Relationship between intra-abdominal pressure and vaginal wall movements during Valsalva in women with and without pelvic organ prolapse: technique development and early observations

Abstract

Objectives To develop and test a method for measuring the relationship between the rise in intra-abdominal pressure and sagittal plane movements of the anterior and posterior vaginal walls during Valsalva in a pilot sample of women with and without prolapse. Methods Mid-sagittal MRI images were obtained during Valsalva while changes in intra-abdominal pressure were measured via a bladder catheter in 5 women with cystocele, 5 women with rectocele, and 5 controls. The regional compliance of the anterior and posterior vagina wall support systems were estimated from the ratio of displacement (mm) of equidistant points along the anterior and posterior vaginal walls to intra-abdominal pressure rise (mmHg). Results The compliance of both anterior and posterior vaginal wall support systems varied along different regions of vaginal wall for all three groups, with the highest compliance found near the vaginal apex and the lowest near the introitus. Women with cystocele had more compliant anterior and posterior vaginal wall support systems than women with rectocele. The movement direction differs between cystocele and rectocele. In cystocele, the anterior vaginal wall moves mostly toward the vaginal orifice in the upper vagina, but in a ventral direction in the lower vagina. In rectocele, the direction of the posterior vaginal wall movement is generally toward the vaginal orifice. Conclusions Movement of the vaginal wall and compliance of its support is quantifiable and was found to vary along the length of the vagina. Compliance was greatest in the upper vagina of all groups. Women with cystocele demonstrated the most compliant vaginal wall support.

Ovine multiparity is associated with diminished vaginal muscularis, increased elastic fibres and vaginal wall weakness: implication for pelvic organ prolapse

“…However, a limitation of the biaxial tensiometry used in this study (“ballburst” test), is that a steel rod may not exert equivalent forces of a pelvic organ, with different shape and hardness. However, the vaginal wall is subject to high intra-abdominal pressures transmitted through pelvic organs pressing on the vaginal wall39. Vaginal tissue is anisotropic1940, thus biaxial testing is currently the most equivalent test available.…”

Paravaginal defect: anatomy, clinical findings, and imaging

“…Its capabilities include dynamic mid-sagittal images that quantify both the direction and magnitude of movement [51]. More recently, 3D stress MRI, in which multi-slice images are captured at the point of maximal Valsalva with the prolapse maximally developed, allows changes in vaginal width, length, and location to be captured and measured relative to bony landmarks.…”

The Relationship of the Pelvic Cavity Shape, its Morphometric Characteristics and Body Composition of Women in Normal Conditions and in Case of Pelvic Organs Prolapse

“…Высокая частота встречаемости данного заболевания объясняет выраженный научный интерес к поискам этиологических факторов, изучению патогенеза, а также выявлению различных предрасполагающих причин пролапса тазовых органов. До настоящего времени не существует единого мнения об этиопатогенезе данного заболевания [2,3,10,16,18,19]. В литературных источниках описано влияние ожирения, травматизации тканей в процессе родов, а также повышения внутрибрюшного давления в результате запоров, хронических заболеваний дыхательной системы и ряда других органов на развитие пролапса тазовых органов.…”