Dr. Aruna Ashok

The perineum is the area between the vagina and the anus. This fragile area plays a significant role in the female reproductive system. This is often intentionally or accidentally torn open to allow for the normal delivery of the baby. This needs to be repaired meticulously to ensure that the pelvic floor is safeguarded from further damage.

The pelvic floor contains multiple muscles and supporting tissues which help in keeping the vagina, rectum, uterus and supporting structures in their places. When these muscles become weak due to childbirth, ageing, perineal injury etc, the uterus, bladder and rectum loosen up and prolapse down.The most common problem that is encountered is urine and fecal incontinence, where the woman has difficulty holding urine and feces. Though not often discussed openly given the private nature of the topic, many women suffer from a weak pelvic floor. Read on to know some of the common causes, symptoms, and management measures.

Causes:

1. Chronic cough: The next time you cough for prolonged periods, notice how much pressure it puts on the pelvic area. This goes unnoticed, but chronic cough can weaken the pelvic floor muscles. It is not common for women to lose some urine during these long-drawn coughing spells.
2. Chronic constipation: The pressure exerted during constipation weakens the pelvic floor, often leading to incontinence.
3. Pregnancy and delivery: Most common cause of perineal injury, where the perineum is torn (accidentally or intentionally) to allow for easy passage of the baby. If it is not repaired meticulously, the pelvic floor is weakened.

Symptoms:

Urinary incontinence is the most common symptom that women present to doctors with. However, there are minor symptoms which a woman would experience prior to reaching this stage. Most often, these are ignored, and only brought to doctor’s notice when symptoms become quite severe. If left unattended, there could be more severe repercussions too.

1. A heavy feeling in the pelvic area, commonly referring to as a bearing down sensation, a feeling that the internal organs are going to pop out through the vagina
2. A small lump that can be felt and/or seen at the vaginal opening
3. Feeling of incomplete emptying of the bladder and/or bowel
4. Constipation
5. Pain or bleeding from the vagina or the rectum
6. Recurrent pelvic and/or urinary tract infections

Management:

1. Kegel exercises are often used to strengthen the pelvic floor. This is very effective if the problem is identified quite early.
2. In more progressive cases, surgical repair is the most effective option. This not only corrects the prolapses but also helps boost confidence of the person, by correcting the incontinence problems and improving sexual experiences. 

In case you have a concern or query you can always consult an expert & get answers to your questions!

Bleeding during pregnancy is relatively common and doesn’t always mean there is a problem. It can be daunting and scary. However contrary to common beliefs, bleeding need not be a necessary harmful to a pregnant woman. However, it is important to take bleeding seriously at any stage of the pregnancy.

What are the possible causes of vaginal bleeding during pregnancy?

Causes of vaginal bleeding during early pregnancy include

1. Implantation bleeding: It is a harmless light bleeding that often occurs around the time your period would have been due. It occurs when the developing embryo implants itself in the wall of the womb.
2. Cervical changes: Cervical changes due to pregnancy may sometimes cause bleeding specifically after sex.
3. Miscarriage: During early pregnancy vaginal bleeding can be a sign of miscarriage. About 1 in 5 pregnancies miscarry and usually, the cause is in the fetus and not the mother or the partner. At the same time, it is important to note that many women who bleed at this stage of pregnancy go on to have normal and successful pregnancies.
4. Ectopic pregnancy: An ectopic pregnancy is when fertilized egg implants outside the womb, for example in the fallopian tube. It can cause bleeding and is dangerous.

Early detection and appropriate management is a must in this case, so as to prevent any life-threatening complication. Other less common causes are molar pregnancy (a mass that forms inside the uterus that does not result in a baby) and problems with the cervix such as a cervical growth or cervical or vaginal infections. Vaginal bleeding might also occur during the later second or third trimester of the pregnancy.

Some of the commonly occurring includes

1. Placenta praevia (low lying placenta): This is when the placenta is attached in the lower part of the womb, near to or covering the cervix. Bleeding from a low lying placenta can be very heavy and put you and your baby at risk
2. Placental abruption: It is a serious condition in which the placenta starts to come away from the womb wall.
3. Vasa praevia: A rare condition where baby’s blood vessels run through the membranes covering the cervix. When your water breaks, these vessels are torn and cause vaginal bleeding.

Vaginal bleeding towards the end of the pregnancy is normal. Often bleeding mixed with mucous (which is called show) can be a sign of the starting of the labor. 

When to visit a doctor?

It is important to keep the doctor informed about any bleeding that may have occurred at any stage of the pregnancy. A woman should carefully note details such as the type of bleeding, its texture, whether it included any tissue or clots, other symptoms such as pain and dizziness To work out what is the causing the bleeding, you may need to have a vaginal or pelvic examination, an ultrasound scan or blood tests and according to the cause and how many weeks pregnant you are it would be advised whether you need to be admitted to hospital or not and further treatment would be planned and advised.

In case you have a concern or query you can always consult an expert & get answers to your questions!