Christine

hi kit
I just have a minute now, but thought I'd write a bit anyway
the vaginal walls, the part you can touch, are covered in a skin called epithileum. same as the inside of your mouth. under that, is muscle, which is wrapped in fascia. inside your body, all of your muscles and organs are wrapped in a sheath called fascia. ever look at a piece of raw chicken? know the stuff that isn't fat, but is whitish and clings to the meat? that's fascia.
the fascia is not attached to the muscle so closely that you cannot separate the two, but it is difficult to separate in places. I *think* the fascia does attach to bone and tendon (please correct me christine??) and that's one reason that it is able to provide support.
ha, nature's bladder 'sling'.
the only problem with fascia, is that is heals with scar tissue. so if you cut it, you lose elasticity and stability in the area. which is why a good hand surgeon will tell you that surgery is to be considered a last resort. they know that if the scarring is bad, the fascial sheaths around the tendons in the fingers can shrink, so to speak, and the person can lose mobility. really, the same thing happens all over, its just more obvious in the fingers.
so much for typing just a bit about vagina's, lol.

Hi Kit,

(thanks so much gmom!)

It took me, too, such a long time reading the literature over and over, rolling the images around and around in my head, and then correcting for their misconceptions.
Look at the picture of the endopelvic fascia on page 27. I decided to use that in lieu of words because it is so very explanatory and a lot of us are visual learners. If you desire further minutiae you’ll need to consult a good anatomy book.

As gmom said, the inside of the vaginal walls are covered with epithelium, which is laid down like an accordion and in spirals so that it’s very stretchy. But from the illustration, you can see the outer walls of all the orifices are covered with fascia. You can also see how the fascia then connects onto muscle and bone, muscle and fat filling the large open areas.

I’ve wondered what exactly is popping in the “pop” that several women have described after heavy lifting and before onset or worsening of their prolapse, including Blue recently. And have no way of knowing, but my best guess is that it’s the fascia connecting bladder to pubic bone, just because of the way that area can become stressed in counternutation – the position most women lift from. Louise gave us a marvelous description of how she used to lift as opposed to now, that I absolutely must post permanently.

:) Christine

Hi Kit,

Well, at long last I understand what happened when I had surgery on my pinkie finger! Another insight that these posts have provided for me! About 9 years ago I cut a tendon in my little finger trying to separate frozen steaks, (ladies take it from me...we all do it, but please learn from me and don't!) and I slipped and cut a tendon and couldn't bend the tip of my pinkie finger. The only repair for that is surgery because tendons don't grow back. What a nightmare. I had to keep my finger stable after the surgery, except when in P.T. and the scar tissue in there grew like crazy! I am sure you can guess that the only cure for that was yet another surgery, after which I was fine for a very short time until the scar tissue started growing back, this time worse than the last. The cure...you guessed it...another surgery. I gave up at that point, although I went to many, many doctors for "second" opinions and not one of them could explain what happened the way you did. I just kept getting told that many people build up a lot of scar tissue and the only way to deal with that was through surgery. Had I known all that, I would have just lived with a finger that didn't bend just at the tip. I have lost some mobility, but the worse part is the now permanent bend in my finger.

Is it any wonder I was so opposed to surgery for my prolapse? Maybe it was actually a God send that happened with my finger. It made me very aware of how bad surgeries can go and I'd sure rather have a bent little finger than suffer the things that can happen with surgery from POP.

Thanks for the insight.

Warmest regards,

Mae

Please see my email to Kit...it should have gone to you since you were the one who originally explained fascia to Kit. Or, probably it should have gone to both of you. Bear with me, I'm new to posting and I'm taking in so much information these days! Thank you so much for the information about this. It certainly cleared things up for me about my hand surgery...not to mention how it relates to the vagina and POP!

Regards,

Mae

I'll share a thank you with kit any day

and thank you for your post. sometimes I feel bad about all the off topic rambling I do. good to know someone found it useful : )

good questions I think. but I really don't know the answers. got me thinking though....

