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Barbier H, Carberry CL, Karjalainen PK, Mahoney CK, Galán VM, Rosamilia A, Ruess E, Shaker D, Thariani K. International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction. Int Urogynecol J 2023; 34:2657-2688. [PMID: 37737436 PMCID: PMC10682140 DOI: 10.1007/s00192-023-05629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/22/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This manuscript from Chapter 2 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reviews the literature involving the clinical evaluation of a patient with POP and associated bladder and bowel dysfunction. METHODS An international group of 11 clinicians performed a search of the literature using pre-specified search MESH terms in PubMed and Embase databases (January 2000 to August 2020). Publications were eliminated if not relevant to the clinical evaluation of patients or did not include clear definitions of POP. The titles and abstracts were reviewed using the Covidence database to determine whether they met the inclusion criteria. The manuscripts were reviewed for suitability using the Specialist Unit for Review Evidence checklists. The data from full-text manuscripts were extracted and then reviewed. RESULTS The search strategy found 11,242 abstracts, of which 220 articles were used to inform this narrative review. The main themes of this manuscript were the clinical examination, and the evaluation of comorbid conditions including the urinary tract (LUTS), gastrointestinal tract (GIT), pain, and sexual function. The physical examination of patients with pelvic organ prolapse (POP) should include a reproducible method of describing and quantifying the degree of POP and only the Pelvic Organ Quantification (POP-Q) system or the Simplified Pelvic Organ Prolapse Quantification (S-POP) system have enough reproducibility to be recommended. POP examination should be done with an empty bladder and patients can be supine but should be upright if the prolapse cannot be reproduced. No other parameters of the examination aid in describing and quantifying POP. Post-void residual urine volume >100 ml is commonly used to assess for voiding difficulty. Prolapse reduction can be used to predict the possibility of postoperative persistence of voiding difficulty. There is no benefit of urodynamic testing for assessment of detrusor overactivity as it does not change the management. In women with POP and stress urinary incontinence (SUI), the cough stress test should be performed with a bladder volume of at least 200 ml and with the prolapse reduced either with a speculum or by a pessary. The urodynamic assessment only changes management when SUI and voiding dysfunction co-exist. Demonstration of preoperative occult SUI has a positive predictive value for de novo SUI of 40% but most useful is its absence, which has a negative predictive value of 91%. The routine addition of radiographic or physiological testing of the GIT currently has no additional value for a physical examination. In subjects with GIT symptoms further radiological but not physiological testing appears to aid in diagnosing enteroceles, sigmoidoceles, and intussusception, but there are no data on how this affects outcomes. There were no articles in the search on the evaluation of the co-morbid conditions of pain or sexual dysfunction in women with POP. CONCLUSIONS The clinical pelvic examination remains the central tool for evaluation of POP and a system such as the POP-Q or S-POP should be used to describe and quantify. The value of investigation for urinary tract dysfunction was discussed and findings presented. The routine addition of GI radiographic or physiological testing is currently not recommended. There are no data on the role of the routine assessment of pain or sexual function, and this area needs more study. Imaging studies alone cannot replace clinical examination for the assessment of POP.
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Affiliation(s)
- Heather Barbier
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cassandra L Carberry
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University/Women & Infants Hospital, Providence, RI, USA
| | - Päivi K Karjalainen
- Department of Obstetrics and Gynecology, Hospital Nova of Central Finland, Jyväskylä, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | | | - Anna Rosamilia
- Urogynaecologist and Reconstructive Pelvic Floor Surgeon, Cabrini Hospital, Malvern, Victoria, Australia.
- Monash Health, Monash University Department of O&G, Hudson Institute of Medical Research, Melbourne, Australia.
| | - Esther Ruess
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | - David Shaker
- Rural Clinical School Rockhampton Australia, Mater Private Hospital Rockhampton Australia, University of Queensland, St Lucia, Australia
| | - Karishma Thariani
- Fellowship in Urogynaecology & Pelvic Reconstructive Surgery, Consultant Urogynaecologist, Centre for Urogynaecology & Pelvic Health, New Delhi, India
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Yumusakhuylu Y, Caglar Yagci H, Bayindir SN. Lower Urinary Tract Symptoms in Patients With Chronic Low Back Pain: A Cross-Sectional Study. Cureus 2023; 15:e45939. [PMID: 37885563 PMCID: PMC10599597 DOI: 10.7759/cureus.45939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION This study aimed to determine the extent of lower urinary tract symptoms (LUTS) in patients with chronic low back pain (CLBP) and the relationship between LUTS and patients' clinical and functional factors. METHODS Patients aged 40 to 80 who were admitted with CLBP were included. Demographic data and the duration of CLBP and LUTS were noted. Anteroposterior and lateral lumbar radiographs and lumbar MRI findings were recorded. Short Form 36 (SF-36) and the Oswestry Disability Index (ODI) were used for functional status assessment. For the LUTS evaluation, patients were asked to tick the symptoms from the list of LUTS prepared. RESULTS We included 90 patients with CLBP. The frequency of urinary incontinence was 81.1%. The mean number of LUTS was 2.81±3.22. The LUTS rates were higher in patients with vertebral height loss (p = 0.03), with central (p = 0.02) and lateral spinal narrow canals (p = 0.03), and with facet hypertrophy (p = 0.04). The rates of LUTS were lower in patients with decreased lumbar lordosis (p = 0.02). The ODI and LUTS were found to be related (p = 0.01). The role limitations due to physical problems of the SF-36 subgroups and LUTS were significantly correlated (p = 0.01). CONCLUSION The incidence of the coexistence of CLBP and LUTS is high. Patients cannot match and report LUTS among their complaints, so physicians should inquire about LUTS in patients with CLBP and carry out the appropriate diagnosis and treatment.
