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Objective: To evaluate the effectiveness and safety of a vaginal bowel-control device and pump system for fecal incontinence treatment., Methods: Women with a minimum of four fecal incontinence episodes over 2 weeks were fit with the intravaginal device. Treatment success, defined as a 50% or greater reduction of incontinent episodes, was assessed at 1 month. Participants were invited into an optional extended-wear period of another 2 months. Secondary outcomes included symptom improvement measured by the Fecal Incontinence Quality of Life, Modified Manchester Health Questionnaire, and Patient Global Impression of Improvement. Adverse events were collected. Intention-to-treat analysis included participants who were successfully fit entering treatment. Per protocol, analysis included participants with a valid 1-month treatment diary., Results: Sixty-one of 110 (55.5%) participants from six clinical sites were successfully fit and entered treatment. At 1 month, intention-to-treat success was 78.7% (48/61, P<.001); per protocol success, 85.7% (48/56, P<.001) and 85.7% (48/56) considered bowel symptoms "very much better" or "much better." There was significant improvement in all Fecal Incontinence Quality of Life (P<.001) and Modified Manchester (P≤.007) subscales. Success rate at 3 months was 86.4% (38/44; 95% confidence interval 73-95%). There were no serious adverse events; the most common study-wide device-related adverse event was pelvic cramping or discomfort (25/110 participants [22.7%]), the majority of events (16/25 [64%]) occurring during the fitting period., Conclusion: In women successfully fit with a vaginal bowel-control device for nonsurgical treatment for fecal incontinence, there was significant improvement in fecal incontinence by objective and subjective measures., Clinical Trial Registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01655498., Level of Evidence: : II.

Objective: To examine the effect of high-fiber diet on constipation in women with pelvic floor disorders., Methods: This was a study of a prospective cohort of 41 consecutive women presenting to a tertiary care facility for pelvic floor disorders with a complaint of constipation from March 2005 to September of 2005. Patient Assessment of Constipation Symptoms and Rome II criteria administered as a questionnaire were obtained through telephone interviews every 14 days and were evaluated at the end of the 42-day study period. Each patient was instructed to supplement her diet with a high-fiber cereal (14 g of fiber per one-half cup). Women gradually increased their cereal intake with a goal of reaching 28 g of fiber daily. Patients with adverse reactions, abdominal bloating or pain, and surgery during the study period were withdrawn., Results: Median age and body mass index were 60 years (range 33-77 years), and 29.9 kg/m(2) (range 21.6-59.8), respectively. Thirty patients (73%) completed the study. Average Rome II scores improved from day 1 to day 42 (P<.05). The total, abdominal, rectal, and stool symptoms of the Patient Assessment of Constipation Symptoms improved significantly during the study period (P<.001). Weekly laxative use and vaginal splinting were decreased from 2.8, 1.5 to 1.4, 0.67 (P<.05), respectively., Conclusion: Increasing fiber intake gradually to the amount recommended by the National Academy of Sciences Institute of Medicine improves constipation and its associated symptoms. Reducing the incidence and severity of straining in constipated women may help a risk factor for the onset, progression, or recurrence of prolapse.

Background: Transurethral bladder eversion is rare. A case of transurethral bladder eversion with concurrent uterovaginal prolapse is presented., Case: The patient was postmenopausal, had a long history of uterovaginal prolapse, and developed bladder eversion. Examination under anesthesia revealed full-thickness transurethral bladder eversion and complete uterine procidentia. Temporary reduction of the prolapse was done initially because of her unstable medical condition. After medical stabilization, definitive surgical reconstruction was completed by a vaginal approach., Conclusion: Full-thickness, transurethral bladder eversion can be surgically treated by a vaginal approach.

Background: When an abdominal approach is chosen for repair of pelvic prolapse, a paravaginal repair is often used to correct lateral cystoceles and a retropubic urethropexy to correct genuine stress incontinence. If concomitant vaginal vault prolapse exists, an approach for vaginal vault support, which can be done through the space of Retzius, would be beneficial. We describe an abdominal approach to the sacrospinous ligament., Technique: The space of Retzius is accessed and important anatomic landmarks, including the obturator canal and neurovascular bundle, paravaginal veins, bladder, and ischial spine, are identified. The sacrospinous ligament complex is palpated and exposed. The superior posterolateral vaginal wall is then fixed to the complex. Often a bilateral repair is possible., Experience: Fifty-five women at two centers had abdominal sacrospinous ligament colpopexies for vaginal vault prolapse. All had other repairs for pelvic organ prolapse. No follow-up operations were needed for recurrent vault prolapse, over an average of 23 months follow-up., Conclusion: An abdominal approach to the sacrospinous ligament complex can be used, providing pelvic reconstruction surgeons with an alternative technique for vaginal vault support when other space-of-Retzius procedures are required.