Pelvic floor function is independently associated with pelvic organ prolapse

Abstract

Objective To investigate the risk factors for pelvic organ prolapse (POP), including physical activity, clinically measured joint mobility and pelvic floor muscle (PFM) function.Design One-to-one age-and parity-matched case-control study.Setting Akershus university hospital and one outpatient physiotherapy clinic in Norway.Population Forty-nine women with POP (POP quantification, stage ‡II) and 49 controls (stages 0 and I) were recruited from community gynaecologists and advertisements in newspapers.Methods Validated questionnaires, interview and clinical examination, including Beighton's scoring system (joint hypermobility) and vaginal pressure transducer measurements (PFM function), were used. Univariate and multivariate conditional logistic regression analyses for one-to-one matched case-control studies were used, and odds ratios with 95% CIs are reported.Main outcome measures Pelvic floor muscle function (strength, endurance and resting pressure), socioeconomic status, body mass index, heavy occupational work, physical activity, family history, obstetric factors and markers of connective tissue weakness (striae, varicose veins, bruising, diastasis recti abdominis, joint hypermobility).Results No significant differences were found between groups with regard to postmenopausal status, current smoking, current low-intensity exercise, type of birth (caesarean, forceps, vacuum), birth weight, presence of striae, diastasis recti abdominis and joint hypermobility. Body mass index (OR 5.0; 95% CI 1.1-23.0), socioeconomic status (OR 10.5; 95% CI 2.2-50.1), heavy occupational work (OR 9.6; 95% CI 1.3-70.3), anal sphincter lacerations (OR 4.5; 95% CI 1.0-20.0), PFM strength (OR 7.5; 95% CI 1.5-36.4) and endurance (OR 11.5; 95% CI 2.0-66.9) were independently related to POP.Conclusions Body mass index, socioeconomic status, heavy occupational work, anal sphincter lacerations and PFM function were independently associated with POP, whereas joint mobility and physical activity were not.Keywords Anal sphincter lacerations, body mass index, casecontrol, joint hypermobility, occupational work, pelvic floor muscle, pelvic organ prolapse, socioeconomic status, varicose veins.Please cite this paper as: Braekken I, Majida M, Ellström Engh M, Holme I, Bø K. Pelvic floor function is independently associated with pelvic organ prolapse.

Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th International Consultation on Incontinence

“…Association between POP and bodyweight: Four new studies addressed obesity and prolapse, [24,[26][27][28] and support the findings from the previous review that obesity and prolapsed may be linked.…”

“…Association between POP and occupation: Three new studies, which support an association between a women's current employment in heavy occupational lifting and prolapse, were found; [24][25][26] however, the odds ratio in one study was only marginally significant.…”

Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women

“…Only contractions with simultaneous visible inward movement of the catheter /perineum were considered correct [9]. Muscle endurance was measured as the area under the curve during attempt to hold the contraction for 10 seconds [12]. Three MVC followed by a short resting period and one holding period were performed.…”

Dyspareunia and pelvic floor muscle function before and during pregnancy and after childbirth

“…The device was positioned with the middle of the balloon 3.5 cm internal to the introitus [20]; a method found to be reliable and valid if used with simultaneous observation of inward movement of the perineum/catheter during a contraction [19,21]. VRP was measured as vaginal pressure, with no voluntary PFM activity, and was registered as cmH 2 O. PFM strength was reported as the mean of 3 maximum voluntary contractions, and registered as cmH 2 O. PFM endurance was defined as a sustained maximum contraction and was quantified as the area under the curve during 10 seconds, measured during 1 attempt and registered as cmH 2 Osec [22]. The atmospheric pressure on the balloon was calibrated to 0 cmH 2 O for each subject before it was placed in the vagina.…”

“…Women scheduled for delivery at Akershus University Hospital, Norway from January 2010 until April 2011 were invited to participate when they attended their routine ultrasound examination at mid-pregnancy (gestational week [18][19][20][21][22]. Background information on presence and level of bother of dyspareunia were collected through an electronic questionnaire at 5 differ-ent time points; pre-pregnancy, at gestational weeks 22 and 37, and at 6 and 12 months postpartum.…”