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Affiliation(s)
- Yasemin Yumusakhuylu
- Physical Medicine and Rehabilitation, Istanbul Medeniyet University, Istanbul, TUR
| | - Hanife Caglar Yagci
- Physical Medicine and Rehabilitation, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, TUR
| | - Seyma N Bayindir
- Physical Medicine and Rehabilitation, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, TUR
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Fuentes-Aparicio L, Rejano-Campo M, López-Bueno L, Marie Donnelly G, Balasch-Bernat M. The effect of an abdominopelvic exercise program alone VS in addition to postural instructions on pelvic floor muscle function in climacteric women with stress urinary incontinence. A randomized controlled trial. Physiother Theory Pract 2023; 39:738-749. [PMID: 35068328 DOI: 10.1080/09593985.2022.2028323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Scarce literature exists regarding the influence of posture-based interventions for the treatment of stress urinary incontinence (SUI). OBJECTIVE The aim of this randomized controlled trial with two parallel groups was to investigate whether the addition of postural instructions to a 12-week abdominopelvic exercise program is superior to an abdominopelvic exercise program alone, in terms of PFMs function and symptoms in climacteric women with SUI. METHODS Climacteric women aged between 40-75 years old who presented with SUI were included in this parallel study (NCT03727945). Two randomized groups performing one 40-minutes session per week for 12-weeks were compared: one performing an abdominopelvic exercise program (AEP) and a second one performing the same intervention with the addition of postural instructions (AEPPI). PFMs electromyographical (EMG) activity and strength (Oxford Grading Scale) were quantified during a maximal voluntary contraction. SUI symptoms were assessed using a 3-day bladder diary. These outcomes were collected at baseline, immediately after intervention, and 3-months after the intervention. RESULTS A total of 47 women were included in the study (AEP [n = 23], AEPPI [n = 24]). Between-group analysis showed significant differences for post-intervention EMG and strength values, showing higher values for the AEPPI compared to the AEP group. At 3-months follow-up, statistically significant differences were only obtained in strength, with higher values in the AEPPI group. No significant differences were obtained in terms of UI symptoms. CONCLUSION A 12-session abdominopelvic exercise program supplemented with postural instructions is superior to an abdominopelvic exercise program alone in terms of PFMs function in women with SUI.
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Affiliation(s)
- Laura Fuentes-Aparicio
- Department of Physical Therapy, University of Valencia, Valencia, Spain
- Physiotherapy in Motion, Multi-Speciality Research Group (Ptinmotion), University of Valencia, Valencia, Spain
| | | | - Laura López-Bueno
- Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Gráinne Marie Donnelly
- Perinatal Physical Activity Research Group, Canterbury Christ Church University, Canterbury, UK
- Pelvic Health department, Absolute Physio, Ireland, UK
| | - Mercè Balasch-Bernat
- Department of Physical Therapy, University of Valencia, Valencia, Spain
- Physiotherapy in Motion, Multi-Speciality Research Group (Ptinmotion), University of Valencia, Valencia, Spain
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Steenstrup B, Cornu JN, Poilvet E, Breard H, Kerdelhue G, Gilliaux M. [Impact of the aged-related changes of sagittal spinal curvature on pelvic organ prolapse. A systematic review of the literature]. Prog Urol 2022; 32:516-524. [PMID: 35337749 DOI: 10.1016/j.purol.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/08/2022] [Accepted: 02/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this review was to specify the potential association between age-related changes in sagittal spinal curvature and risk of pelvic organ prolapse in women. METHODS A systematic review based on the PRISMA statement was performed. Keywords were chosen according to the eligibility criteria in line with the PICO model. For inclusion, studies had to be based on observational cohorts, case controls and cross sectional studies. The quality of the articles was assessed using the STROBE scale. RESULTS Five papers from 1996 to 2021 were included in the present review with conflicting results. Four studies reported a positive association between anatomical pelvic organ prolapse at clinical examination, a loss of lumbar lordosis and an increase in thoracic kyphosis. The remaining study, using a questionnaire-based assessment of symptoms, found no association between prolapse-related symptoms and age-related changes in sagittal spinal curvatures. CONCLUSION Based on the available evidence, this systematic review suggested a very moderate evidence of association between the development of anatomical pelvic organ prolapse and age-related changes in sagittal spinal curvature in women. This review remains very limited by the small number and the heterogeneity of the studies included. Further studies in the lifetime continunm, with high quality methodology are needed to better understand the physiopathology of pelvic organ prolapse.
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Affiliation(s)
- B Steenstrup
- Service d'urologie, centre hospitalier universitaire, Rouen, France.
| | - J N Cornu
- Service d'urologie, centre hospitalier universitaire, Rouen, France
| | - E Poilvet
- IFMK La Musse, Saint-Sébastien-de-Morsent, France
| | - H Breard
- Service de gynécologie obstétrique, centre hospitalier universitaire, Rouen, France
| | - G Kerdelhue
- Département informatique biomédicale, centre hospitalier universitaire, Rouen, France
| | - M Gilliaux
- IFMK La Musse, Saint-Sébastien-de-Morsent, France; Département de recherche clinique, hôpital La Musse, Saint-Sébastien-de-Morsent, France; CETAPS laboratory, EA 3832, université de Rouen, Rouen, France
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The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor. Life (Basel) 2021; 11:life11121397. [PMID: 34947928 PMCID: PMC8704638 DOI: 10.3390/life11121397] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 12/13/2022] Open
Abstract
The pelvic floor (PF) is made of muscles, ligaments, and fascia, which ensure organ statics, maintain muscle tone, and are involved in contractions. This review describes the myofascial relationships of PF with other parts of the body that determine the proper functions of PF, and also provides insight into PF disorders and the factors contributing to them. PF plays an important role in continence, pelvic support, micturition, defecation, sexual function, childbirth, and locomotion, as well as in stabilizing body posture and breathing, and cooperates with the diaphragm and postural muscles. In addition, PF associates with distant parts of the body, such as the feet and neck, through myofascial connections. Due to tissue continuity, functional disorders of muscles, ligaments, and fascia, even in the areas that are distant from PF, will lead to PF disorders, including urinary incontinence, fecal incontinence, prolapse, sexual dysfunction, and pain. Dysfunctions of PF will also affect the rest of the body.
