ABSTRACT

Objectives: The vagina has an important role in transmission of 3 opposite striated pelvic muscle forces acting against pelvic ligaments to close urethra distally and at bladder neck. The same muscle forces stretch vagina to support the urothelial stretch receptors to prevent them activating the micturition reflex at low bladder volumes, and to open the urethra prior to micturition. Striated muscles have a limited contractile force. The hypothesis the weight of the intraabdominal contents on the vaginal membrane adds additional weight for the striated pelvic muscles to move when they tension the vagina to close the urethra for continence, open it for evacuation and prevent urothelial stretch receptors from activating micturition prematurely (interpreted as urgency).

Materials and Methods: To test if a binary musculo-elastic model of bladder control can explain significant cure/improvement of lower urinary tract symptoms following weight loss after bariatric surgery.

Results: The results for improvement of stress urinary incontinence (SUI), overactive bladder syndrome (OAB) and mixed symptoms were consistent with the concept of an extra intraabdominal intestinal load on the vagina membrane which prevented the 3 opposite striated muscle forces stretching the vagina sufficiently to close the urethra (SUI) and/or prevent excessive afferent impulses from the urothelial stretch receptors activating micturition prematurely (OAB).

Conclusion: Removing the burden of intestinal contents on the vagina restored several different areas of incontinence, SUI, mixed incontinence, urgency (OAB) seemingly validates the hypothesis.