Anatomical and functional characteristics of the pelvic floor in women of various age groups

Capa

Citar

Texto integral

Acesso aberto Acesso aberto
Acesso é fechado Acesso está concedido
Acesso é fechado Acesso é pago ou somente para assinantes

Resumo

Objective: To evaluate the anatomical and functional characteristics of the pelvic floor in women of different age groups.

Materials and methods: This study was conducted at the Military Medical Academy and included 1,546 women who were divided into three age groups. Anatomical characteristics were assessed using the POP-Q system and transperineal ultrasound examinations. Functional characteristics were analyzed with the PERFECT system, and the PFDI-20 and SF-36 questionnaires were utilized. In addition, the Female Sexual Function Index was evaluated.

Results: The study revealed that women in the second group experienced age-related shifts in the locations of points Aa and Ba, along with a statistically significant increase in the angle of urethral inclination and bladder neck displacement (p=0.01). Women in group 3 showed a significant decrease in strength, endurance, and muscle contractions (p=0.001). The PFDI-20 questionnaire results indicated an increase in the severity of pelvic dysfunction symptoms, rising from 9.4 points in group 1 to 144.8 points in group 3 (p=0.001). The increase in prolapse symptoms and severity of pelvic dysfunction correlated with a decrease in both the physical (ρ=-0.56, p=0.001) and psychological components of health (ρ=-0.60, p=0.001).

Conclusion: This study demonstrated that anatomical and functional changes in most women begin long before menopause onset. The data obtained can be used to develop individualized prevention and treatment measures.

Texto integral

Acesso é fechado

Sobre autores

Alexander Bezmenko

S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation

Email: bezmenko@yandex.ru
ORCID ID: 0000-0003-2837-1260

PhD, Head of the Department of Obstetrics and Gynecology

Rússia, 6g, Ac. Lebedev str., St. Petersburg, 194044

Igor Zakharov

S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation

Autor responsável pela correspondência
Email: isza@mail.ru
ORCID ID: 0000-0001-6167-2968

Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology

Rússia, 6g, Ac. Lebedev str., St. Petersburg, 194044

Vitaly Bezhenar

Pavlov First St. Petersburg State Medical University, Ministry of Health of Russia

Email: bez-vitaly@yandex.ru
ORCID ID: 0000-0002-7807-4929

Professor, Head of the Department of Obstetrics, Gynecology and Neonatology

Rússia, 6-8 Lva Tolstogo str, St. Petersburg, 197022

Anna Staroverova

S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation

Email: staroverova.anna85@mail.ru
ORCID ID: 0000-0003-0916-4012

Head of the Obstetric (Observation) Department of the Clinic of Obstetrics and Gynecology