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Effect of the App-Based Video Guidance on Prenatal Pelvic Floor Muscle Training Combined with Global Postural Re-education for Stress Urinary Incontinence Prevention: A Protocol for a Multicenter, Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412929. [PMID: 34948546 PMCID: PMC8700899 DOI: 10.3390/ijerph182412929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/15/2021] [Accepted: 12/01/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND As the effectiveness on stress urinary incontinence (SUI) prevention of pelvic floor muscle training (PFMT) for pregnant women has been inconclusive, we are planning to conduct a trial to evaluate a video program designed for prevention of SUI developed through combining PFMT with global postural reeducation (GPR). METHODS As a randomized controlled trial, eligible participants will be randomized (1:1) into an exercise group and a control group to perform PFMT regularly following video guidance or with no intervention, respectively. The experimental stage will be from the 16th gestation week (GW) to the 12th month postpartum, with eight appointments at the 16th, 28th, 37th GW, delivery, the 6th week and the 3rd, 6th, and 12th month postpartum. Data will be collected regarding urinary leakage symptoms, the stress test, the modified Oxford Scale, pelvic floor ultrasound, perineal laceration classification at delivery, neonatal Apgar score, and questionnaires (PISQ-12, ICIQ-UI SF, I-QOL, OABSS). The primary outcome is the occurrence of the symptomatic SUI and positive stress test at the 6th week postpartum. DISCUSSION This protocol is anticipated to evaluate the efficacy of the intervention via video app for the design of a future randomized control trial (RCT). TRIAL REGISTRATION The trial has been registered at Chinese Clinical Trial Registry (registration number: ChiCTR2000029618).
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Postural Sensorimotor Control on Anorectal Pressures and Pelvic Floor Muscle Tone and Strength: Effects of a Single 5P ® LOGSURF Session. A Cross-Sectional Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073708. [PMID: 33918217 PMCID: PMC8037751 DOI: 10.3390/ijerph18073708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022]
Abstract
Pelvic floor dysfunction (PFD) is a functional condition present most frequently in women. Despite pelvic floor muscle training being considered by the International Continence Society (ICS) as the first-line treatment in uncomplicated urinary incontinence, other more comprehensive postural methods as 5P® LOGSURF have emerged. This preliminary cross-sectional study explores the effects of a single 5P® LOGSURF session on pelvic floor muscle (PFM) tone and strength (MVC), resting anal tone, intrarectal pressure, and deep abdominal muscles activation. Thirty women were included (11 without PFD and 19 with PFD). Primary outcome measures were PFM tone, PFM MVC and resting anal tone and secondary measures outcomes were intrarectal pressure and deep abdominal activation. All outcome measures were collected before, throughout and after a single 30′ 5P® LOGSURF session. The findings from this study suggest that PFM tone (PFD group: p = 0.09, d = 0.72; non-PFD group: p = 0.003, d = 0.49) and PFM MVC (PFD group: p = 0.016; non-PFD group: p = 0.005) decreased in both groups after a single 5P® LOGSURF session, with a medium effect size for women with PFD. Contrarily, deep abdominal muscle MVC increased (PFD group: p < 0.001; non-PFD group: p = 0.03). Intrarectal pressure and resting anal tone decreased in both groups throughout the session. These results suggest that 5P® LOGSURF method may be interesting if is performed by women with mild symptoms of PFD or healthy women to achieve a decrease in PFM tone in women who manifested pain to intracavitary techniques or practices. Further research with higher sample sizes and long-term are necessary for generalizing.
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Liu T, Hou X, Xie B, Wu J, Yang X, Sun X, Wang J. Pelvic incidence: A study of a spinopelvic parameter in MRI evaluation of pelvic organ prolapse. Eur J Radiol 2020; 132:109286. [PMID: 33007519 DOI: 10.1016/j.ejrad.2020.109286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aims to compare pelvic incidence (PI), a skeletal angle formed by the first sacral vertebrae and femoral heads, in women with and without pelvic organ prolapse (POP) and to explore the correlation of PI with the progression of POP, through 3D reconstruction of MRI scans. METHOD The case-control study enrolled 48 prolapse patients and 48 paired subjects by collecting and screening clinical information including age, BMI, vaginal deliveries, and levator ani defect scores. PI values were measured in 3D reconstruction models based on MRI scans, and the mean and standard deviation values of PI in both groups were calculated. Receiver operating characteristic (ROC) analysis and logistic regression were used to quantify relationships between PI and prolapse. Additionally, by performing a cross-section study of 69 patients with POP, correlations between PI values and descending vaginal locations were assessed by multivariate linear regression models. RESULTS Compared with the control group, the patient group has a significantly larger average PI (48.68 ± 10.77˚ vs 42.20 ± 8.55˚, P=0.002). ROC analysis for the classification of prolapse based on PI has an area under the curve of 70.1 % (P < 0.001). Logistic regression identified a larger PI value as a risk factor of prolapse with an odds ratio of 2.90 (95 %CI: 1.46-5.74, P = 0.002) for PI per increasing 10˚. Point Ba and Bp represent the most distal positions of any part of the upper anterior and posterior vaginal walls, respectively. In the patient group, internally, Ba and Bp would descend 0.62 (95 %CI: 0.24-1.00, P=0.002) cm and 0.74 (95 %CI 0.22-1.26, P=0.006) cm for every 10° increase in PI, respectively. The coefficients of the partial correlation of PI for Ba and Bp are 0.381 (P = 0.002) and 0.336 (P = 0.006). CONCLUSIONS PI is significantly related to morbidity and progression of POP, especially for the anterior and posterior pelvic compartments. As an individual constant value of the spinopelvic skeletal shape, a larger PI value is a risk factor and should be evaluated carefully in medical imaging of POP.
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Affiliation(s)
- Tianhang Liu
- Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Xiaoman Hou
- The Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Bing Xie
- Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Jing Wu
- Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China
| | - Xin Yang
- Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Xiuli Sun
- Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China.
