مقایسه وضعیت راستای ستون فقرات و لگن و عملکرد عضلات کف لگن در زنان با و بدون افتادگی احشاء لگنی

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دفتر تحقیقات و فناوری دانشجویی، دانشجوی کارشناسی ارشد فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

2 دکتری تخصصی فیزیوتراپی، استادیار گروه فیزیوتراپی. عضو هیئت علمی دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران. ایران.

3 استادیار گروه زنان و زایمان، دانشکده علوم پزشکی بابل . بابل. ایران

4 دانشیار گروه آمار زیستی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی. تهران. ایران

10.22037/jrm.2015.1100226

چکیده

مقدمه و اهداف
افتادگی احشاء لگنی یکی از انواع اختلالات کف لگن و عارضه ای است که کیفیت زندگی فرد مبتلا را تحت تاثیر قرار می دهد. با توجه به شیوع نسبتا بالای افتادگی احشاء لگنی در زنان و لزوم بررسی تاثیر عوامل مستعد کننده این بیماری در جوامع مختلف، این تحقیق با هدف مقایسه وضعیت راستای ستون فقرات و لگن و عملکرد عضلات کف لگن در زنان با و بدون افتادگی احشاء لگنی انجام شد.
مواد و روش­ها
در مجموع 60 نفر، با روش نمونه گیری غیر تصادفی متوالی در این مطالعه توصیفی-تحلیلی که به روش مقطعی انجام شد، شرکت کردند. 30 زن مبتلا به افتادگی احشاء لگنی درجه 2 و 2 به بالا با توجه به معیارهای لحاظ شده، از بین بیماران مراجعه کننده به بیمارستان آیت الله روحانی بابل به عنوان گروه مورد  و 30 زن از مراجعین همان بیمارستان که درجه افتادگی آن ها صفر و یا یک بود به عنوان گروه شاهد انتخاب شدند. پس از گرفتن اطلاعات جمعیت شناختی و سوابق پزشکی، بررسی بالینی شامل ارزیابی وضعیت پوسچرال ستون فقرات، سطح تون واژینال و مقادیر قدرت و استقامت عضلات کف لگن انجام شد.
یافته ها
بین دو گروه تفاوت معنی داری از لحاظ وجود کایفوز پشتی  (0/98=P ) و شیب لگن  (0/06=P)  وجود نداشت. ولی مقادیر زوایای لوردوز کمری و سطح تون واژینال ، قدرت و استقامت عضلات کف لگن درزنان مبتلا به افتادگی احشاء لگنی کمتر از زنان بدون این عارضه بود (0/05>P) .
نتیجه گیری
کاهش لوردوز کمری به عنوان یکی از عوامل خطرزای احتمالی در بیماران با افتادگی احشاء لگنی باید در نظر گرفته شود و مطابق نتایج این مطالعه، احتمال افزایش کایفوز و تیلت خلفی لگن در زنان با افتادگی احشاء لگنی، در یک جامعه بزرگتر آماری، می رود. همچنین در ارایه خدمات درمانی به این بیماران بر تقویت عضلات کف لگن تاکید می شود.

کلیدواژه‌ها


عنوان مقاله [English]

Comparison of the alignment of spine and pelvis and pelvic floor muscles’ function between women with and without pelvic organ prolapse

نویسندگان [English]

  • Mahboubeh Homayounzadeh Ahangar 1
  • Farideh Dehghan Manshadi 2
  • Shahnaz Barat 3
  • Alireza Akbarzadeh Bagheban 4
1 Students` Research Office. Msc in Physiotherapy. School of Rehabilitation Scienses. Shahid Beheshti University of Medical Science. Tehran. Iran
2 Assistant Professor of Physiotherapy. Shcool of Rehabilitation Scienses, Shahid Beheshti University of Medical Science. Tehran. Iran
3 Assistant Professor, Genycologist Department, Faculty of Rehabilitation Scienses, Babol University of Medical Science. Babol. Iran
4 Associate Professor of Biostatistics, Shcool of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده [English]

