, Volume 12, Issue 5, pp 449–452 | Cite as

Signs of herniosis in women with vaginal prolapse and/or stress incontinence

  • R. C. Read


Gynecological literature pertaining to prolapse or stress urinary incontinence published over the past four decades was reviewed to determine whether signs of herniosis, the systemic connective tissue co-morbidity known to play a significant role in abdominal herniation, were present and differed from controls. A total of eight indications were reported: (1) Genetic factors, i.e., family history and race, were predictive. (2) An increase in the incidence was observed in association with heritable diseases of collagen and their formes frustes (e.g., joint laxity). (3) Recurrence rate after repair was high (30%). (4) Fragmentation and degeneration of smooth muscle and collagen fibers were observed histologically. (5) Biochemistry demonstrated a decline of 24–40% in collagen content of skin, round ligament, cardinal ligament, periurethral vaginal wall, cervix, pubocervical, cervicococcygeal, and vesicovaginal fasciae. (6) In patients with stress urinary incontinence, collagen content decreased 60%. This change was independent of age, parity, menopausal status, and weight. (7) Matrix metalloproteinase (MMP-2 and MMP-9) activity increased fourfold and that of their inhibitor TIMP-1 decreased. (8) Cigarette smoking, an acquired factor, increased the incidence of stress urinary incontinence. This commonality with the etiology of abdominal herniae explains why gynecologists have decreased their emphasis on childbirth injury and, like herniologists, have moved to discard the dogma “prolapse” as a designate for extraperitoneal herniation in the pelvis.