| | - Jianliu Wang
- Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
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Russell BS, Muhlenkamp-Wermert KA, Hoiriis KT. Measurement of Lumbar Lordosis: A Comparison of 2 Alternatives to the Cobb Angle. J Manipulative Physiol Ther 2020; 43:760-767. [PMID: 32888701 DOI: 10.1016/j.jmpt.2020.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 04/10/2020] [Accepted: 05/17/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to compare 2 alternative methods, the radiologic Harrison Posterior Tangent Method (HPTM) and the nonradiologic Spinal Mouse (SM), to the Cobb angle for measuring lumbar lordosis. METHODS Sixteen participants with previously existing lateral lumbopelvic radiographs underwent nonradiographic lordosis assessment with a Spinal Mouse. Then 2 investigators analyzed each radiograph twice using the Harrison Posterior Tangent Method and Cobb angle. Correlations were analyzed between HPTM, the Cobb angle, and SM using the Spearman rank correlation coefficient; intraexaminer and interexaminer agreement were analyzed for HPTM and the Cobb angle using intraclass correlation coefficients. RESULTS The HPTM correlated highly with the Cobb angle (Spearman ρ = 0.936, P < .001); SM had moderate to strong correlations with the Cobb angle (ρ = 0.737, P = .002) and HPTM (ρ = 0.707, P = .003). Intraexaminer and interexaminer agreement for the Cobb angle and HPTM were excellent (all intraclass correlation coefficients > 0.90). One participant had slight kyphosis according to HPTM and SM analyses (which consider the entire lumbar region), whereas the Cobb angle, based only on L1 and L5, reported mild lordosis for that participant. CONCLUSION In this sample, HPTM measurements showed high correlation with the commonly used Cobb angle, but this method requires more time and effort, and normal values have not been established. The SM may be an alternative when radiographs are inappropriate, but it measures soft tissue contours rather than lordosis itself.
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Affiliation(s)
- Brent S Russell
- Dr. Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia.
| | | | - Kathryn T Hoiriis
- Dr. Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia
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de Tayrac R, Schantz C. [Childbirth pelvic floor trauma: Anatomy, physiology, pathophysiology and special situations - CNGOF perineal prevention and protection in obstetrics guidelines]. ACTA ACUST UNITED AC 2018; 46:900-912. [PMID: 30396762 DOI: 10.1016/j.gofs.2018.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess whether pelvic size and shape, spinal curvature, perineal body length and genital hiatus size are associated with the incidence of childbirth pelvic floor trauma. Special situations, such as obesity, ethnicity and hyperlaxity, will also be studied. METHODS A bibliographic research using Pubmed and Cochrane Library databases was conducted until May 2018. Publications in English and French were selected by initial reading of the abstracts. Randomized trials, meta-analyzes, case-control studies and large cohorts were studied in a privileged way. RESULTS A pubic arch angle<90° (measured clinically) does not appear to increase the risk of OASIS (Level 3), but appears to be a risk factor for postnatal anal incontinence at short-term, but not at long-term (Level 3). Measurement of pelvic dimensions and the subpubic angle is not recommended to predict OASIS or to choose the mode of delivery for the purpose of protecting the perineum (GradeC). Prenatal measurement of both perineal body (Level 3) and genital hiatus (Level 2) does not predict the incidence of 2nd or 3rd degree OASIS. Therefore, the routine prenatal measurement of the length of the perineal body or the genital hiatus is not recommended for any objective related to perineal protection (Grade C). Levator avulsion, resulting in a widening of the genital hiatus, is potentially a source of long-term pelvic floor dysfunction. Biomechanical models suggest that performing a mediolateral episiotomy and applying the fingers to the posterior perineum at the time of expulsive phase may reduce pelvic floor trauma. Obese women have a longer perineal body (Level 3), and obesity does not seem to increase the risk of OASIS (Level 2). There is no difference between Asian and non-Asian women perineal body (Level 3). No studies have validated that the liberal practice of episiotomy in Asian women reduced the risk of OASIS. It is therefore not recommended to practice an episiotomy for simple ethnic reasons in Asian women (GradeC). Compared to white women, black women do not appear to have an increased risk of OASIS and even appear to have a decreased risk of perineal tears of all stages (Level 2). Ligament hyperlaxity seems to be associated with an increased risk of OASIS (Level 2). CONCLUSIONS Prenatal assessment of pelvis bone, spine curvature, perineal body and genital hiatus do not allow to predict the incidence of childbirth pelvic floor trauma. Obesity and ethnicity are not risk factors for OASIS.
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Affiliation(s)
- R de Tayrac
- Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Debré, 30900 Nîmes, France.
| | - C Schantz
- Commission Scientifique du Collège National des Sages-Femmes (CNSF), Centre population et développement (Ceped), institut de la recherche et du développement (IRD), université Paris Descartes, Inserm, 75006, Paris, France
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Oakley PA, Jaeger JO, Brown JE, Polatis TA, Clarke JG, Whittler CD, Harrison DE. The CBP ® mirror image ® approach to reducing thoracic hyperkyphosis: a retrospective case series of 10 patients. J Phys Ther Sci 2018; 30:1039-1045. [PMID: 30154597 PMCID: PMC6110211 DOI: 10.1589/jpts.30.1039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To present a case series demonstrating the reduction of thoracic hyperkyphosis
by the Chiropractic BioPhysics® multimodal rehabilitation program.
[Participants and Methods] Ten randomly selected files and corresponding radiographs were
chosen from recent clinic archives of patients who were treated for thoracic
hyperkyphosis. All patients were treated by CBP mirror image® thoracic
extension traction and exercises, as well as spinal manipulative therapy. [Results]
Results demonstrated an average reduction in hyperkyphosis of 11.3° over an average of 25
treatments, over an average of 9 weeks. Patients also experienced a reduction in pain
levels and disability ratings. [Conclusion] Postural hyperkyphosis is a serious
progressive deformity that is related to a plethora of symptoms, syndromes, and early
death. Thoracic hyperkyphosis may be reduced/corrected by posture-specific, thoracic
extension protocols including mirror image extension traction and exercises, as well as
spinal manipulation as part of the CBP multi-modal rehabilitation program.
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Affiliation(s)
- Paul A Oakley
- Private Practice: 11A-1100 Gorham Street, Newmarket, ON, L3Y 8Y8, Canada
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Abstract
OBJECTIVES To characterize the association between thoracic (T) and lumbar (L) spinal curvature and pelvic floor (PF) symptoms (pelvic organ prolapse, urinary incontinence [UI], fecal incontinence [FI]). METHODS Of women undergoing a bone mineral density scan from January 2007 to October 2010, patients who completed PF symptom questionnaires and had T and/or L spine radiographs or computed tomography examinations within 3 years of questionnaire completion were included in this study. The spine angles were measured using the Cobb angle method. The T and L curvatures were categorized as hypokyphosis (<20°), normal T kyphosis (20-40°), hyperkyphosis (>40°), hypolordosis (<40°), normal L lordosis (40-70°), and hyperlordosis (>70°). The presence and type of UI were identified with the 3 Incontinence Questionnaire and FI with the Modified Manchester Questionnaire. Pelvic organ prolapse was defined as a positive response to the presence of a bulge question from the PF Distress Inventory-20. RESULTS Of 1665 eligible women, 824 and 302 (mean age 64 ± 10 for both) had T and L spine images, respectively. No differences in PF symptoms were observed in the T or L spine groups categorized by hypo-, normal, and hyperkyphosis/lordosis except for urgency UI being more prevalent in the hypolordosis group (P = 0.01). However, upon further characterization using logistic regression, no association was noted between PF symptoms and T or L spine angles; no differences in the mean angles were found between women with versus without PF symptoms (P ≥ 0.05). CONCLUSIONS The current study shows that the T and L spinal curvatures are not associated with the presence of PF symptoms.
