THE VAGINA 389 



degree according to the extent of the rupture. In a severe 

 case the tear may pass backwards through the perineal body, 

 and both the internal and external sphincters may be divided, 

 as well as some fibres of the levator ani. When, and only 

 when, the internal sphincter is ruptured, incontinence of 

 faeces results. 



The condition is as important in view of its remote conse- 

 quences as it is in view of the possibility of immediate sepsis. 

 Injury to the levator ani muscle lessens the support normally 

 provided for the wall of the vagina and, during defalcation, the 

 anterior wall of the rectum is thrust forwards, bulging into the 

 posterior vaginal wall and carrying it downwards and forwards. 

 Such a bulging may appear at the vulva and is then known as 

 a recto-cele. Following this condition, a strain is thrown on 

 the anterior wall of the vagina, which also prolapses through 

 the vulva, sometimes carrying a part of the bladder with it a 

 cysto-cele. As a result, traction is exerted in a downward 

 direction on the uterus, and the utero-sacral ligaments (p. 391) 

 become lengthened. Finally, the cervix itself appears at the 

 vulva and a complete prolapse of the uterus is present. 



Although perineal lacerations are the most common fore- 

 runners of uterine prolapse, there are other factors which assist 

 in its causation. Anything which tends to increase the intra- 

 abdominal pressure ascites, chronic constipation, etc. or 

 anything which tends to increase the size of the uterus, will 

 help to produce the condition. In rare cases, the cause may 

 be congenital laxity of the uterine ligaments and the pelvic 

 floor. Such cases are usually accompanied by partial or 

 complete enteroptosis. 



On account of these sequelae, every perineal laceration 

 should be repaired as soon as possible. 



The Uterus. The uterus projects upwards and forwards 

 into the peritoneal pelvic cavity and separates the utero-rectal 

 from the utero-vesical fossa. It measures 3 inches long, 2 

 inches wide and i inch thick. Under normal conditions, the 

 long axis of the uterus meets the long axis of the vagina at an 



