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Related Experiment Videos

Does vaginal closure force differ in the supine and standing positions?

Daniel M Morgan1, Gurpreet Kaur, Yvonne Hsu

  • 1Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan Medical School, Ann Arbor 48109, USA. morgand@umich.edu

American Journal of Obstetrics and Gynecology
|May 20, 2005
PubMed
Summary

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Vaginal closure force significantly increases when standing compared to lying down due to higher intra-abdominal pressure and pelvic floor muscle activity. This study quantifies these changes in continent women.

Area of Science:

  • Urogynecology
  • Pelvic Floor Physiology
  • Biomechanical Engineering

Background:

  • The pelvic floor muscles play a crucial role in maintaining continence and supporting pelvic organs.
  • Understanding the biomechanics of pelvic floor function, specifically vaginal closure force, is essential for diagnosing and managing pelvic floor disorders.
  • Posture-related changes in intra-abdominal pressure can influence pelvic floor muscle activity and force generation.

Purpose of the Study:

  • To quantify resting vaginal closure force (VCF(REST)), maximum vaginal closure force (VCF(MAX)), and augmented vaginal closure force (VCF(AUG)) in women in both supine and standing positions.
  • To investigate whether changes in intra-abdominal pressure associated with postural changes explain the observed differences in VCF.
  • To analyze the relationship between posture, intra-abdominal pressure, and pelvic floor muscle function in continent women.

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Main Methods:

  • Thirty-nine asymptomatic, continent women participated in the study.
  • Vaginal closure force (VCF) was measured using an instrumented vaginal speculum in both supine and standing postures.
  • Bladder pressure was recorded using a microtip catheter during rest and maximal voluntary contraction to determine VCF(REST), VCF(MAX), and VCF(AUG).

Main Results:

  • Vaginal closure force significantly increased with posture change: VCF(REST) increased by 92% (3.6 N supine vs. 6.9 N standing) and VCF(MAX) by 35% (7.5 N supine vs. 10.1 N standing) (P < .001 for both).
  • Intra-abdominal pressure was significantly higher when standing (31.0 cm H2O) compared to supine (10.5 cm H2O) (P < .001).
  • However, the increase in intra-abdominal pressure did not correlate with the observed differences in VCF at rest or during maximal contraction. Supine VCF(AUG) was greater than standing VCF(AUG).

Conclusions:

  • Postural changes, specifically from supine to standing, lead to increased vaginal closure force.
  • This increase is attributed to elevated intra-abdominal pressure and enhanced resistance from pelvic floor muscles.
  • The findings highlight the dynamic nature of pelvic floor muscle function in response to postural variations.