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Onal S, Chen X, Lai-Yuen S, Hart S. Automatic vertebra segmentation on dynamic magnetic resonance imaging. J Med Imaging (Bellingham) 2017; 4:014504. [PMID: 28386577 DOI: 10.1117/1.jmi.4.1.014504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/16/2017] [Indexed: 11/14/2022] Open
Abstract
The automatic extraction of the vertebra's shape from dynamic magnetic resonance imaging (MRI) could improve understanding of clinical conditions and their diagnosis. It is hypothesized that the shape of the sacral curve is related to the development of some gynecological conditions such as pelvic organ prolapse (POP). POP is a critical health condition for women and consists of pelvic organs dropping from their normal position. Dynamic MRI is used for assessing POP and to complement clinical examination. Studies have shown some evidence on the association between the shape of the sacral curve and the development of POP. However, the sacral curve is currently extracted manually limiting studies to small datasets and inconclusive evidence. A method composed of an adaptive shortest path algorithm that enhances edge detection and linking, and an improved curve fitting procedure is proposed to automate the identification and segmentation of the sacral curve on MRI. The proposed method uses predetermined pixels surrounding the sacral curve that are found through edge detection to decrease computation time compared to other model-based segmentation algorithms. Moreover, the proposed method is fully automatic and does not require user input or training. Experimental results show that the proposed method can accurately identify sacral curves for nearly 91% of dynamic MRI cases tested in this study. The proposed model is robust and can be used to effectively identify bone structures on MRI.
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Affiliation(s)
- Sinan Onal
- Southern Illinois University Edwardsville , Department of Mechanical and Industrial Engineering, Edwardsville, Illinois, United States
| | - Xin Chen
- Southern Illinois University Edwardsville , Department of Mechanical and Industrial Engineering, Edwardsville, Illinois, United States
| | - Susana Lai-Yuen
- University of South Florida , Department of Industrial and Management Systems Engineering, Tampa, Florida, United States
| | - Stuart Hart
- University of South Florida , College of Medicine Obstetrics and Gynecology, Tampa, Florida, United States
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TOPRAK ÇELENAY Ş, ÖZER KAYA D. Relationship of spinal curvature, mobility, and low back pain in womenwith and without urinary incontinence. Turk J Med Sci 2017; 47:1257-1262. [DOI: 10.3906/sag-1609-67] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Gachon B, Desseauve D, Fradet L, Decatoire A, Lacouture P, Pierre F, Fritel X. Modifications de la statique pelvienne et de la laxité ligamentaire pendant la grossesse et le post-partum. Revue de la littérature et perspectives. Prog Urol 2016; 26:385-94. [DOI: 10.1016/j.purol.2016.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 12/30/2022]
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The genital prolapse of Australopithecus Lucy? Int Urogynecol J 2015; 26:975-80. [DOI: 10.1007/s00192-015-2635-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 01/21/2015] [Indexed: 10/24/2022]
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Borycka-Kiciak K, Wawiernia K, Namysł J, Garstka-Namysł K, Tarnowski W. Role of electromyography and functional electrical stimulation in the treatment of anorectal diseases. POLISH JOURNAL OF SURGERY 2015; 87:194-202. [DOI: 10.1515/pjs-2015-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Indexed: 11/15/2022]
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Kotarinos RK, Kotarinos E. The Past, Present and Future of POP and Physical Therapy. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0088-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abdel-Raoof N, Kamel D, Tantawy S. Influence of second-degree flatfoot on spinal and pelvic mechanics in young females. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2013. [DOI: 10.12968/ijtr.2013.20.9.428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To investigate the effect of bilateral flexible second-degree flatfoot on pelvic and spinal mechanics in young females. Methods: A case-control trial was conducted at the Faculty of Physical Therapy, Cairo University, Egypt, on 60 female participants who were assigned into two groups. Group A (the control group) included 31 healthy subjects, and group B (the study group) included 29 subjects with bilateral flexible second-degree of flatfoot deformity. For each subject in both groups, using lateral weight-bearing radiographs, foot assessments were performed bilaterally to measure the talus–first metatarsal angle. Using the formetric-II device, 3D assessments of the pelvis were performed on the frontal and sagittal planes in addition to lumbar and thoracic curvatures on the sagittal plane. Outcome measures were pelvic inclination, pelvic tilt, and lumbar lordotic and thoracic kyphotic angles. Results: There was a significant difference in pelvic inclination and in lumbar and thoracic angles (P=0.012, 0.009, and 0.028, respectively) between both groups. There was no significant difference between both groups in pelvic tilt (P=0.688). Conclusion: Subjects with bilateral flexible second-degree flatfoot demonstrated increased pelvic inclination, lumbar lordotic and thoracic kyphotic angles than normal subjects. Foot assessments should be performed as an essential part of the evaluation of female patients with spine and pelvic problems. Bilateral flexible second-degree flatfoot may act as a predictor for pelvic organs prolapse in their later lives.
