Background: Pelvic floor trauma with vaginal delivery and heavy lifting, are thought to be risk factors for symptomatic pelvic organ prolapse (SPOP) in young Nepali women. The 2011 Nepal Demographic and Health Survey found 6% of nulliparous women report SPOP, compared to 7% in the general population of Nepali women ages 15 – 49. The average age of SPOP onset in Nepal is 27.3 In western countries SPOP is usually reported between the 4th and 6th decade of life. This study investigated the effect of increased intra-abdominal pressure (IAP) on pelvic organ descent during simulated lifting tasks in Nepali women across the menstrual cycle. The aims were to (i) calculate the descent of the pelvic floor organs during a simulated lifting task in a population of Nepali women, (ii) compare the descent between three stages of the menstrual cycle, and (iii) investigate the capacity of the pelvic floor muscles to resist pelvic organ descent by voluntarily contracting prior to performing the lifting task. We hypothesized that there was a relationship between heavy lifting during menstruation that could account for the unexpectedly high rates of young and nulliparous women with SPOP in Nepal possibly linked to their unique custom of Chhaupadi (ritual impurity during menstruation). Methods: 22 asymptomatic Nepali women aged 18-30 years who regularly lift heavy loads were included in the study. Intra-abdominal pressure was measured intra-vaginally during both typical lifting tasks and simulated lifting tasks. Simulated tasks included: ballistic lifting, ramped lifting, ballistic lift with pre-contraction of the pelvic floor muscles, cough, Valsalva, and pelvic floor contraction. Transperineal ultrasound (US) recorded displacement (mm) of the bladder base with simulated tasks during: menstruation, ovulation, and mid-luteal phase. Findings: More pelvic floor displacement was found during menstruation than ovulation with simulated ballistic lifting (6˙0 ± 1˙6 vs 5˙1 ±1˙5, p = ˙03). However, there was no significant difference in pelvic floor displacement with lifting when the pelvic muscles were pre-contracted. Interpretation: The pelvic floor supportive tissues may be at increased risk for stretching and injury when lifting a heavy load during menstruation versus ovulation. Pre-contracting the pelvic muscles when lifting may demonstrate a protective effect.
|Advisor:||Lohman, Everett, Brandon, Karen|
|Commitee:||Berk, Lee, Daher, Noha, Hodges, Paul, Petrofsky, Jerrold, Stafford, Ryan, Thapa, Uma|
|School:||Loma Linda University|
|School Location:||United States -- California|
|Source:||DAI-B 78/12(E), Dissertation Abstracts International|
|Subjects:||Womens studies, Health sciences, Biomechanics|
|Keywords:||Compliance, Lifting, Menstrual cycle, Nulliparous, Pelvic floor, Prolapse|
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