Caagbay D-M1, Turel F1, Raynes-Greenow C2, Dietz HP1, Black K1
1The University of Sydney, Central Clinical School, Sydney, Australia, 2The University of Sydney, Public Health, Sydney, Australia
Background: Pelvic floor muscle (PFM) strength and thickness have been shown to be negatively associated with pelvic organ prolapse (POP) in Western women. Previous studies have found variations in pelvic floor functional anatomy among different ethnic groups. Therefore, ethnicity is likely to play an important role in the pathogenesis of pelvic floor dysfunction. This appears to be the case in Nepal where there is a lower prevalence of maternal birth trauma in the form of levator avulsion and obstetric anal sphincter injury and a higher rate of uterine retroversion.
Purpose: Our study aimed to determine the association between PFM strength and thickness with POP in Nepali women with a stage I-III POP.
Methods: This cross-sectional study assessed Nepali women attending an outpatient gynaecology clinic. A clinical examination was performed which included the Pelvic Organ Prolapse Quantification system (POP-Q) examination and the modified oxford scale (MOS) to assess PFM strength. Translabial 4D realtime ultrasound (TLUS) was performed at rest and maximal PFM contraction. Postprocessing of the volume datasets occurred at a later date where the hiatal area was measured in the plane of the minimal hiatal dimensions. Pubovisceral muscle thickness was measured using the maximal diameters in two locations bilaterally and the mean was calculated. Statistical analysis included Pearson's correlation coefficient and P 0.05 was considered statistically significant.
Results: Of the 129 women assessed, 111 women had a POP-Q stage I-III and the mean age was 39 (range 22-74) years, BMI was 26 (range 18-39) kg/m2and median parity was 2 (range 0-9). There were 33 (29%) women with POP-Q stage I, 70 (64%) with stage II and eight (7%) with stage III. Mean MOS at rest was 2.21 (range 1.5-3) and contraction was 3.38 (range 2-5). On TLUS, four women with inadequate ultrasound images were excluded. Mean pubovisceral muscle thickness at rest was 1.13 (range 0.65-1.79) cm and contraction was 1.23 (range 0.73-2.27) cm. Mean hiatal area at rest was 14.79 (range 8.35-27.09) cm2and contraction 11.24 (range 6.17-16.93) cm2. We found no association between PFM strength (MOS) and pubovisceral muscle thickness. There were no associations found between MOS or pubovisceral muscle thickness and POP stage.
Conclusion(s): Our study found no association between pelvic floor muscle strength or thickness and POP in Nepali women. Furthermore, the women in our study displayed good PFM strength regardless of POP stage. These results highlight that there may be differences in PFM functional anatomy in Nepali women when compared to other populations. It is important to consider these differences when developing POP treatment and management strategies.
Implications: Pelvic floor muscle training may not be an effective treatment strategy for Nepali women with a stage I-III POP who display good PFM function. Further research is needed exploring the role of vaginal pessaries and lifestyle factors in managing POP in this population. This study confirms that the aetiology of POP is complex and multifactorial and having strong and thick PFMs may not be protective against developing a POP.
Keywords: Pelvic floor muscle, Prolapse, Strength
Funding acknowledgements: DC: Dr Albert S McKern Research Scholarship, CRG: NHMRC grant, HPD has received unrestricted educational grants from GE Medical
Purpose: Our study aimed to determine the association between PFM strength and thickness with POP in Nepali women with a stage I-III POP.
Methods: This cross-sectional study assessed Nepali women attending an outpatient gynaecology clinic. A clinical examination was performed which included the Pelvic Organ Prolapse Quantification system (POP-Q) examination and the modified oxford scale (MOS) to assess PFM strength. Translabial 4D realtime ultrasound (TLUS) was performed at rest and maximal PFM contraction. Postprocessing of the volume datasets occurred at a later date where the hiatal area was measured in the plane of the minimal hiatal dimensions. Pubovisceral muscle thickness was measured using the maximal diameters in two locations bilaterally and the mean was calculated. Statistical analysis included Pearson's correlation coefficient and P 0.05 was considered statistically significant.
Results: Of the 129 women assessed, 111 women had a POP-Q stage I-III and the mean age was 39 (range 22-74) years, BMI was 26 (range 18-39) kg/m2and median parity was 2 (range 0-9). There were 33 (29%) women with POP-Q stage I, 70 (64%) with stage II and eight (7%) with stage III. Mean MOS at rest was 2.21 (range 1.5-3) and contraction was 3.38 (range 2-5). On TLUS, four women with inadequate ultrasound images were excluded. Mean pubovisceral muscle thickness at rest was 1.13 (range 0.65-1.79) cm and contraction was 1.23 (range 0.73-2.27) cm. Mean hiatal area at rest was 14.79 (range 8.35-27.09) cm2and contraction 11.24 (range 6.17-16.93) cm2. We found no association between PFM strength (MOS) and pubovisceral muscle thickness. There were no associations found between MOS or pubovisceral muscle thickness and POP stage.
Conclusion(s): Our study found no association between pelvic floor muscle strength or thickness and POP in Nepali women. Furthermore, the women in our study displayed good PFM strength regardless of POP stage. These results highlight that there may be differences in PFM functional anatomy in Nepali women when compared to other populations. It is important to consider these differences when developing POP treatment and management strategies.
Implications: Pelvic floor muscle training may not be an effective treatment strategy for Nepali women with a stage I-III POP who display good PFM function. Further research is needed exploring the role of vaginal pessaries and lifestyle factors in managing POP in this population. This study confirms that the aetiology of POP is complex and multifactorial and having strong and thick PFMs may not be protective against developing a POP.
Keywords: Pelvic floor muscle, Prolapse, Strength
Funding acknowledgements: DC: Dr Albert S McKern Research Scholarship, CRG: NHMRC grant, HPD has received unrestricted educational grants from GE Medical
Topic: Women's & men's pelvic health; Non-communicable diseases (NCDs) & risk factors; Musculoskeletal
Ethics approval required: Yes
Institution: Public Health Concern Trust Nepal
Ethics committee: Institutional Review Committee
Ethics number: Letter dated June 16, 2016
All authors, affiliations and abstracts have been published as submitted.