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Affiliation(s)
- Neveen Abdel-Raoof
- Physical Therapy, Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Dalia Kamel
- Physical Therapy, Physical Therapy for Obstetrics & Gynecology Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Sayed Tantawy
- Physical Therapy, College of Medical Health & Sciences, Physiotherapy Department, Ahlia University, Kingdom of Bahrain
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Abstract
Our understanding of esophageal disease and the foregut has evolved over the past 100 years, especially in recent times. Modern diagnostic technologies and new management paradigms have provided progressive insights into the anatomy, physiology, and normal and abnormal function of the esophagus, as well as improving patient care. Yet, the relationship between the esophagus and its close neighbor, the spine, is rarely discussed and likely underappreciated. Anatomic proximity and intertwined pathophysiology led early investigators to postulate relationships between esophageal disease and spinal abnormalities. More recent studies have illustrated a link between spinal disease and hiatal hernias. Objective radiographic measurements of kyphoscoliosis have correlated with increased hiatal hernia formation. Spinal abnormalities and disease of the esophageal hiatus are becoming more common in our aging population, with each carrying significant risk of morbidity and decreased quality of life. Operative planning and subsequent hiatal hernia repair must be undertaken in the context of these spinal abnormalities. A historical review of past publications related to the subject forms the basis for this publication, thus revealing insight and improving our understanding of the association between spinal abnormalities and hiatal hernias.
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Affiliation(s)
- M Polomsky
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester, School of Medicine and Dentistry, Rochester, New York 14642, USA.
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Sran MM. Filling in the gaps before clients fall through the cracks: physiotherapists have the skills to help clients preserve bone and prevent falls. Physiother Can 2012; 63:261-4. [PMID: 22654230 DOI: 10.3138/physio.63.3.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Meena M Sran
- Meena M. Sran, PT, PhD: Osteoporosis Program, BC Women's Hospital & Health Centre; Movement Essentials Physiotherapy, Vancouver, BC
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Investigation of correlation between diameters of pelvic inlet and outlet planes and female pelvic floor dysfunction. Eur J Obstet Gynecol Reprod Biol 2011; 159:461-4. [DOI: 10.1016/j.ejogrb.2011.07.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 05/18/2011] [Accepted: 07/14/2011] [Indexed: 01/18/2023]
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Sran MM. Combler les lacunes avant que surviennent des problèmes : les physiothérapeutes possèdent les compétences pour aider les patients à conserver de bons os et à prévenir les chutes. Physiother Can 2011. [DOI: 10.3138/physio.63.3.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Meena M. Sran
- Meena M. Sran, PT, PhD : Programme d'ostéoporose, BC Women's Hospital & Health Centre; Clinique de physiothérapie Movement Essentials, Vancouver (Colombie-Britannique)
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The relationship between anthropometric measurements and the bony pelvis in African American and European American women. Int Urogynecol J 2011; 22:1019-24. [DOI: 10.1007/s00192-011-1416-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 03/14/2011] [Indexed: 10/18/2022]
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Fritel X. Périnée et grossesse. ACTA ACUST UNITED AC 2010; 38:332-46. [DOI: 10.1016/j.gyobfe.2010.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 03/16/2010] [Indexed: 01/26/2023]
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Sran MM. Prevalence of urinary incontinence in women with osteoporosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:434-9. [PMID: 19604424 DOI: 10.1016/s1701-2163(16)34174-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the prevalence and frequency of urinary incontinence in women presenting to a specialist osteoporosis clinic. METHODS Participants included 412 female patients aged 22 to 94 years (mean 62 years) presenting to a hospital-based specialist multidisciplinary osteoporosis clinic over one year. The presence or absence of urinary incontinence, urgency without leakage, type of symptoms (stress, urge, mixed) and frequency of urinary incontinence were recorded. RESULTS Sixty-seven percent of patients (277/412) reported some symptoms of urinary incontinence, 23% reported no symptoms and 10% reported urgency without any leakage. Of those who reported some urinary incontinence, 51% reported symptoms of stress incontinence, urgency, and urge incontinence. Almost 40% of all patients (163/412) and 59% of those with any urinary incontinence (163/277) reported leakage at least once per week. CONCLUSION The prevalence of at least weekly urinary incontinence in this population is much higher than that reported in studies of other older adult female populations. There is also a high prevalence of incontinence accompanied by urgency in women with osteoporosis. Based on these results and because urinary incontinence can limit a woman's ability to be physically active and increase the risk of falls and fractures, screening for incontinence should be a routine part of osteoporosis management. Clinicians seeing patients for osteoporosis should consider the presence of incontinence when prescribing exercise for bone health and fall prevention.
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Affiliation(s)
- Meena M Sran
- BC Women's Hospital and Health Centre, Osteoporosis Program, Vancouver BC; Simon Fraser University, Injury Prevention and Mobility Laboratory, Burnaby, BC
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Polomsky M, Siddall KA, Salvador R, Dubecz A, Donahue LA, Raymond D, Jones C, Watson TJ, Peters JH. Association of kyphosis and spinal skeletal abnormalities with intrathoracic stomach: a link toward understanding its pathogenesis. J Am Coll Surg 2009; 208:562-9. [PMID: 19476791 DOI: 10.1016/j.jamcollsurg.2009.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 12/30/2008] [Accepted: 01/07/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Modern-day concepts about the pathogenesis of an intrathoracic stomach include crural diaphragm muscular deterioration, loss of phrenoesophageal ligament integrity, and presence of abdominothoracic pressure gradients. The role of spinal abnormalities has received little attention. Based on clinical observation, we hypothesized that kyphosis and other spinal diseases are components of the pathophysiology of an intrathoracic stomach. STUDY DESIGN The study population consisted of 98 patients (men, n = 22; women, n = 76; mean age 69.4 years) undergoing operations for type III or IV hiatal hernia with an intrathoracic stomach. Twenty-four age- and gender-matched control patients without hiatal hernia undergoing pulmonary or pleural procedures were used for comparison. Chest radiographs were assessed for spinal abnormalities, including degree of kyphosis, measured from superior T4 to inferior T12 (modified Cobb method), spinal fractures, osteoporosis, and scoliosis. Statistical analyses included two-sample t-test and Fisher's exact test. RESULTS Patients with intrathoracic stomach had a greater degree of kyphosis than control patients (Cobb angle, 50.2 degrees versus 39.7 degrees; p < 0.001). This difference was most pronounced in women (Cobb angle, 51.7 degrees versus 40.4 degrees; p < 0.001), although the difference in men was not significant (Cobb angle, 45.0 degrees versus 38.1 degrees; p = 0.25). Patients with an intrathoracic stomach had significantly more vertebral fractures (37 of 98 [38%] versus 3 of 24 [13%]; p < 0.05). There was no difference in prevalence of degenerative changes (51 of 98 [52%], versus 13 of 24 [54%]), osteopenia (30 of 98 [31%] versus 6 of 24 [25%]), and scoliosis (27 of 98 [28%] versus 6 of 24 [25%]). CONCLUSION Patients with an intrathoracic stomach have a higher degree of kyphosis and more vertebral fractures than age- and gender-matched controls. These data suggest that change in spinal curvature can be important in the pathogenesis of the intrathoracic stomach, a growing problem of our aging population.
