Association Between Measures of Trunk Recovery 5 to 10 Weeks Postpartum and Pelvic Floor Support and Symptoms 1 Year Postpartum in Primiparas Delivered Vaginally

To develop an anatomically based customizable finite-element (FE) model of the pelvic floor support system to simulate pelvic organ prolapse (POP): POP-SIM1.0. This new simulation platform allows for the construction of an array of models that objectively represent the key anatomical and functional variation in women with and without prolapse to test pathomechanism hypotheses of the prolapse formation. POP-SIM1.0 consists of anatomically based FE models and a suite of Python-based tools developed to rapidly construct FE models by customizing the base model with desired structural parameters. Each model consists of anatomical structures from three support subsystems which can be customized based on magnetic resonance image measurements in women with and without prolapse. The customizable structural parameters include presence of levator ani (LA) avulsion, hiatus size, anterior vaginal wall dimension, attachment fascia length and apical location in addition to the tissue material properties and intra-abdominal pressure loading. After customization, the FE model was loaded with increasing intra-abdominal pressure (0–100 cmH 2 O) and solved using ABAQUS explicit solver. We were able to rapidly construct anatomically based FE models with specific structural geometry which reflects the morphology changes often observed in women with prolapse. At maximum loading, simulated structural deformations have similar anatomical characteristics to those observed during clinical exams and stress magnetic resonance images. Simulation results showed the presence of LA muscle avulsion negatively impacts the pelvic floor support. The normal model with intact muscle had the smallest exposed vaginal length of 11 mm, while the bilateral avulsion produced the largest exposed vaginal length at 24 mm. The unilateral avulsion model had an exposed vaginal length of 18 mm and also demonstrated a tipped perineal body similar to that seen in clinical observation. Increasing the hiatus size, vaginal wall length and fascia length also resulted in worse pelvic floor support, increasing the exposed vaginal length from 18 mm in the base model to 33 mm, 54 mm and 23.5 mm, respectively. The developed POP-SIM1.0 can simulate the anatomical structure changes often observed in women with prolapse. Preliminary results showed that the presence of LA avulsion, enlarged hiatus, longer vaginal wall and fascia length can result in larger prolapse at simulated maximum Valsalva.

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PELVIC FLOOR SUPPORT IN CONSTIPATION

The Lancet ◽

10.1016/s0140-6736(89)92182-x ◽

1989 ◽

Vol 333 (8639) ◽

pp. 674 ◽

Cited By ~ 3

Author(s):

Luc Lesaffer

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Support

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The Therapeutic Logic behind Various Forms of Pelvic Floor SupportThe Therapeutic Logic behind Various Forms of Pelvic Floor Support

Obstetrics & Gynecology International Journal ◽

10.15406/ogij.2017.07.00248 ◽

2017 ◽

Vol 7 (3) ◽

Author(s):

Yu Chye Wah

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Support

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Pelvic Floor Support

Obstetrics ◽

10.5772/intechopen.70153 ◽

2017 ◽

Author(s):

Yu Chye Wah ◽

Chew Heng Hai

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Support

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Role of chronic exercise on pelvic floor support and function

Current Opinion in Urology ◽

10.1097/mou.0000000000000390 ◽

2017 ◽

Vol 27 (3) ◽

pp. 257-261 ◽

Cited By ~ 8

Author(s):

Janet M. Shaw ◽

Ingrid E. Nygaard

Keyword(s):

Pelvic Floor ◽

Chronic Exercise ◽

And Function ◽

Pelvic Floor Support

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Aging effects on pelvic floor support: a pilot study comparing young versus older nulliparous women

International Urogynecology Journal ◽

10.1007/s00192-019-04063-z ◽

2019 ◽

Vol 31 (3) ◽

pp. 535-543 ◽

Cited By ~ 2

Author(s):

Carolyn W. Swenson ◽

Mariana Masteling ◽

John O. DeLancey ◽

Lahari Nandikanti ◽

Payton Schmidt ◽

...

Keyword(s):

Pilot Study ◽

Pelvic Floor ◽

Aging Effects ◽

Nulliparous Women ◽

Pelvic Floor Support

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Relationship Between High Intra-Abdominal Pressure and Compliance of the Pelvic Floor Support System in Women Without Pelvic Organ Prolapse: A Finite Element Analysis

10.21203/rs.3.rs-1075420/v1 ◽

2021 ◽

Author(s):

Xiaode Liu ◽

Qiguo Rong ◽

Jianliu Wang ◽

Bing Xie ◽

Shuang Ren

Keyword(s):

Finite Element ◽

Pelvic Organ Prolapse ◽

Finite Element Model ◽

Pelvic Floor ◽

Support System ◽

Element Model ◽

Pelvic Organ ◽

Abdominal Pressure ◽

Pelvic Support ◽

Pelvic Floor Support

Abstract Background: The objective of this study was to study the relationship between high intra-abdominal pressure and the compliance of the pelvic floor support system in a normal woman without pelvic organ prolapse (POP), using a finite element model of the whole pelvic support system.Methods: A healthy female volunteer (55 years old) was scanned using magnetic resonance imaging (MRI) during the Valsalva maneuver. According to the pelvic structure contours traced by a gynecologist and anatomic details measured from dynamic MRI, a finite element model of the whole pelvic support system was established, including the uterus, vagina with cavity, cardinal and uterosacral ligaments, levator ani muscle, rectum, bladder, perineal body, pelvis, and obturator internus and coccygeal muscles. This model was imported into ANSYS software, and an implicit iterative method was employed to simulate the biomechanical response with increasing intra-abdominal pressure.Results: Stress and strain distributions of the vaginal wall showed that the posterior wall was more stable than the anterior wall under high intra-abdominal pressure. Displacement at the top of the vagina was larger than that at the bottom, especially in the anterior–posterior direction.Conclusion: These results imply potential injury areas with high intra-abdominal pressure in non-prolapsed women, and provide insight into clinical managements for the prevention and surgical repair plans of POP.

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