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Treatment

Antibiotics are the first treatment for PID; in severe cases, antibiotics are given intravenously (through a vein) in the hospital. If antibiotics do not clear up the infection, or if an abscess shows no signs of shrinking, a doctor may perform a laparoscopic procedure (through a small incision in the abdomen) to remove as much of the infected tissue as possible. Recovery and fertility both depend on the extent of the infection and the surgery required to treat it.

Pelvic Support Problems

The uterus, vagina, and other lower abdominal organs are held in place by strong pelvic muscles and ligaments at the base of the abdomen. If these supporting muscles and ligaments are weakened, they can no longer support organs in the pelvis (such as the bladder, urethra, uterus, vagina, small intestine, and rectum), causing the organs to slip from their original position. Pelvic floor muscles can become stretched and weakened by a number of factors, including injury during vaginal delivery, loss of muscle tone that can accompany aging, decreased estrogen production after menopause, chronic constipation (which causes straining during bowel movements), a chronic respiratory condition (which can cause persistent coughing), or lifting heavy objects.

The uterus, bladder, rectum, and urethra are especially vulnerable to sagging or prolapse when pelvic floor muscles become weakened. Minor degrees of prolapse are common, especially for a few months after childbirth and later in life. A prolapse can be uncomfortable and inconvenient but poses few risks to your overall health.

Following are some of the most common types of pelvic support problems, which often occur together:

• Prolapse of the uterus When the uterus drops from its normal position, it sags downward. This process causes a bulging of the front or back wall of the vagina. Sometimes the uterus may descend so far that the cervix or even the entire uterus bulges out of the body (called a complete prolapse). The displacement of the uterus often brings other pelvic organs, such as the bladder or intestines, down with it.

• Cystocele A cystocele occurs when the bottom of the bladder drops into the front of the vagina.

• Cystourethrocele A cystourethrocele results from the weakening of the tissues supporting the urethra and bladder.

• Enterocele An enterocele forms when a part of the intestine bulges into the top of the vagina.

• Rectocele A rectocele is the bulging of the rectum into the vagina.

• Vaginal vault prolapse Vaginal vault prolapse occurs when the top part of the vagina (called the vaginal vault) loses its support from the uterus after a hysterectomy (see page 870) and collapses.

Symptoms

The involuntary leaking of urine may be the first sign of a pelvic support problem. A cystourethrocele often causes stress incontinence (see page 877). You may feel a sensation of heaviness and discomfort in your pelvis and an ache in your lower back, especially after lifting or otherwise straining your muscles. If the condition has progressed, and if the back wall of the vagina has descended, bowel movements can be difficult. A large rectocele may make it difficult to empty the bowels completely. In severe cases, a lump or bulge may protrude outside the vagina. Constipation (see page 769), hemorrhoids (see page 777), and urinary incontinence sometimes accompany pelvic support problems. In severe cases, the pressure from the slipping of the bladder in a cystocele may make urination difficult.

Prolapse of the Uterus

Prolapsed uterus

One of the most common pelvic support problems is prolapse of the uterus, in which the uterus drops from its normal position into the vagina. The uterus may drop part of the way into the vagina or protrude completely outside the vagina. Prolapse of the uterus can be corrected surgically.

Prolapsed uterus supported by a pessary

A pessary is a rubber or plastic device worn inside the vagina to keep a prolapsed uterus in place. A pessary is a good option for women whose prolapse