Background and Aim: Pelvic Organ Prolapse (POP) is a kind of pelvic floor disorders that affects the quality of life of affected individuals. According to relatively high prevalence of POP in women and the need to review the impact of risk factors in different populations, the present study aimed at compareing the alignment of the spine and pelvis and pelvic floor muscles’ function between women with and without POP.
Material & Methods: Atotal of 60 women with sequential non-random sampling were selected to participate in this descriptive-analytic cross-sectional study. Thirty women with POP who had reffered to Ayatollah Rohani hospital, according to inclusion criteria, were set asas case group and 30 women referring to the same hospital with zero or one degree of prolapse were selected as the control group. After obtaining demographic information, clinical examination including assessment of the spinal posture, state of vaginal rest tone, pelvic floor muscles' strength, and endurance were assessed. Obtained data were analysed by Kolmogorov-Smirnov test, t-test, Logistic Regression, chi-square test and Spearma.
Results: The data showed no significant differences between the two groups in terms of kyphosis (P=0.98) and pelvic tilt (p=0.06). But there is a significant differences in lumbar lordosis (P=0.04). Vaginal tone and pelvic floor muscle strength were significantly lower in patients compared with that in participants without pelvic organ prolapse (p<0.05).
Conclusion: Loss of lumbar lordosis as one of the possible risk factors should be considered in patients with pelvic organ prolapse and, according to the results, the possibility of increase in kyphosis and posterior tilt of the pelvis in women with pelvic organ prolapse is higher in a larger population. Pelvic floor muscles are also emphasized in providing health care services for these patients.

کلیدواژه‌ها [English]

