WOMEN SCHEDULED FOR PELVIC FLOOR RECONSTRUCTIVE SURGERY: A NEURO-MUSCULOSKELETAL PERSPECTIVE

Brandt C.¹, Cronje H.¹, Janse van Vuuren C.¹, Nel R.¹

¹University of the Free State, Physiotherapy, Bloemfontein, South Africa

Background: The pelvic floor muscles (PFM) are important in the prevention and treatment of pelvic floor dysfunction. A more integrated definition of PFM function is necessary, based on more recent bio-psychosocial and motor control models. Controversy and a lack of research exist regarding the interaction between the PFM and abdominal muscles (motor control), and pelvic organ prolapse (POP).

Purpose: To determine quality of life (QOL), PFM and abdominal muscle function in women scheduled for pelvic floor reconstructive surgery.

Methods: One hundred women scheduled for pelvic floor reconstructive surgery were non-randomly sampled for ultrasonography, electromyography (EMG), strength (PERFECT scale) and endurance measurement of the PFM. The abdominal muscles were assessed by the Sahrmann scale, Pressure Biofeedback Unit and EMG. QOL was assessed by means of the standardised prolapse-specific QOL questionnaire (the P-QOL). Demographic data and medical history was recorded on a self-compiled questionnaire. Descriptive statistics and Spearman/Pearson correlation coefficients were used to describe data.

Results: The participants (average 59 years) were mostly unemployed (80%) and physically inactive (85%). Approximately 47% were treated for heart/vascular disease, 18% for hypo-thyroidism and 12% for depression. The median scores of the prolapse impact (66.67, IQ range [33.33-100.0]), social (33.3, IQ range [0-66.7], emotional (44.4, IQ range [11.1-72.2]), sleep/energy (33.3, IQ range [16.7-50.0]) and severity domains (25, IQ range [12.5-41.7]) of the P-QOL also indicated impairment. The mean levator hiatus at rest (56.38mm), thickness (5.1mm), amount of movement (4.28mm), strength (level 1.89) and endurance (4.04s) of the PFM indicated dysfunction. Median values of zero were found for the Sahrmann scale (IQ range [0-1]) and PBU (IQ range [0-2]), and 10.95µV for the abdominal EMG (IQ range [7.9-17.8]). Significant correlations were found between PFM strength, endurance, movement and EMG activity (r>0.4, p 0.001), as well as between PFM strength, endurance and abdominal muscle function (r>0.4, p 0.05).

Conclusion(s): It seems as if social/emotional aspects, co-morbidities, PFM and abdominal muscle function may affect the neuro-musculoskeletal interaction necessary for pelvic organ support and function.

Implications: These aspects should be considered when assessing and treating patients with pelvic floor dysfunction. The neuro-musculoskeletal aspects were further investigated by a randomised controlled trial assessing the outcomes of different intervention programmes based on the findings from this study.

Funding acknowledgements: None

Topic: Women's & men’s pelvic health

Ethics approval: Ethics committee of the Faculty of Health Sciences, University of the Free State (Ecufs nr 252012)

All authors, affiliations and abstracts have been published as submitted.