I think the analogy to a cheek is a good one. the muscles of the cheek are attached to bones, and stretched between. a good thing, because the cheek has to be able to accomodate various sized loads (ie food or anything else you might put in your mouth). similar to the vagina. I think the vaginal muscles are also attached to bones, and stretched between, allowing elasticity to accomodate various sized loads (babies or anything else you'd put in there ; ) ).

the difference between the cheeks and the vagina is that the cheeks are the only muscles there. one side is the epithelium (you mouth) the other side is skin (face). the vagina's inside is epithelium, and on the other side of the muscle is some fascia and then I would imagine other muscles in the area. or ligaments. or something. I have to go back to the books and look that one up.

I have no idea how thick a 'normal' vaginal wall is. my guess is that is one of the things kegels can actually do, bulk up the muscle. and that in turn would give the sensation of a tighter vagina (the bulk would take up some space). but I still don't see how that would repositon a prolapsed bladder (not that you asked, just saying).

anyway, I can't wait to hear what you're on to, and I'm glad my figure 8 made sense to you.

Hi Kit. I think you might find the picture helpful if you can put your hands on my book. And remember – although the illustration is one-dimensional, the entire pelvic interior is vertically oriented from front to back. If you want to try to think of it in terms of words, the lower third of the vagina is connected laterally to each levator ani (pelvic floor muscle); the middle third to the levators as well (lower and middle vagina have the same axis as pf muscles); and the upper third connected to the ‘cardinal ligaments’, which continue toward the back to form the uterosacral ligaments ultimately attaching to the spine. The vagina is continuous with the cervix, which together form a right angle placing the uterus at the front of the body behind the lower abdominal wall.

On the other (lateral) side of the pf muscles is the sidewall of the bony pelvis and the ‘arcus tendineus’ – a sinewy structure like a curtain rod that runs along the wall from pubic bone to ischial spine. It is classically taught that the pelvic floor muscles are connected to the bottom of this structure and the obturator internus muscles to the top. The reason (which is all explained in the book) you can feel your vagina move when you make large circles with your arms is because these fascial structures are indeed all connected.

However, the pelvic anatomy is not always as cut and dried as this. Here’s what a well-respected international team of reconstructive pelvic surgeons have to say on the matter.

“As far as lateral stabilizers of the vagina are concerned, one hears a lot about the so-called paravaginal defect, which is likely to be present in 30-40% of cases with genital prolapse. In actual fact, anchorage of the lateral edge of the vagina to the pelvic sidewall is debatable. The arcus tendineus is not a constant structure. Neither is the pelvic fascia. At least, it is more than easy in normal cases to detach the vagina from the pelvic sidewall by means of gentle digital pressure and this disruption, which is performed during radical hysterectomy does not result in genital prolapse.”

I do not know the thickness of the vaginal wall or fascia.

:) Christine

Hi fellow wholewomen

You know, a fundamental truth just occurred to me. Every time Christine explains pelvic anatomy to us she is addressing a different audience; one that has assimmilated the previous explanations and is now asking different, more sophisticated questions, and pointing out nuances that then feed back into Christine's thinking to prepare her for the next telling.

Each explanation is like reading a good novel again from cover to cover. At each reading the reader picks up new information, new subplots, new aspects of each character. What's more, when you know the ending of novel you read the beginning (next time you read it) with different eyes; eyes that know what happens on the last page. Then Members chime in and tell the story through the eyes of a different character, which gives the story new depth again.

The fact that there are so many misleading illustrations and explanations of the female pelvic area and its functions makes it just like wiping the slate clean and going back several centuries and figuring it out, all over again. We do have most of the pieces of the puzzle from the existing anatomical illustrations and descriptions, but we can no longer rely on the completeness or correctness of them, so we have to complete the new model for ourselves, inserting some of the old puzzle pieces and adding new ones.

