Compartment syndrome refers to pressure buildup in muscles

Q: What is compartment syndrome, and how does it happen? I developed this following an embolism from hip replacement surgery. I had eight days on wound vacuum-assisted closure, plus physical therapy. The hip is fine now, but nerve damage along my leg to my foot and ankle persists.

A: To understand compartment syndrome, we need to begin with a bit of anatomy. In this context, the word "compartment" refers to specific groupings of muscles, along with the nerves and blood vessels that serve them.

Because muscles are wrapped in a taut and tough membrane known as the fascia, these groupings form distinct units that are referred to as compartments.

When someone develops compartment syndrome, it means that something has caused an abnormal buildup of pressure within the affected muscles. The cause can be a wound, broken bone, deep muscle bruise, severe sprain or a cast or bandage that is too tight. The increase in internal pressure adversely affects the flow of blood throughout the tissues, which starves the muscles and nerves of nutrients and oxygen. Compartment syndrome can occur in any limb, but it is most commonly seen in the lower leg.

Depending on the cause, symptoms can range from mild to severe. These include cramps, pain or burning in the affected muscles and stiffness, numbness or tingling in the affected limb. If the muscle becomes herniated, swelling or a bulge may become visible.

Compartment syndrome can occur as a result of intensive exercise. This is known as chronic or exertional compartment syndrome, and the symptoms will typically subside with rest. When the condition arises due to injury, it is known as acute compartment syndrome. This is always a medical emergency.

In your case, an embolism led to compartment syndrome in the lower leg. An embolism is an arterial blockage caused by a foreign body, such as a blood clot or air bubble. While this is a known complication of hip replacement surgery, it is rare for an embolism to lead to compartment syndrome.

The most effective treatment of acute compartment syndrome is a surgical procedure known as fasciotomy. This involves cutting into the tough, inflexible fascia that surrounds the muscle, which allows the internal pressure to decrease.

The vacuum-assisted closure of the wound, or VAC, that you underwent is a type of therapy used to aid in wound healing. As the name suggests, it works by lowering the air pressure in the region of the wound. Once the internal pressure of the muscles involved in compartment syndrome has been successfully eased, the focus shifts to healing the surgical site.

Prompt diagnosis followed by immediate treatment is crucial to recovery from acute compartment syndrome. Left unaddressed, it can lead to nerve damage, muscle damage, impaired blood flow and neuropathy.

The cause of the initial injury that led to the condition also plays a role in the scope of the subsequent recovery. A neurologist can help you learn if there is lasting nerve damage in your leg and if ongoing physical therapy may be helpful.

Q: I have been told I have a stage 2 rectocele and that there are two ways to approach treating it. One is insertion of something into the rectum; the other is surgery. Can you please discuss these two options? Could doing physical therapy be helpful?

A: The term rectocele refers to a type of pelvic organ prolapse. It can occur when the wall of supportive tissue that sits between the rectum and the vagina, known as the rectovaginal septum, becomes weakened. Both the rectum and the vagina are flexible passageways that rely on surrounding tissues to help maintain their hollow structure.

If that support weakens, it becomes possible for the tissues of the rectum to begin to push against the rear wall of the vagina. When this results in a bulge that intrudes into the passageway of the vagina, it is known as a rectocele.

It is possible for the condition to occur in men, typically in tissues associated with the prostate gland. However, the vast majority of cases are seen in women.

Risk factors for developing a rectocele include multiple vaginal deliveries; stress, trauma or damage to the vaginal tissues, including during a vaginal delivery; chronic constipation, which can lead to repeated straining during bowel movements; gynecological or rectal surgeries; and the physical changes that occur after menopause.

Symptoms include a feeling of fullness within the vagina, rectal pain or bleeding, and an increase in difficulty in emptying the rectum during a bowel movement. Additional effects can include itching that may become intense, fecal incontinence and sexual dysfunction.

The degree of protrusion in a rectocele can range from so slight as to be undetectable to pronounced enough that the tissues of the rectum can be felt or seen within the vagina. In stage 2 rectocele, herniated tissue may be visible within the vagina.

Treatment depends on the degree of prolapse and the individual's age and physical condition. When the condition is mild, nonsurgical management is recommended. A high-fiber diet, along with fiber supplements, stool softeners and adequate hydration will help ease bowel movements and lessen straining.

Postmenopausal women may benefit from hormone replacement therapy. Pelvic floor exercises have also been found to be quite effective.

In more advanced cases of rectocele, surgery may be required. This entails removing the herniated tissue and using sutures to reinforce the supportive wall of tissue between the vagina and the rectum. The procedure is performed either by a urologist, gynecologist or colorectal surgeon, depending on if the surgery is approached from the anus or the vagina.

Surgical mesh, which had been used in the past, is no longer recommended for this condition. The FDA has recently approved the use of an implantable device that anchors the ligaments in the vaginal wall. In use since 2019, this is a fairly new approach to managing pelvic organ prolapse.

In deciding between a surgical repair and this novel approach, it is important to speak with your health care provider about the risks involved in each procedure. Once you have decided on a path forward, seek out a surgeon who specializes in pelvic floor conditions.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.