Spasticity of the pelvic floor mimicking an obstructive anomaly.
OBJECTIVE
Hematocolpos or hydrocolpos in menstruating women raises suspicion of a partial uterine or vaginal obstruction. The study objective is to report two unusual cases of a spastic pelvic floor leading to urine collecting in the vagina and mimicking an outflow obstruction.


METHODS
The study took place at a tertiary care university's Reproductive Health Care Clinic for Women with Developmental Disabilities and involved two patients with spastic quadriplegic cerebral palsy and developmental disabilities who presented with irregular menses and abdominal pain and whose radiological evaluations were suspicious for an outflow obstruction. Medical records, including clinic visits, radiological findings, and surgical findings, were reviewed.


METHODS
Both patients underwent ultrasound and MRI evaluation of their reproductive tracts that demonstrated fluid collections in the vagina. An examination under anesthesia was performed in one patient to rule out an obstruction. In the second patient, a pelvic examination under ultrasound observation revealed initial vaginal distension with urine, which resolved after placement of a speculum.


RESULTS
In both cases, the pseudo-obstruction was felt to be a urine-distended vagina due to a spastic pelvic floor.


CONCLUSIONS
A spastic pelvic floor in an incontinent patient with spastic quadriplegia may result in urine accumulation in the vagina, mimicking an outflow tract obstruction. If the history, pelvic examination, and radiological images are inconsistent, performing an ultrasound-guided examination may assist with diagnosis.
Quint
Elisabeth H
EH
Department of Obstetrics and Gynecology, University of Michigan Health Systems, Ann Arbor, Michigan 48109-0276, USA. equint@umich.edu
Smith
Yolanda R
YR
Bowerman
Richard A
RA
DeLancey
John O L
JO
D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000150:complications; D003937:Diagnosis, Differential; D005260:Female; D006399:Hematocolpos / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000209:etiology; D017773:Pelvic Floor; D014549:Urinary Incontinence / Q000209:etiology; D014623:Vaginal Diseases / Q000175:diagnosis*