The difference is that few of us has access to the cadavers we need for the dissections to work out properly what is going on in that mysterious cave, and cadavers are notoriously difficult to deal with because they won't stand upright, let alone in Wholewoman posture. ;-) We don't even have the advantage of standing in a room together and figuring it out with each other.

Newbies, please tell us if you don't understand something we are talking about. Some of us have been rabbiting on with Christine for years about this stuff!

Please buy the second edition of Saving the Whole Woman as well. It contains all the illustrations that we refer to in these discussions, and all the background theory. It will make your understanding, and therefore your progress, much quicker. It also means that you are equipped with the basic information needed to assimilate the finer points that are developing day by day as we discuss them here.

Cheers

Louise

Apart from loving the talk of fascia in this old thread, I found a reference to the 'popping' sound that I remembered reading about in these forums in some of my meanderings (yes, I am pouring over some very old posts!)
From Chrsitine's post:
"I’ve wondered what exactly is popping in the “pop” that several women have described after heavy lifting and before onset or worsening of their prolapse, including Blue recently. And have no way of knowing, but my best guess is that it’s the fascia connecting bladder to pubic bone, just because of the way that area can become stressed in counternutation – the position most women lift from."
Any other comments? Off to look at Blue and Zelda's posts now...

I have never experienced that pop, though I did experience something like a painless tearing sensation on the right, quite deep in my pelvis towards the back, at one point, before I learned not to strain on the toilet. My POPs seemed to get worse after that incident. I could have kicked myself when it happened. Needless to say I didn't strain at all after that, but discovered splinting as an aid to evacuating. Now I don't even need to do that!

Louise

Aza,

Hey, check out this photograph of what I was envisioning in this old thread. It’s a fresh cadaver dissection of the pubourethral ligaments that connect the bladder to the pubic bones. S.P stands for symphysis pubis; P stands for pubourethral ligament; and L.A. stands for levator ani, or pelvic floor muscles. The bladder has been pulled back for easier visualization.

I think it’s a pretty safe bet that stretching of these structures plays at least some role in the development of cystocele. If they were acutely stretched under pressure - i.e. heavy lifting with the tailbone tucked under - the ligament could very possibly “pop”. This doesn’t mean it would rip off the bone, but dislocate like many other ligaments.

I suppose it’s as plausible an explanation as any. Maybe at some future time we will know more.

Cheers,

Christine

I find the wording for all the anatomy stuff confusing and not really able to visiualize it due to the confusion. I am sure I will for sometime until I can wrap my head around all this. It's not as though I have been looking/reading/dealing with this as long as some of you others. But.....I too had a similar feeling. Although mine felt more like a PAINFUL tearing (instead of a pop). I had been running, and then sneezed super hard. I felt it right then. It hit from the left to the right, right above the hairline in the lower tummy area. Almost like something ripped??? I even invision now, that that is exactly what happened although I don't know for sure. All I do know is I did not notice the bulges in my vagina until after the tearing sensation day. I only know that I hadn't noticed because I was checking on a stitch from my tear from the birth of my daughter. It took forever to "fall" off & I was trying to keep an eye on it. Also, I was wondering, with birth of my 2nd daughter, I tore UP toward the clitoris, not DOWN toward the rectum. Is that normal?? Karla

I have been thinking of this board myself, any ideas. Good or bad for cys, rec or other prolapse. I almost think it would not be good. Any thoughts.

Rosebud, I know what you mean. We all got a terrible cough this winter and it didn't help the prolapse any. There were nights I was up coughing so hard I thought I might pass out. And there were several times I sneezed and felt like something was tearing.

Heavenly, before I discovered WW I saw one of the most dramatic improvements of a significant cystocele in a woman who spent a lot of time kegaling while laying on her belly on one of her kids jungle gym slides with her face at the ground and her bum at the top of the slide. It seemed to give her an added boost to get the cele where she wanted it and then strengthen things around it while it was in place.