Importance of Pelvic Orientation for Pelvic Organ Prolapse (POP)

Pelvic Organ Prolapse (POP) is a condition that affects many women worldwide. It is caused by the weakening of the connective tissue in the pelvis, which can cause the pelvic organs (bladder, uterus, and/or bowel) to drop downwards and push into the vagina. This can lead to significant discomfort and disruption to a woman’s daily life. However, understanding the importance of pelvic orientation and how it affects pelvic organ support can play a critical role in preventing and managing POP.

According to Matthew D. Barber, a Urogynecologist, and a well-respected expert in the field of female pelvic anatomy, the bony pelvis plays a critical role in supporting the pelvic organs. In a standing woman, the pelvis should be oriented such that the anterior superior iliac spine ( front of the pelvis) and the front edge of the pubic bone are in the same vertical plane, perpendicular to the floor. This orientation directs the pressure of the intra-abdominal and pelvic contents toward the bones of the pelvis instead of the muscles and connective tissue of the pelvic floor. Loss of lumbar lordosis( lower back inward arch) and a less vertically oriented pelvic inlet are more common in women who develop POP than in those who do not. A less vertical orientation of the pelvic inlet often described as the posterior or backward pelvic tilt is thought to result in an alteration of the intra-abdominal pressure that is normally directed onto the pubic bone instead of the pelvic organs and soft tissue of the pelvic floor.

To improve pelvic orientation and prevent POP, Pelvic Floor Muscle Functional Training is a recommended exercise program for women with POP, based on expert opinion as evidence is lacking. This involves coordination training of different parts of the body, which work together smoothly and efficiently to best support pelvic organs through lifestyle modifications for everyday function.

 

This training incorporates correct Pelvic Floor Muscle contraction into activities of daily living, such as breathing, sitting, standing, bending, lifting, walking, and jogging. The goal is to coordinate the Pelvic Floor Muscles with other muscle groups of the body, to elevate and best support the Pelvic Organs in everyday activities of life.

Pelvic orientation can also be influenced by various factors such as pregnancy, delivery, sedentary occupation, and menopause. Pregnancy and delivery can cause stretching and weakening of the pelvic floor muscles and connective tissue, which can result in a change in pelvic orientation. Sedentary occupation can decondition our abdominal cylinder muscles and contribute to loss of lordosis. Menopause, on the other hand, can lead to thinning and weakening of the supportive tissues of the pelvic organs, further exacerbating the issue.

It is important, women learn how to properly contract their pelvic floor and core muscles and move their pelvic organs up and forward to be best supported on the pubic bone.

In conclusion, understanding the importance of pelvic orientation and how it affects pelvic organ support appears important in preventing and managing POP. By focusing on Pelvic Floor Muscle Functional Training and incorporating it into daily activities, women can strengthen their pelvic floor muscles, maintain pelvic orientation, and reduce their POP bother.

Reference: Barber, M. D. (2005). Contemporary views on female pelvic anatomy. Cleveland Clinic Journal of Medicine, 72(Suppl 4), S3-S10.

 

 

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