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Affiliation(s)
- Marek Polomsky
- Division of Thoracic and Foregut Surgery, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
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Abstract
OBJECTIVE To estimate quality of life, prevalence, and risk factors associated with symptomatic pelvic organ prolapse (POP) among middle-aged women. METHODS This was a cross-sectional study. A questionnaire was mailed to 3,114 women aged 50-61 years in the GAZEL cohort; 2,640 (85%) returned it. Symptomatic POP was defined by feeling a bulge from the vagina (sometimes, often, or all the time compared with never or rarely). Quality of life was determined with the Nottingham Health Profile questionnaire. Multiple linear regression was used to examine the association between frequency of POP symptoms and the quality-of-life score. Logistic regression was used to estimate the effect of risk factors on past or present symptomatic POP (current symptoms or previous surgery for POP). RESULTS The prevalence of symptomatic POP was 3.6% (96 of 2,640) and that of surgery for POP was 2.7% (70 of 2,640). Pelvic organ prolapse symptoms were associated with difficulty defecating, lower abdominal pain, and difficulty voiding. The frequency of POP symptoms was associated with a poorer quality-of-life score in each Nottingham Health Profile domain (physical mobility, pain, emotional reaction, social isolation, energy, and sleep). Even when we took general characteristics, medical history, and lifestyle associated with quality of life into account, the global Nottingham Health Profile score was significantly impaired by POP symptoms. Factors significantly associated with past or present symptomatic POP were high body mass index and the number of vaginal deliveries. CONCLUSION In our population of women in their 50s, POP symptoms are associated with impaired quality of life, and the number of vaginal deliveries is a risk factor for past or present symptomatic POP.
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Christensen ST, Hartvigsen J. Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. J Manipulative Physiol Ther 2009; 31:690-714. [PMID: 19028253 DOI: 10.1016/j.jmpt.2008.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 07/07/2008] [Accepted: 07/20/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The purposes of this study were to (1) determine whether sagittal spinal curves are associated with health in epidemiological studies, (2) estimate the strength of such associations, and (3) consider whether these relations are likely to be causal. METHODS A systematic critical literature review of epidemiological (cross-sectional, case-control, cohort) studies published before 2008 including studies identified in the CINAHL, EMBASE, Mantis, and Medline databases was performed using a structured checklist and a quality assessment. Level of evidence analysis was performed as outlined by van Tulder et al (Spine. 2003;28:1290-9), and the strength of associations were determined using the procedure outlined by Hemingway and Marmot (BMJ. 1999;318:1460-7). Quality of the included articles were assessed by our own scoring system based on the STrengthening the Reporting of OBservational studies in Epidemiology checklist. Studies scoring maximum points (4/4 or 3/3) were considered to be of higher quality. RESULTS Fifty-four original studies were included. We found no strong evidence for any association between sagittal spinal curves and any health outcomes including spinal pain. The included studies were generally of low methodological quality. There is moderate evidence for association between sagittal spinal curves and 4 health outcomes as follows: temporomandibular disorders (no odds ratios [ORs] provided), pelvic organ prolapse (OR, 3.18; 95% confidence interval [CI], 1.46-96.93), daily function (OR range, 1.8-3.7; 95% CI range, 1.1-6.3), and death (OR, 1.40; 95% CI, 1.08-1.91). These associations are however unlikely to be causal. CONCLUSIONS Evidence from epidemiological studies does not support an association between sagittal spinal curves and health including spinal pain. Further research of better methodological quality may affect this conclusion, and causal effects cannot be determined in a systematic review.
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Affiliation(s)
- Sanne Toftgaard Christensen
- Clinical Locomotion Science, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
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Boulay C, Prudhomme M, Prat-Pradal D, Pouderoux P, Duval-Beaupère G, Pélissier J. Perineal descent predicted by a pelvic bone factor: the pelvic incidence angle. Dis Colon Rectum 2009; 52:119-26. [PMID: 19273966 DOI: 10.1007/dcr.0b013e3181972447] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE By measuring the pelvic incidence angle, we assessed the relationship between pelvic floor disorders and pelvic morphology, which allowed us to document for the first time the hypothesis that pelvic incidence may be a predictive factor of perineal descent. METHODS In a retrospective study of 197 women, the perineal descent at rest and during straining was assessed by defecography. The pelvic incidence angle (53 degrees +/- 9 degrees , independent of the subject position) was defined as the angle between the line perpendicular to the sacral plate at its midpoint and the line connecting this point to the middle of the femoral heads axis. The pelvic incidence angle was correlated with the incidence of pelvic floor descent. RESULTS In those with pelvic floor descent at rest compared with those without, pelvic incidence angle was significantly larger (64 degrees vs. 53 degrees , P < 10E-06). As a predictive factor of perineal descent at rest, a great pelvic incidence (>62 degrees ) had a sensitivity (73 percent), specificity (82 percent), positive predictive value (81 percent), and negative predictive value (75 percent). CONCLUSIONS A large pelvic incidence (>62 degrees ) may be a predictive factor of perineal descent at rest before the apparition of other acquired factors. With pelvic incidence >62 degrees , a large overhang between the insertions increases the strains on the perineum, which is rather horizontal.
