1
|
Biswokarma Y, Brandon K, Lohman E, Stafford R, Daher N, Petrofsky J, Thapa U, Berk L, Hitchcock R, Hodges PW. Potential role of physical labor and cultural views of menstruation in high incidence of pelvic organ prolapse in Nepalese women: a comparative study across the menstrual cycle. Front Med (Lausanne) 2024; 11:1265067. [PMID: 38487031 PMCID: PMC10939065 DOI: 10.3389/fmed.2024.1265067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Pelvic organ prolapse (POP) is a significant health concern for young Nepali women, with potential risk factors including pelvic floor trauma from vaginal delivery and heavy lifting. The prevalence of symptomatic POP (SPOP) among nulliparous women in Nepal is 6%, while the general population of Nepali women aged 15-49 years reports a prevalence of 7%. Surprisingly, the average age of SPOP onset in Nepal is 27 years, challenging the assumption that postmenopausal age and vaginal delivery are the sole risk factors. This study aims to investigate the influence of increased intra-abdominal pressure (IAP) during lifting tasks on pelvic organ descent in Nepali women across different menstrual cycle stages. Methods The study included 22 asymptomatic Nepali women aged 18-30 years who regularly engage in heavy lifting. Intra-abdominal pressure was measured intra-vaginally during typical and simulated lifting tasks, which encompassed various scenarios such as ballistic lifting, ramped lifting, and pre-contraction of pelvic floor muscles, as well as coughing, Valsalva maneuver, and pelvic floor contractions. Pelvic floor displacement was recorded using transperineal ultrasound during menstruation, ovulation, and the mid-luteal phase. Results Results indicated that pelvic floor displacement was greater during menstruation than ovulation when performing a simulated ballistic lifting task (6.0 ± 1.6 mm vs. 5.1 ± 1.5 mm, p = 0.03, d = 0.6). However, there was no significant difference in pelvic floor displacement during lifting when the pelvic muscles were pre-contracted. Conclusion These findings suggest that lifting heavy loads during menstruation may increase the risk of stretching and injuring pelvic floor supportive tissues, potentially contributing to SPOP in young Nepali women. Pre-contracting pelvic floor muscles during lifting tasks may offer a protective effect. Understanding these factors could aid in developing targeted preventive measures and raising awareness about the impact of heavy lifting on pelvic floor health among Nepali women.
Collapse
Affiliation(s)
- Yvonne Biswokarma
- Allied Health Department, Loma Linda University Heath, Loma Linda, CA, United States
| | - Karen Brandon
- Allied Health Department, Loma Linda University Heath, Loma Linda, CA, United States
| | - Everett Lohman
- Allied Health Department, Loma Linda University Heath, Loma Linda, CA, United States
| | - Ryan Stafford
- School of Health and Rehabilitation Sciences, Queensland University, St Lucia, QLD, Australia
| | - Noha Daher
- Allied Health Department, Loma Linda University Heath, Loma Linda, CA, United States
| | - Jerold Petrofsky
- Allied Health Department, Loma Linda University Heath, Loma Linda, CA, United States
| | - Uma Thapa
- Scheer Memorial Adventist Hospital College of Nursing, Banepa, Kavre, Nepal
| | - Lee Berk
- Allied Health Department, Loma Linda University Heath, Loma Linda, CA, United States
| | - Robert Hitchcock
- Biomedical Engineering Department, University of Utah, Salt Lake City, UT, United States
| | - Paul W. Hodges
- School of Health and Rehabilitation Sciences, Queensland University, St Lucia, QLD, Australia
| |
Collapse
|
2
|
Sánchez-García O, López-Juárez R, Corona-Quintanilla DL, Ruiz ÁC, Martínez-Gómez M, Cuevas-Romero E, Castelán F. Estrogens influence differentially on the pelvic floor muscles activation at somatovisceral reflexes involved in micturition of rabbits. Menopause 2021; 28:1287-1295. [PMID: 34520412 DOI: 10.1097/gme.0000000000001838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the estrogen-dependency of the bladder and urethral function and the coordinated activation of pelvic floor muscles (PFM) during micturition. METHODS We allocated age-matched female rabbits to control, 1-month ovariectomized (OVX), and OVX plus 2-week estradiol benzoate (EB) groups to record cystometry, urethral pressure, and electromyograms of bulbospongiosus (Bsm), and pubococcygeus muscles (Pcm) simultaneously. We also measured serum estradiol levels and myofiber cross-sectional area. We assessed urodynamic and urethral variables, categorized the Bsm-Pcm activation patterns at storage and voiding