Effects of Posture and Gravity on Pelvic Organ Prolapse

Abstract

Female pelvic floor dysfunction occurs when the integrity of the pelvic floor muscles is compromised and impacts the position and function of the pelvic organs. Physicians use international guidelines to evaluate and treat women for POP taking into account that posture and gravity impact pelvic organ position, and degree of prolapse. Our clinical focuses on the description of surface anatomy. This examination alone is insufficient. Although imaging is recommended, the modalities currently available are recognized to have flaws. MRI is performed in the supine position regardless the effect of posture and gravity on POP. A literature search was performed using databases, searching MEDLINE and PubMed using the key terms ultrasound, MRI, and CT. We describe use of a new protocol and advanced technique to evaluate the changes of POP in different positions using open MRI (MRO). POP patients underwent MRO imaging of the pelvic floor using a 0.5 T MRO scanner. The extent of displacement of prolapsed organs was determined using validated reference lines drawn on the mid-sagittal images. Manual segmentation and surface modeling were used to construct the 3D models. MRO offers new levels of anatomic detail; 3D sequences based on 2D images are an additional refinement.