What's the relationship between UI and Prolapse?

You know I’m not an anatomist, but this is what I think:

The pelvic organs are supported both from above and from below (and in between through a vast fascial network.) The bladder is attached to the cervix, but it is the bladder neck, or very top of the urethra, that is attached to both the urogenital diaphragm (just below and almost synonymous with the pelvic floor) and the pubic bone by way of the pubourethral ligaments.

Different areas can retract from the front of the body depending upon the alignment of the greater structural framework, the internal anatomy, and the way in which the breath flows through that anatomy. It is the breath that actually creates and maintains pelvic organ support.

In some women, the pelvic floor musculature begins to drop and in doing so stretches the pubourethral ligaments. This causes a slight straightening of the urethrovesical angle, or the almost 90 degree angle between urethra and bladder, so that the urethra is unable to clamp down completely, or kink like a gardenhose, under sharp increases in pressure, such as a cough or sneeze. The result is momentary loss of urine.

In other women, the pubourethral ligaments remain taut, preserving urinary continence, as the base of the bladder falls backward, resulting in cystocele without UI. A common cause of this scenario is misalignment of the abdominal wall.

Most women are aware of their rectus abdominis muscles, the most surface layer of muscle that runs vertically from pubis to sternum. It is generally considered good posture to hold these muscles in.

On the contrary, when we suck in the belly the thoracic diaphragm, which expands downward ALL THE WAY TO THE BOTTOM OF THE RIBCAGE with every breath, and in doing so PUSHES THE ABDOMINAL AND PELVIC ORGANS OUT AGAINST THE ABDOMINAL WALL, is impeded. The top of the pubic bone is pulled up and the entire pelvis rotated backward so that the outlet is more horizontal than vertical. The already dysfunctional (from too much sitting) hip flexor muscles are reinforced in their weakness.

Relaxing the belly does not make it vulnerable. It provides the flexibility needed to allow the organs to expand the abdominal wall with every breath. The deeper and highly supportive transverse abdominal muscles form a girdle around the pelvis that serves to pull it forward on its axis, thus maintaining this vital function.

I think all of us have various combinations of misaligned bones, imbalanced muscles, and compromised connective tissue that cause pelvic organ prolapse and urinary incontinence to manifest in different ways.

What you can take to the bank, however, is that we are a lot more alike than we are different. That is why so many women of different shapes and sizes see results with this work. Rolling the tape all the way back to supportive anatomy is a long and slow process. I’m convinced though, that in time we will have enough answers to satisfy the majority of women that it’s work worth doing.

I cannot wait to have this all written down so I don’t have to type it again and again. It’s just impossible not to try to answer questions in real time.

Christine

you wrote: "I cannot wait to have this all written down so I don’t have to type it again and again. It’s just impossible not to try to answer questions in real time."

thank you christine, for yet another description. each time you take the time to type it out I learn something new. I had not realized (though its been mentioned before) how breathing affects prolapse. what are your thoughts re: deep vs shallow breathing in this regard? assuming of course, one is standing with belly relaxed, head tall and shoulders down. I know that deep breathing is 'better' for you, but does the breath then actually support the pelvic organs?

Well, my sense is that all of it will take a little getting used to, but that the correct depth of breath will just naturally happen. I think the posture forces deeper breathing and deeper breathing pins the organs.