. The Principles and practice of gynecology : for students and practitioners. e outlets the muscles control—that is, in the blad-der, urethra, vagina, and rectum. Rectocele.—Figure 264 shows the direction of the anus to be at anangle to that of the rectum, so that as fecal matter comes down itmust, in passing from the rectum out through the anus, turn thisangle; in so doing it strikes against the rectal side of the perineum,and thence is deflected through the anus. If the injury to the peri-neal body has made it thin, weak, or relaxed, or otherwise impaired its LACERATIONS OF THE PERINEUM. 531
. The Principles and practice of gynecology : for students and practitioners. e outlets the muscles control—that is, in the blad-der, urethra, vagina, and rectum. Rectocele.—Figure 264 shows the direction of the anus to be at anangle to that of the rectum, so that as fecal matter comes down itmust, in passing from the rectum out through the anus, turn thisangle; in so doing it strikes against the rectal side of the perineum,and thence is deflected through the anus. If the injury to the peri-neal body has made it thin, weak, or relaxed, or otherwise impaired its LACERATIONS OF THE PERINEUM. 531 rcsistiny; power, tlic dowinvard lorce of the feees, instead of l)eiiij^deflected backward and outward, will cause the posterior vaginal wallto pouch forward into the vagina. This pouch is a rectocele. Thefecal matter thus arrested recjuires, with the enlarging pouch, moreand more force for its exj)ulsion, and the poucli therefore will in-crease ; the result will be rectal and anal tenesmus, irritation, andsometimes anal fissure or fistula, or hemorrhoids. Figure Same as Figure 268. The torn parts are being held together with the fingers, so that X coin-cides with X and M with M. This adjustment shows what parts should be united in repair ofthe injury. Cystocele.—The perineum having been impaired by rupture, thevesicovaginal septum, which normally rests upon it, tends to sag andbulge forward into the vaginal outlet in the form of a pouch. Thispouch is called cystocele. The patient, except in the knee-chest posi-tion, may not be able to empty the bladder completely. Residualurine may accumulate in the pouch, decompose, irritate the bladder,and may set up cystitis or may lead to the formation of stone inthe bladder. In order to expel the contents of the bowel the womanmay have to hold back the protruding organs with the hand. 532 TRAUMATISMS. Figure 270.
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