phases, and obtained the power spectrum density of muscle activation around the voiding phase. We investigated the influence of ovarian hormones, in general, and the contribution of estrogen, particularly on the functions of the bladder, urethra, and PFM. Statistical significance was set at P < 0.05. RESULTS Ovarian hormones influence the bladder, urethral, and PFM functions. The urodynamics analyses indicated estrogens contribute to voiding duration and, to a lesser extent, to the time between bladder contractions. Urethral pressure at closure (maximal pressure-to-maximal urethral pressure ratio) improved partially (8%, P < 0.05) in the OVX plus 2-week estradiol benzoate compared with OVX, but urethral resistance increased (∼1.9-fold, P < 0.05) compared with control rabbits. Our findings support that Pcm activity at voiding is estrogen-sensitive, albeit EB administration reduced it at storage resume, which relates to high urethral resistance. CONCLUSIONS Ovariectomy impairs bladder and urethral pressures and Bsm and Pcm activation at micturition in anesthetized rabbits. Estrogen administration partially reverts some of these effects and influences Pcm activation.
Collapse
Affiliation(s)
- Octavio Sánchez-García
- Tlaxcala Center for Biology of Behavior, Autonomous University of Tlaxcala, Zacatelco, Mexico
- School of Clinical Chemistry, Faculty of Health Sciences, Autonomous University of Tlaxcala, Tlaxcala, Mexico
| | - Rhode López-Juárez
- Tlaxcala Center for Biology of Behavior, Autonomous University of Tlaxcala, Zacatelco, Mexico
- School of Clinical Chemistry, Faculty of Health Sciences, Autonomous University of Tlaxcala, Tlaxcala, Mexico
| | | | - Ángeles Carrasco Ruiz
- Tlaxcala Center for Biology of Behavior, Autonomous University of Tlaxcala, Zacatelco, Mexico
- Faculty of Dentistry, Autonomous University of Tlaxcala, Tlaxcala, Mexico
| | - Margarita Martínez-Gómez
- Tlaxcala Center for Biology of Behavior, Autonomous University of Tlaxcala, Zacatelco, Mexico
- Departament of Cellular Biology and Physiology, Institute for Biomedical Research, National Autonomous University of Mexico, Mexico City, Mexico
| | - Estela Cuevas-Romero
- Tlaxcala Center for Biology of Behavior, Autonomous University of Tlaxcala, Zacatelco, Mexico
| | - Francisco Castelán
- Tlaxcala Center for Biology of Behavior, Autonomous University of Tlaxcala, Zacatelco, Mexico
- Departament of Cellular Biology and Physiology, Institute for Biomedical Research, National Autonomous University of Mexico, Mexico City, Mexico
| |
Collapse
|
3
|
Huang WC, Yang JM, Chen HF. Four-Dimensional Introital Ultrasound in Assessing Perioperative Pelvic Floor Muscle Functions of Women with Cystoceles. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:e31-e41. [PMID: 32365385 DOI: 10.1055/a-1109-2493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Research on the use of ultrasound to explore the pelvic floor in women is rarely done with introital ultrasound. This study aimed to investigate the performance of four-dimensional (4D) introital ultrasound in the perioperative assessment of pelvic floor muscle (PFM) function in women with cystocele. MATERIALS AND METHODS The reliability and agreement of ultrasound measurements were determined by intraclass correlation coefficients (ICC) with 95 % confidence interval and Bland-Altman analysis in 20 women. The validity of ultrasound parameters was assessed by correlating squeezing ultrasound measurements with the modified Oxford scale (MOS) in 317 women. 4D introital ultrasound data of 241 women with (n = 29) and without (n = 212) postoperative cystocele at the 12-month postoperative assessment were retrospectively analyzed. Levator avulsion was diagnosed using tomographic ultrasound imaging. Involuntary and voluntary PFM functions were explored by dynamic changes in the bladder neck and genital hiatus, respectively, upon coughing and squeezing on 4D introital ultrasound. RESULTS The ICC for the reliability of all tested ultrasound parameters was good to very good. The changes and change ratios of most ultrasound measurements from resting to squeezing were fairly correlated with MOS. Women with postoperative cystocele demonstrated more rates of complete levator avulsion [41.3 % vs. 4.7 %, P < 0.001, odds ratio (OR) 14.26, 95 % confidence interval (CI) 4.88-42.42] and fewer rates of capable voluntary PFM contraction (65.5 % vs. 92.5 %, P < 0.001, OR 0.16, 95 % CI 0.06-0.43) than those without postoperative cystocele postoperatively. CONCLUSION 4D introital ultrasound is feasible to assess perioperative PFM function in women with cystocele.