Herniosis Vaginal prolapse Incontinence 


  1. 1.
    Klinge U, Junge K, Mertens PR (2004) Herniosis: a biological approach. Hernia 8(4):300–301PubMedCrossRefGoogle Scholar
  2. 2.
    Read RC (2007) Review: archaic terms and dogmas impeding care of abdominal and pelvic herniation. Hernia 11:299–302PubMedCrossRefGoogle Scholar
  3. 3.
    Drutz HP, Alarab M (2006) Pelvic organ prolapse: demographics and future growth prospects. Int Urogynecol J 17:S6–S9CrossRefGoogle Scholar
  4. 4.
    Stoddard FJ, Myers RE (1968) Connective tissue disorders in obstetrics and gynecology. Am J Obstet Gynecol 102(2):240–243PubMedGoogle Scholar
  5. 5.
    Carley ME, Schaffer J (2000) Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers–Danlos syndrome. Am J Obstet Gynecol 182(5):1021–1023PubMedCrossRefGoogle Scholar
  6. 6.
    Al-Rawi Z, Al-Rawi R (1982) Joint hypermobility in women with genital prolapse. Lancet 40(1):1439–1441CrossRefGoogle Scholar
  7. 7.
    Marshman D, Percy J, Fielding DL (1987) Rectal prolapse: relationship with joint hypermobility. Aust NZ J Surg 57:827–829CrossRefGoogle Scholar
  8. 8.
    Norton PA, Baker JE, Sharp HC et al (1995) Genitourinary prolapse and joint hypermobility in women. Obstet Gynecol 85(2):225–228PubMedCrossRefGoogle Scholar
  9. 9.
    Bai SW, Choe BH, Kim JY et al (2002) Pelvic organ prolapse and connective tissue abnormalities in Korean women. J Reprod Med 47(3):231–234PubMedGoogle Scholar
  10. 10.
    Rinne KM, Kirkinen PP (1999) What predisposes young women to genital prolapse. Eur J Obstet Gynecol Reprod Biol 84:23–25PubMedCrossRefGoogle Scholar
  11. 11.
    Watson REB, Parry EJ, Humphries JD et al (1998) Fibrillin microfibrils are reduced in skin exhibiting striae distensae. Br J Dermatol 138:931–937PubMedCrossRefGoogle Scholar
  12. 12.
    Salter SA, Batra RS, Rohrer TE et al (2006) Striae and pelvic relaxation: two disorders of connective tissue with a strong association. J Invest Derm 126:1745–1748PubMedCrossRefGoogle Scholar
  13. 13.
    Chang ALS, Agredano YZ, Kimball AB (2004) Risk factors associated with striae gravidarum. J Am Acad Dermatol 51:881–885PubMedCrossRefGoogle Scholar
  14. 14.
    El-Kholi GY, Mina SN (1975) Elastic tissue of the vagina in genital prolapse. A morphological study. J Egypt Med Assoc 58:196–204PubMedGoogle Scholar
  15. 15.
    Jackson SR, Avery NC, Tarlton JF et al (1996) Changes in metabolism of collagen in genitourinary prolapse. Lancet 347(1):1658–1661PubMedCrossRefGoogle Scholar
  16. 16.
    Klinge U, Zheng H, Si Z et al (1999) Synthesis of type I and III collagen, expression of fibronectin and matrix metalloproteinases-1 and -13 in hernial sac of patients with inguinal hernia. Int J Surg Investig 1(3):219–227PubMedGoogle Scholar
  17. 17.
    Mathrubutham M, Maytal A, Rao SK et al (2000) Elastolytic and collagenolytic activity is elevated in conditioned media from skin and endopelvic fascia explants of women with pelvic floor weakening. J Urol 155:163–195Google Scholar
  18. 18.
    Wong MY, Harmanli OH, Agar M (2003) Collagen content of nonsupport tissue in pelvic organ prolapse and stress urinary incontinence. Am J Obstet Gynecol 189(6):1597–1600PubMedCrossRefGoogle Scholar
  19. 19.
    Ulmsten U, Ekman G, Giertz G et al (1987) Different biochemical composition of connective tissue in continent and stress incontinent women. Acta Obstet Gynecol Scand 66:455–457PubMedCrossRefGoogle Scholar
  20. 20.
    Rechberger T, Donica H, Baronowski W et al (1993) Female urinary stress incontinence in terms of connective tissue biochemistry. Eur J Obstet Gynecol Reprod Biol 49:187–191PubMedCrossRefGoogle Scholar
  21. 21.
    Falconer C, Ekman G, Malmstrom A et al (1994) Decreased collagen synthesis in stress-incontinent women. Obstet Gynecol 84(4):583–586PubMedGoogle Scholar
  22. 22.
    Keane DP, Sims TJ, Abrams P et al (1997) Analysis of collagen status in premenopausal nulliparous women with genuine stress incontinence. Br J Obstet Gynaecol 104:994–998PubMedGoogle Scholar
  23. 23.
    Rechberger T, Postawski K, Jakowicki JA et al (1998) Role of fascial collagen in stress urinary incontinence. Am J Obstet Gynecol 179(6):1511–1514PubMedCrossRefGoogle Scholar
  24. 24.
    Chen BH, Wen Y, Li H et al (2002) Collagen metabolism and turnover in women with stress urinary incontinence and pelvic prolapse. Int Urogynecol J 13:80–87CrossRefGoogle Scholar
  25. 25.
    Kushner L, Mathrubutham M, Burney T et al (2004) Excretion of collagen derived peptides is increased in women with stress urinary incontinence. Neurourol Urodyn 23:198–203PubMedCrossRefGoogle Scholar
  26. 26.
    Chen Y, DeSautel M, Anderson A et al (2004) Collagen synthesis is not altered in women with stress urinary incontinence. Neurourol Urodyn 23:367–373PubMedCrossRefGoogle Scholar
  27. 27.
    Bump RC, McClish DK (1992) Cigarette smoking and urinary incontinence in women. Am J Obstet Gynecol 167(5):1213–1218PubMedGoogle Scholar
  28. 28.
    Last JA, King TE, Nerlich AG et al (1990) Collagen cross-linking in adult patients with acute and chronic fibrotic lung disease. Am Rev Respir Dis 141:307–313PubMedGoogle Scholar
  29. 29.
    Strinic T, Bukovic D, Eterovic D et al (2002) Pulmonary ventilatory function in premenopausal women with and without genital descensus. Spirometry prolapse. Coll Antropol 26(Suppl):139–142PubMedGoogle Scholar
  30. 30.
    Cannon DJ, Read RC (1981) Metastatic emphysema: a mechanism for acquiring inguinal herniation. Ann Surg 194:270–278PubMedCrossRefGoogle Scholar
  31. 31.
    Fabbri LM, Rabe KF (2007) Viewpoint: from COPD to chronic systemic inflammatory syndrome? Lancet 370(9589):797–799PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of  SurgeryUniversity of  Arkansas for Medical SciencesLittle RockUSA
  2. 2.RockvilleUSA

Personalised recommendations