Chronic pelvic pain and pelvic organ prolapse: a consequence of upright position?

Abstract

Objective: The pathogenesis of chronic pelvic pain (CPP) is still incompletely understood. Generally accepted is, that soft tissue structures mutate with age, loose tension and by this can provoke CPP. This raises the question, of whether the bony pelvis underlies comparable age-dependent changes and if so, how this alteration has impact on the static anatomy of the pelvic floor and the suspension and supporting system. Materials and Methods: In order to answer this question we analysed the biological evolution of human beings and checked the historical literature regarding age-dependent static changes of the bony pelvis. Results: The vertical spine position is primarily due to an angulation of the lumbar spine against the sacrum causing a lordotic curve. The upright position of human beings forces the sacrum to curve, age dependent more and more. This leads to a descent of the promontorium causing a lifting of the coccyx and the pubic symphysis. This rotation causes a flatter pelvic floor. Conclusion: The age-dependent, now horizontal positioned pelvic floor provokes an unphysiological stretching on the soft-tissue-pelvic-floor structures causing and boosting a decompensation of the pelvic organ support and suspension system. Overstretched connective tissue, ligaments, nerves and muscles react with pain.

Late‐occurring pain/other dysfunctions in midurethral sling class actions are likely caused by uterosacral ligament weakness, not implant or surgeon

“…Posterior fornix syndrome (PFS) symptoms may occur months or years after MUS, but may be present "below the surface" preoperatively, as shown by Goeschen 7 and others. [6][7][8] Late PFS symptoms are not necessarily the fault of the implant, or the surgeon. They are more likely a consequence of diverted pelvic forces onto USLs weakened from childbirth or aging.…”

“…The diagnostic algorithm, a foundation stone of the integral theory system, Figure 1, was used as a diagnostic guide for the surgical studies. [6][7][8] The algorithm, Figure 1, shows how the relationships between symptoms and loose ligaments, rectangle Figure 1, may cause pelvic dysfunctions. Finally showing how the hypothesis of USL causation of pain/bladder/ bowel dysfunctions, can be partly tested by speculum or pessary tests, and more fully by referral to published works which validate cure such symptoms following repair of USLs.…”

“…Finally showing how the hypothesis of USL causation of pain/bladder/ bowel dysfunctions, can be partly tested by speculum or pessary tests, and more fully by referral to published works which validate cure such symptoms following repair of USLs. [6][7][8] F I G U R E 1 The pictorial diagnostic algorithm 2 relates symptoms to prolapse and ligament weakness. Symptoms in each of three zones indicate which ligaments have been damaged.…”

“…Table 2 is from a single surgeon in 198 women who presented with SUI, chronic pelvic pain and prolapse, also 2nd & 3rd degree. 7 Surgery was midurethral and uterosacral ligament repair using the IVS tunneler. Hospital stay was 3-4 days.…”

Surgical cure of chronic pelvic pain in the female by uterosacral ligament repair

“…7 1.4 | Cure of CPP cure by USL repair Since 1996, many surgical studies have reported cure of CPP and co-occurring bladder and bowel symptoms following USL repair, with or without slings. [8][9][10][11][12][13][14][15][16][17][18][19][20] F I G U R E 1 Diagnostic algorithm. Posterior fornix syndrome symptoms are contained in the posterior zone rectangle.…”