Rússia, 6g Acad. Lebedev str., St. Petersburg, 194044

Elina Bagramyan

S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation

Email: elin.bagramian@yandex.ru
ORCID ID: 0009-0009-8650-2426

Resident at the Clinic of Obstetrics and Gynecology

Rússia, 6g Acad. Lebedev str., St. Petersburg, 194044

Olga Ivanova

S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation

Email: oa_ivanova_63@mail.ru
ORCID ID: 0009-0007-7125-4736

Physician at the Ultrasound Diagnostics Department

Rússia, 6g Acad. Lebedev str., St. Petersburg, 194044

Margarita Kapitanova

S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation

Email: lysya08@mail.ru
ORCID ID: 0009-0005-7331-4099

Physician at the Ultrasound Diagnostics Department

Rússia, 6g Acad. Lebedev str., St. Petersburg, 194044

Bibliografia

  1. Гилядова А.В., Ищенко А.А., Решетов И.В., Ищенко А.И., Аполихина И.А., Саидова А.С., Пучкова Е.Н., Петровичев В.С., Мершина Е.А., Новрузалиева М.Ф. Роль динамической магнитно-резонансной томографии в диагностике пролапса тазовых органов. Акушерство и гинекология. 2023; 4: 28-39. [Gilyadova A.V., Ishchenko A.A., Reshetov I.V., Ishchenko A.I., Apolikhina I.A., Saidova A.S., Puchkova E.N., Petrovichev V.S., Mershina E.A., Novruzalieva M.F. The role of dynamic magnetic resonance imaging in the diagnosis of pelvic organ prolapse. Obstetrics and Gynecology. 2023; (4): 28-39 (in Russian)]. https://dx.doi.org/10.18565/aig.2023.1
  2. Wang B., Chen Y., Zhu X., Wang T., Li M., Huang Y. et al. Global burden and trends of pelvic organ prolapse associated with aging women: An observational trend study from 1990 to 2019. Front. Public Health. 2022; 10: 975829. https://dx.doi.org/10.3389/fpubh.2022.975829
  3. Yuk J.S., Lee J.H., Hur J.Y., Shin J.H. The prevalence and treatment pattern of clinically diagnosed pelvic organ prolapse: a Korean National Health Insurance Database-based cross-sectional study 2009-2015. Sci. Rep. 2018; 8(1): 1334. https://dx.doi.org/10.1038/s41598-018-19692-5
  4. American College of Obstetricians and Gynecologists and the American Urogynecologic Society; INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect the US Food and Drug Administration order to stop the sale of transvaginal synthetic mesh products for the repair of pelvic organ prolapse. Pelvic Organ Prolapse. Female Pelvic Med. Reconstr. Surg. 2019; 25(6): 397-408. https://dx.doi.org/10.1097/SPV.0000000000000794
  5. Hadizadeh-Talasaz Z., Khadivzadeh T., Mohajeri T., Sadeghi M. Worldwide prevalence of pelvic organ prolapse: a systematic review and meta-analysis. Iran. J. Public. Health. 2024; 53(3): 524-38. https://dx.doi.org/10.18502/ijph.v53i3.15134
  6. Безменко А.А., Берлев И.В., Скворцов В.Г. Опыт использования синтетических сетчатых имплантов для коррекции пролапса гениталий. Военно-медицинский журнал. 2012; 333(8): 35-7. [Bezmenko A.A., Berlev I.V., Skvortsov V.G. Experience of use of synthetic cellular implants for correction of genitals prolapse. Military Medical Journal. 2012; 333(8): 35-7. (in Russian)]. https://dx.doi.org/10.17816/RMMJ74693
  7. Эйзенах И.А., Власова В.В., Мозес В.Г., Захаров И.С. Ранние mesh-ассоциированные послеоперационные осложнения при установке синтетических сетчатых имплантов с двумя и четырьмя рукавами у женщин с пролапсом гениталий. Медицина в Кузбассе. 2017; 16(1): 61-4. [Eisenakh I.A., Vlasova V.V., Mozes V.G., Zakharov I.S. Early postoperative mesh-related complications after placing two- and four-sleeved synthetic implants in women with genitals prolapse. Medicine in Kuzbass. 2017; 16(1): 61-4. (in Russian)].
  8. DaSilva K.A., Lee D.H., Sterling E.K., Hong A.H., Rahman S., Carter-Brooks C.M. Younger age is associated with pelvic floor muscle dysfunction in women with urinary symptoms. Urogynecology (Phila). 2024 Oct 18. https://dx.doi.org/10.1097/SPV.0000000000001557
