1. IFOMPT PELVIC ORGAN PROLAPSE - WOULD YOU MOVE DIFFERENTLY IF YOUR UTERUS WAS FALLING OUT A NARRATIVE REVIEW
Kerstin McPherson1,2, Dr Irmina Nahon1, Dr Gordon Waddington 1 and Dr Angela Fearon  
University of Canberra Charles Sturt University 2
PELVIC ORGAN PROLAPSE IS THE DESCENT OF THE PELVIC ORGANS FROM THEIR ANATOMICAL POSITION
Complex support from ligaments, fascia, muscles and motor control
POSSIBLE CAUSES OF PROLAPSE
ALTERED LOADING
OF TISSUES
REDUCED ACTIVITY (WOMEN WORRIED ABOUT BULGE)
TRAUMA DURING CHILDBIRTH (AVULSION PELVIC FLOOR MUSCLES/FASCIA, ANAL SPINCTER TEARS)
ANTERIOR VAGINAL WALL LOOSES CONTACT WITH POSTERIOR WALL
ALTERED LOADING
OF TISSUES
INCREASED RISK OF CARDIOVASCULAR PROBLEMS, OBESITY
LARGE UROGENITAL
HIATUS
PROLONGED STAGE 2 LABOUR (PUDENDAL NERVE DAMAGE)
STRETCHING FASCIA/LIGAMENTS AND NERVES
CHRONIC COUGHING
CHANGE IN SHAPE, ORIENTATION AND FUNCTION OF PELVIC FLOOR MUSCLES
CONSITPATION
HEAVY LIFTING
PREGNANCY (MECHANICAL AND HORMAONAL CHANGES TO PELVIC FLOOR MUSCLES AND CONNECTIVE TISSUE)
HIGH / POOR REGULATION OF INTRA ABDOMINAL PRESSURE
WHAT IS KNOWN FROM OTHER
RESEARCH AREAS
Pelvic floor muscle activity is modulated by abdominal muscle activity2
Altered abdominal activity and active straight leg raise in those with pelvic girdle pain, groin pain and pregnancy1,3,4,5
Pelvic floor muscles and transverus abodminus increase force closure of pelvic girdle3
References:
. 1. Cowan, S. M., et al. (2004). "Delayed onset of transversus abdominus in long-standing groin pain." Med Sci Sport Exerc 36(12):
2. Junginger, B., Baessler K, Sapsford R, Hodges PW. (2010). "Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck." Int Urogynecol J 21(1):
3. Lee, D. G. (2011). The Pelvic Girdle: An integration of clinical expertise and research: Elsevier Health Sciences UK.
4. Mens, J. M. A., in 't Veld, Y. H. H., & Pool-Goudzwaard, A. (2012). The Active Straight Leg Raise test in lumbopelvic pain during pregnancy. Manual Therapy, 17(4),
5. Roussel, N. A., Nijs, J., Truijen, S., Smeuninx, L., & Stassijns, G. (2007). Low back pain: clinimetric properties of the Trendelenburg test, active straight leg raise test, and breathing pattern during active straight leg raising. Journal of manipulative and physiological therapeutics, 30(4),
CUMULATIVE DAMAGE OVER A LIFE TIME
PELVIC ORGAN PROLAPSE
DEVLOPS
DOMINANCE OF UPPER ABDOMINAL MUSCLE ACTIVITY IN WOMEN WITH PROLAPSE
WHAT ARE THE CURRENT MANAGEMENT CONCEPTS
Watch and wait
Change lifestyle e.g. reduce lifting
Pelvic floor muscle strengthening
Pessaries
Surgery
REDUCED QUALITY OF LIFE AND INCREASED SURGICAL RISK
If altered lumboplevic motor control is changed do the symptoms of pelvic organ prolapse change ?
Is there altered lumboplevic motor control in women with pelvic organ prolapse ?