Collapse
Affiliation(s)
- Wen-Chen Huang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jenn-Ming Yang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Fu Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
4
|
Cacciari LP, Morin M, Mayrand MH, Tousignant M, Abrahamowicz M, Dumoulin C. Pelvic floor morphometrical and functional changes immediately after pelvic floor muscle training and at 1-year follow-up, in older incontinent women. Neurourol Urodyn 2020; 40:245-255. [PMID: 33075192 DOI: 10.1002/nau.24542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/05/2020] [Indexed: 11/11/2022]
Abstract
AIMS To compare the effects of group-based and individual physiotherapy for stress or mixed urinary incontinence (UI) on pelvic floor morphometry, pelvic floor muscle (PFM) function, and related self-efficacy, immediately after treatment and at 1 year. METHODS This is a planned secondary analysis of the group rehabilitation or individual physiotherapy study, an assessor-blinded, randomized, noninferiority trial. Eligible participants included 362 community-dwelling older women with symptoms of stress/mixed UI. After learning how to contract PFMs, participants completed 12 weeks of PFM training, either individually (one-on-one) or as part of a group (eight women). Pelvic floor transperineal ultrasound volumes (morphometry), PFM intravaginal dynamometric data (function), and self-efficacy in performing PFM exercises were acquired at baseline, posttreatment, and at 1 year. RESULTS Groups were comparable at all time points. Immediately posttreatment, both groups demonstrated significant changes in pelvic floor morphometry during coughs, and in PFM function during contractions and coughs. Participants also reported improved self-efficacy in performing PFM exercises. Results were sustained at 1 year. When participants coughed, pelvic floor structures were better supported (reflected by less caudal movement of the puborectalis sling and a smaller opening of the levator hiatus) in a pattern consistent with the "knack" strategy. Furthermore, both interventions resulted in stronger, faster, more coordinated, and more endurant PFMs. CONCLUSION In older women with stress or mixed UI, both individual and group-based PFM training resulted in comparable improvements in overall PFM function, pelvic floor morphometry during coughs, and related self-efficacy in performing PFM exercises, which were sustained at 1 year.
Collapse
Affiliation(s)
- Licia P Cacciari
- School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Mélanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Research Center of the Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marie-Hélène Mayrand
- Departments of Obstetrics and Gynecology and Social and Preventive Medicine, Université de Montréal and Research Center of the Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Michel Tousignant
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Research Center of the Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University and Research Institute of the McGill University Health Center, Montreal, Québec, Canada
| | - Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| |
Collapse
|
5
|
Badillo SA. Evidence-Based Women’s Health Physical Therapy Across the Lifespan. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
6
|
Huang WC, Yang JM, Chen HF. The significance of pelvic floor support on the pelvic floor muscle functions of women with lower urinary tract symptoms. Taiwan J Obstet Gynecol 2020; 59:551-555. [DOI: 10.1016/j.tjog.2020.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 11/16/2022] Open
|
7
|
|