  9. Campos N.C., de Carvalho G.M., de Santos R.A., de Brito Oliveira R.D., de Oliveira Sunemi M.M., Figueiredo E.M. Prevalence, bother, and risk factors associated with occurrence of pelvic floor dysfunctions in young women: a cross-sectional survey. Journal of Women's & Pelvic Health Physical Therapy. 2024; 48(3): 194-201. https://dx.doi.org/10.1097/jwh.0000000000000305
  10. Zhang S., Li B., Liu J., Yang L., Li H., Hong L. The causal effect of reproductive factors on pelvic floor dysfunction: a Mendelian randomization study. BMC Womens Health. 2024; 24(1): 74. https://dx.doi.org/10.1186/s12905-024-02914-6
  11. DeLancey J.O., Mastrovito S., Masteling M., Horner W., Ashton-Miller J.A., Chen L. A unified pelvic floor conceptual model for studying morphological changes with prolapse, age, and parity. Am. J. Obstet. Gynecol. 2024; 230(5): 476-484.e2. https://dx.doi.org/10.1016/j.ajog.2023.11.1247
  12. Gao Y., Luo X. Sonographic study on structural and functional impacts on female pelvic floor upon pregnancy, vaginal delivery and elective cesarean delivery. Chinese Journal of Obstetrics & Gynecology and Pediatrics (Electronic Edition). 2011; 07(01): 30-3. https://dx.doi.org/10.3877/cma.j.issn.1673-5250.2011.01.008
  13. Haylen B.T., de Ridder D., Freeman R.M., Swift S.E., Berghmans B., Lee J. et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int. Urogynecol. J. 2010; 21: 5-26. https://dx.doi.org/10.1007/s00192-009-0976-9
  14. Чечнева М.А., Буянова С.Н., Попов А.А., Краснопольская И.В. Ультразвуковая диагностика пролапса гениталий и недержания мочи у женщин. М.: МЕДпресс-информ; 2016. 136c. [Chechneva M.A., Buyanova S.N., Popov A.A., Krasnopolskaya I.V. Ultrasound diagnostics of genital prolapse and urinary incontinence in women. Moscow: MEDpress-inform, 2016. 136p. (in Russian)].
  15. Laycock J., Jerwood D. Pelvic floor muscle assessment: The PERFECT Scheme. Physiotherapy. 2001; 87(12): 631-42. https://dx.doi.org/10.1016/s0031-9406(05)61108-x
  16. Asfour V., Digesu G.A., Fernando R., Khullar V. Ultrasound imaging of the perineal body: a useful clinical tool. Int. Urogynecol. J. 2020; 31(6): 1197-202. https://dx.doi.org/10.1007/s00192-019-04166-7
  17. Zhou M., Shui W., Bai W., Wu X., Ying T. Ultrasonographic study of female perineal body and its supportive function on pelvic floor. Front. Med. (Lausanne). 2023; 10: 1176360. https://dx.doi.org/10.3389/fmed.2023.1176360.
  18. Al-Saadi W.I. Transperineal ultrasonography in stress urinary incontinence: The significance of urethral rotation angles. Arab J. Urol. 2016; 14(1): 66-71. https://dx.doi.org/10.1016/j.aju.2015.11.003.
  19. Turkoglu A., Erturk Coskun A.D., Arinkan S.A., Vural F. The role of transperineal ultrasound in the evaluation of stress urinary incontinence cases. Int. Braz. J. Urol. 2022; 48(1): 70-7. https://dx.doi.org/10.1590/ S1677-5538.IBJU.2020.1100
  20. Naranjo-Ortiz C., Shek K.L., Martin AJ., Dietz H.P. What is normal bladder neck anatomy? Int. Urogynecol. J. 2016; 27(6): 945-50. https://dx.doi.org/10.1007/s00192-015-2916-1
  21. Hajebrahimi S., Azaripour A., Sadeghi-Bazargani H. Clinical and transperineal ultrasound findings in females with stress urinary incontinence versus normal controls. Pak. J. Biol. Sci. 2009; 12(21): 1434-7. https://dx.doi.org/10.3923/pjbs.2009.1434.1437
  22. Dietz H.P. Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet. Gynecol. 2004; 23(1): 80-92. https:// dx.doi.org/10.1002/uog.939

Arquivos suplementares

Arquivos suplementares
Ação
1. JATS XML
Baixar
2. Fig. 1. Ultrasound determination of the anterior urethral angle (a, urethral inclination angle)

Baixar (284KB)
Metadados
3. Fig. 2. Age dynamics of symptoms of POP and disorders of bladder and bowel function based on the PFDI-20 questionnaire

Baixar (178KB)
Metadados

Declaração de direitos autorais © Bionika Media, 2025