  • Spine alignment
  • pelvic floor muscles
  • pelvic organ prolapsed
  1. Bump R, Norton P. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am 1998;25:723-46.##
  2. Marinkovic SP, Staton S.I. Incontinence and voidig difficulties associated with prolapse. J Urol 2004; 171(3): 1021-8 .##
  3. Nevéus T, von Gontard A, Hoebeke P, Hjälmås K, Bauer S, Bower W, et al. The standardization of terminology of lower urinarytract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. The Journal of urology. 2006;176(1):314-24##
  4. Beck R. Pelvic relaxational prolapse. Principles and practice of clinical gynecology New York: John Wiley&Sons. 1983:677-85. ##
  5. Mousavi A, Mostafaei P. Assessment of the frequency of pelvic organ prolapse and its risk factors in menopausal women referred to the hospitals of Iran University of Medical Sciences in 2004. Razi Journal of Medical Sciences. 2007;14(54):167-77. [In Persian]##
  6. Thakar R, Stanton S. Regular review: management of genital prolapse. BMJ: British Medical Journal. 2002;324(7348):125-8##
  7. Samuelsson EC, Arne Victor F, Tibblin G, Svärdsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. American journal of obstetrics and gynecology. 1999;180(2):299-305.##
  8. Bump RC, Sugerman HJ, Fantl JA, McClish DK. Obesity and lower urinary tract function in women: Effect of surgically induced weight loss. Am J Obstet Gynecol 1992;167(2):392- 399.##
  9. Jorgensen S, Hein HO, Gyntelberg F. Heavy lifting at work and risk of genital prolapse and herniated lumbar disc in assistant nurses. Occup Med 1994;44(1):47–49.##
  10. Nguyen J, Lind L, Choe J, Mckindsey F, Sinow R, Bhatia N. Lumbosacral spine and pelvic inlet changes associated with pelvic organ prolapse. Obstet Gynecol. 2000;95(3):332-6.##
  11. Lind R, Lucente V, Kohn N. Thorasic Kyphosis and the prevalence of advanced uterin prolapse. Ostet Gynecol. 1996;87(4):605-9.##
  12. Kaplan FS, editor Osteoporosis. Pathophysiology and prevention. Clinical symposia (Summit, NJ: 1957); 1986.##
  13. Mattox TF, Lucente V, Mcintyre P, Miklos JR, Tomezsko J. Abnormal spinal curvature and its relationship to pelvic organ prolapse. Am J Obstet Gynecol 2000; 183(6): 183-4.##
  14. Richardson C, Hodges P, Hides J. Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain. 2 editioned: Churchill Livingstone; 2004.##
  15. Berglas B, Rubin I. Study of the supportive structures of the uterus by levator myography. Surgery, gynecology & obstetrics. 1953;97(6):677-92.##
  16. Norton P. Pelvic floor disorders: the role of fascia and ligaments. Clinical obstetrics and gynecology. 1993;36(4):926-38.##
  17. Wall LL. The Muscles of the Pelivc Floor. Clinical obstetrics and gynecology. 1993;36(4):910-25.##
  18. Zacharin RF. Pulsion enterocele: review of functional anatomy of the pelvic floor. Obstetrics & Gynecology. 1980;55(2):135-40.##
  19. DeLancey JO. The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. American journal of obstetrics and gynecology. 2005;192(5):1488-95.##
  20. Chen L, Ashton-Miller JA, Hsu Y, DeLancey JO. Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstetrics & Gynecology. 2006;108(2):324-32.##
  21. Grewar H, McLean L. The integrated continence system: A manual therapy approach to the treatment of stress urinary incontinence . Manual therapy . 2008; 13(5):375-386##
  22. Dehghan F, Ghanbari Z, Frootan M, Kuhpayeh Zadeh J, Moshtaghi Z. Chronic Pelvic Pain Frequency among a group of Iranian employed Women. Tehran University Medical Jornal. 2009;66(10):767-73. [In Persian]##
  23. Bump R, Mattiasson A, BoK, Brubaker LP, DeLancey JOL, Klarskov P, et al. The  standardization  of  terminology  of  female  pelvic  organ prolapse  and  pelvic  floor  dysfunction Am J Obstet Gyneco. 1996 July;175(1):10-17##
  24. Youdas J, Garrett T, Harmsen S, Suman V, Carry G. Lumbar lordosis and pelvic inclination  of asymptomatic adults. Phsy Ther. 1996;76(10):1066-81.##
  25. Herrington  L.  Assessment  of  the  degree  of  pelvic  tilt  within  a  normal  asymptomatic  population.  Manual Therapy. 2011;16(6):646-8.##
  26. Eftekhar H, Khalkhali M. The designe and implementation of two instrument for mesearingpure hip flexion and pelvic tilt. [ In Persian]. Informative Scientific Journal of Shahed University. 1994;1(4):48-51.##
  27. Ombregt L. Atlas of Ortho Exam of Peripheral Joints. 1st edition ed: Bailliere Tindall; 1999##
  28. Kendall FP, McCreary E, Provance P, Abeloff D. Muscles: testing and function. Baltimore: Lippincott Williams & Wilkins 1993##
  29. Hungerford B, Gilleard W, Lee D. Altered patterns of pelvic bone motion determined in subjects with posterior pelvic pain using skin markers . Clinical Biomechanics. 2004;19(5):456-464##
  30. Bø K, Bo K, Berghmans B, Van Kampen M, Morkved S. Evidence-based physical therapy for the pelvic floor: bridging science and clinical practice: Elsevier Health Sciences; 2007.##
  31. BøK, Raastad R, Finckenhagen HB. Does the size of the vaginal probe affect measurement of pelvic floor muscle strength? Acta obstetricia et gynecologica Scandinavica. 2005;84(2):129-33.##
  32. Fletcher E. Differential diagnosis of high-tone and low-tone pelvic floor muscle dysfunction. Journal of Wound Ostomy & Continence Nursing. 2005;32(3S): 10-1.##
  33. Payal D. Patel, Kaytan V. Amrute, and Gopal H. Badlani . Pelvic organ prolapse and stress urinary incontinency: A review of etiological factors. Indian J Urol. 2007;23(2):135-141.##
  34. Sapsford RR, Richardson CA, Maher CF, Hodges PW. Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Arch Phys Med Rehabil 2008; 89(9):1741-1747.##
  35. DeLancey JO, Morgan DM, Fenner DE, Kearney R . Comparison of  Levator Ani Muscle Defects and Function in Women With and Without Pelvic Organ Prolapse .obstetrics and gynecology 2007;109(2):295-302.##
  36. Model AN, Shek KL, Diets HP. Levator defects are associated with prolapse after pelvic floor surgery . European journal ofobstetrics and gynecology and Reproductive Biology 2010;153(2):220-223.##
  37. Dehghan F, Ghanbari Z, Jabbari Z, Sadat Miri E, Moshtaghi Z. Urinary Incontinence, its Related Disorders and Risk Factors in Women. Scientific Journal of School of Public Health and Institute of Public Health Research.2013;11(2):53-63. [ In Persian]##