvic floor muscles.

  • Perineal Relaxation- Weakened perineum muscles resulting in stretching and loosening of the vagina.

  • Uterine Prolapse- The uterus slips down and protrudes into the vagina.

How Is Relaxed Vaginal Outlet Diagnosed?

• Medical history and physical examination of the vagina is the best way to diagnose the relaxed vaginal outlet. The doctor examines all the sections of the vagina to determine the type and extent of prolapse.

Tests that can be used for diagnosis purposes include-

• Q-tip test- It is done to measure the hypermobility of the urethra and the extent of its prolapse into the vagina.

• Bladder Function Test- It is done to check bladder incontinence. This test helps the doctor decide which type of surgery is needed for the patient.

• Pelvic Floor Strength- Pelvic floor and sphincter muscles are checked for strength.

• Imaging Tests-

  • Magnetic resonance imaging (MRI) scan.

  • Ultrasound.

• Cystourethroscopy- A cystoscope (a small tube-like device with light and camera) lubricated with an anesthetic gel is inserted into the urethra. This procedure helps the doctor to see internal organs and their respective positions.

What Is the Treatment of Relaxed Vaginal Outlet?

Depending upon the condition of the patient and the extent of prolapse, the treatment can be either medical or surgical. These treatments are explained as follows-

1. Medical Treatment- These are the non-surgical and more conservative treatment options. It includes-

• Pelvic Floor Physical Therapy (PFPT)- A non-invasive treatment method that aims to strengthen and relax the pelvic floor muscles.

• Kegel Exercises- Exercise to strengthen the pelvic floor muscles. Regular practice significantly improves the symptoms.

• Vaginal Cones- A device that helps women improve their pelvic floor muscle tone.

• Biofeedback- A small sensor is placed in the vagina, on the buttocks, and on the abdomen. Doctors can see pelvic floor muscle contractions on the computer to detect any incontinence or abnormalities.

• Pessaries- These are the removable devices placed into the vagina to support pelvic organs and decrease urinary incontinence.

• Estrogen Replacement Therapy- Helps to strengthen muscles in and around the vagina.

2. Surgical Treatment- Repair surgeries are performed to strengthen the weak structures by either suturing or placing support in the form of a graft (biological or synthetic). The surgical procedure used to correct the relaxed vaginal outlet is-

• Perineorrhaphy- The surgery is performed under general anesthesia. This surgery aims to repair prolapse, improve sexual function, and narrow the relaxed vaginal outlet.

What Is the Prognosis of a Relaxed Vaginal Outlet?

• It is not a life-threatening condition, so the prognosis is usually good.

• Some women have no symptoms initially.

• Mild cases can be treated with only medical management, regular exercise (strengthening pelvic floor muscles), and lifestyle changes.

• Severe cases need surgical intervention, but the success rate is high.

• High chances of recurrence are present.

How to Prevent Relaxed Vaginal Outlet?

Women who are at risk of developing a relaxed vaginal outlet must take care of the following points-

• Avoid lifting heavy objects.

• Avoid any activities that increase pressure on the abdomen.

• Reduce weight to overcome obesity.

• Kegel exercises to strengthen pelvic floor muscles.

Conclusion:

The relaxed vaginal outlet is not a life-threatening condition; non-surgical and surgical procedures can easily manage the situation. The outcomes are good, but there are possibilities of recurrence. Women suffering from relaxed vaginal outlet are often depressed and embarrassed by this condition, but proper management with lifestyle changes can lead to a happy life.