Effect of Heavy Lifting with a Head Strap on the Pelvic Floor across the Menstrual Cycle

Background: Pelvic organ prolapse (POP) occurs in 10% of women in Nepal, even 6% of nulliparous women have symptomatic POP.1 This may be linked to the heavy lifting tasks performed by women using a head strap.2 This study explored the impact of hormonal changes on the pelvic floor when performing these tasks during each phase of the menstrual cycle. Methods: The study included 22 female Nepali participants with a mean age of 27.4(3.6) years; all were from rural villages and frequently carried with a head strap. Using intravaginal pressure transducers (IVT), the mean change in intraabdominal pressure (IAP) was found to be 37.1(4.3) cmH20 when lifting a load with a mean weight of 19.8(3.2)kg using a head strap. Lifting tasks were simulated with isometric ballistic lifts against a head strap secured to the plith with the participant lying supine. The mean increase in IAP from rest was 31.6(2.1)cmH20. Displacement of the pelvic floor was measured by transperineal ultrasound. Mean displacement of the pelvic floor at ovulation was 5.1(0.4)mm and a mean of 5.9(0.4)mm during the early follicular phase (p 0.03). Conclusion: during the early follicular phase, when basal body temperature and beta estrogen are lowest, the compliance of the pelvic floor is greatest. Repetitive lifting during this time may predispose some woman to POP

Effect of Heavy Lifting with a Head Strap on the Pelvic Floor across the Menstrual Cycle

Background: Pelvic floor trauma with vaginal delivery and heavy lifting, are thought to be risk factors for symptomatic pelvic organ prolapse (SPOP) in young Nepali women. The 2011 Nepal Demographic and Health Survey found 6% of nulliparous women report SPOP, compared to 7% in the general population of Nepali women ages 15 – 49. The average age of SPOP onset in Nepal is 27.3 In western countries SPOP is usually reported between the 4th and 6th decade of life. This study investigated the effect of increased intra-abdominal pressure (IAP) on pelvic organ descent during simulated lifting tasks in Nepali women across the menstrual cycle. The aims were to (i) calculate the descent of the pelvic floor organs during a simulated lifting task in a population of Nepali women, (ii) compare the descent between three stages of the menstrual cycle, and (iii) investigate the capacity of the pelvic floor muscles to resist pelvic organ descent by voluntarily contracting prior to performing the lifting task. We hypothesized that there was a relationship between heavy lifting during menstruation that could account for the unexpectedly high rates of young and nulliparous women with SPOP in Nepal possibly linked to their unique custom of Chhaupadi (ritual impurity during menstruation). Methods: 22 asymptomatic Nepali women aged 18-30 years who regularly lift heavy loads were included in the study. Intra-abdominal pressure was measured intra-vaginally during both typical lifting tasks and simulated lifting tasks. Simulated tasks included: ballistic lifting, ramped lifting, ballistic lift with pre-contraction of the pelvic floor muscles, cough, Valsalva, and pelvic floor contraction. Transperineal ultrasound (US) recorded displacement (mm) of the bladder base with simulated tasks during: menstruation, ovulation, and mid-luteal phase. Findings: More pelvic floor displacement was found during menstruation than ovulation with simulated ballistic lifting (6˙0 ± 1˙6 vs 5˙1 ±1˙5, p = ˙03). However, there was no significant difference in pelvic floor displacement with lifting when the pelvic muscles were pre-contracted. Interpretation: The pelvic floor supportive tissues may be at increased risk for stretching and injury when lifting a heavy load during menstruation versus ovulation. Pre-contracting the pelvic muscles when lifting may demonstrate a protective effect