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Sapsford RR, Richardson CA, Maher CF, Hodges PW. Pelvic Floor Muscle Activity in Different Sitting Postures in Continent and Incontinent Women. Arch Phys Med Rehabil 2008; 89:1741-7. [DOI: 10.1016/j.apmr.2008.01.029] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 12/01/2007] [Accepted: 01/16/2008] [Indexed: 11/25/2022]
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Harrison DE, Janik TJ, Cailliet R, Harrison DD, Normand MC, Perron DL, Oakley PA. Upright Static Pelvic Posture as Rotations and Translations in 3-Dimensional From Three 2-Dimensional Digital Images: Validation of a Computerized Analysis. J Manipulative Physiol Ther 2008; 31:137-45. [DOI: 10.1016/j.jmpt.2007.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Revised: 06/14/2007] [Indexed: 11/28/2022]
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Abstract
To determine the relationship between pelvic organ prolapse and spinal curvature changes, a cross-sectional study was done in Gynecologic and Obstetrics educational hospitals and clinics in North West of Iran. One hundred patients were classified as cases based on the presence of abnormality at the spinal curvature and 100 patients classified as controls with no abnormality. The POP-Q (pelvic organ prolapse quantitation) staging system was used for assessment of prolapse stage and a flexi-curve malleable rod for measurement of thoracic and lumbar length and width, respectively. Main outcome was the stage of prolapses. The stage of prolapse was higher in cases compared to controls. There was a significant statistical difference between prolapse stage in two groups (p-value = 0.035). Among cases, grade II prolapse was the most prevalent abnormally (56%) and the grade III, I and IV were observed in 32, 5 and 7%, respectively. These observations underline the importance of taking into account the abnormal changes in spine curvature of patients when investigating risk factors for development of pelvic organs prolapse.
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Affiliation(s)
- Manizheh Sayyah Melli
- Department of Obstetrics and Gynecology, Alzahra Research and Development Center of Clinical Studies, Tabriz Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Koskelo R, Vuorikari K, Hänninen O. Sitting and standing postures are corrected by adjustable furniture with lowered muscle tension in high-school students. ERGONOMICS 2007; 50:1643-1656. [PMID: 17917904 DOI: 10.1080/00140130701587236] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study compared the effect of 24 months of adjustable school desks and chairs usage (the intervention) and traditional non-adjustable usage (the control condition) on sitting and standing postures, muscle strength, classroom muscle tension, pain and learning in 15 (8 female and 7 male) high-school students and 15 anthropometrically and gender matched control students from neighbouring schools. It was assessed whether any responses took place after growth cessation. In comparison with controls, the intervention group of students' sitting postures standing kyphosis, scoliosis and lordosis became significantly better, both before and after growth cessation. Trunk muscle strength increased in the intervention students whose muscle tension during classes fell significantly in the trapezius and lumbar muscles, whereas in control students' lumbar tension increased. Headache and low-back pain correlated with neck-shoulder pain and trapezius muscle tension. Intervention students reported that they experienced benefits from the adjustable tables and chairs. They also received significantly better overall marks than the controls at the end of high school. It is concluded that the adjustable school desks and chairs promoted better sitting and standing postures, increased muscle strength, alleviated pain and appeared to be associated with better overall academic marks.
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Affiliation(s)
- R Koskelo
- Department of Physiology, University of Kuopio, Kuopio, Finland
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Abstract
Pelvic organ prolapse is downward descent of female pelvic organs, including the bladder, uterus or post-hysterectomy vaginal cuff, and the small or large bowel, resulting in protrusion of the vagina, uterus, or both. Prolapse development is multifactorial, with vaginal child birth, advancing age, and increasing body-mass index as the most consistent risk factors. Vaginal delivery, hysterectomy, chronic straining, normal ageing, and abnormalities of connective tissue or connective-tissue repair predispose some women to disruption, stretching, or dysfunction of the levator ani complex, connective-tissue attachments of the vagina, or both, resulting in prolapse. Patients generally present with several complaints, including bladder, bowel, and pelvic symptoms; however, with the exception of vaginal bulging, none is specific to prolapse. Women with symptoms suggestive of prolapse should undergo a pelvic examination and medical history check. Radiographic assessment is usually unnecessary. Many women with pelvic organ prolapse are asymptomatic and do not need treatment. When prolapse is symptomatic, options include observation, pessary use, and surgery. Surgical strategies for prolapse can be categorised broadly by reconstructive and obliterative techniques. Reconstructive procedures can be done by either an abdominal or vaginal approach. Although no effective prevention strategy for prolapse has been identified, considerations include weight loss, reduction of heavy lifting, treatment of constipation, modification or reduction of obstetric risk factors, and pelvic-floor physical therapy.
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Affiliation(s)
- J Eric Jelovsek
- Department of Obstetrics and Gynecology A81, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Abstract
Pelvic organ prolapse is prevalent among older women. Milder stages of prolapse, cranial to the hymen, are common and usually symptomless. A specific symptom is a bulge outside the vagina. Functional symptoms from the bladder, bowel and sexual life frequently coexist without a known cause/effect relationship to prolapse. Prolapse should be measured by the validated internationally approved pelvic organ prolapse quantification (POPQ) system that can measure prolapse in the three compartments and three levels of the vagina. We should work on a common classification system and agreement in which symptoms should be recorded as related to prolapse and expected to improve by prolapse surgery.
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Affiliation(s)
- Lone Mouritsen
- Department of Gynecology & Obstetrics, Glostrup Hospital, University of Copenhagen, 2600 Glostrup, Denmark.
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Rizk DEE, Czechowski J, Ekelund L. Dynamic assessment of pelvic floor and bony pelvis morphologic condition with the use of magnetic resonance imaging in a multiethnic, nulliparous, and healthy female population. Am J Obstet Gynecol 2004; 191:83-9. [PMID: 15295346 DOI: 10.1016/j.ajog.2003.12.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine dynamic pelvic floor and bony pelvis morphologic condition in asymptomatic multiethnic women. STUDY DESIGN Pelvic floor anthropometry, at rest and after the Valsalva maneuver, and pelvimetry were compared with the use of magnetic resonance imaging in nulliparous young volunteers from 5 ethnic groups (n=11 x 5 volunteers: Emirati, other Arab, Filipino, Indian/Pakistani, and European/white volunteers), with the white volunteers as the reference group. RESULTS The white volunteers were significantly taller (P <.0001) than the other women. Their levator hiatus was significantly longer than the Emirati women (P=.03) and wider than the Filipino women (P=.04). The bladder neck descent on straining was also significantly greater than the other groups (P <.00001). The white women also had the longest transverse diameter of the pelvic inlet (P=.002). Their sagittal outlet diameter was significantly longer than the Emirati and Arab women (P=.02), and their interspinous diameter was significantly longer than the Arab women (P=.002). CONCLUSION Nulliparous, healthy white women have larger levator hiatus and bony pelvis with greater bladder neck descent on straining than non-white women.
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Affiliation(s)
- Diaa E E Rizk
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
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