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The human body has more than 600 muscles that help us move, breathe, and survive. Skeletal muscles, which connect to our bones, make up 30% to 40% of our total body mass. They are the only type of voluntary muscle tissue in the human body, allowing us to perform a wide range of movements. The uterosacral ligament (USL), on the other hand, is a pelvic structure associated with female pelvic floor disorders (PFDs) and urinary incontinence (UI). This topic will explore the role of the USL in pelvic health and its connection to surrounding muscles and tissues.
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What You'll Learn
Pelvic floor disorders (PFDs)
Pelvic floor dysfunction (PFD) is a common condition that affects around 25% of women in the United States. It refers to a group of symptoms and anatomical changes related to abnormal function of the pelvic floor muscles. The disordered function can be due to increased activity (hypertonicity), decreased activity (hypotonicity), or poor coordination of the pelvic floor muscles.
The most common pathologies associated with PFD are urinary incontinence (UI) and pelvic organ prolapse (POP). Other symptoms include constipation, straining during bowel movements, urine or stool leakage, and a frequent urge to urinate. Patients may experience a complex of multiple symptoms, with 82% of patients with defecatory disorders also experiencing multiple urinary symptoms.
The Pelvic Floor Disorders Consortium (PFDC) has developed tools such as the IMPACT long and short forms to standardize the collection of information and facilitate further studies. These tools enable consistent evaluation and monitoring of patients.
PFD can be studied through various methods, including experimental tensile tests using cadaveric tissues or tissues collected during transvaginal hysterectomy, as well as imaging techniques such as magnetic resonance imaging (MRI). The mechanical aspects of pelvic organ prolapse are associated with changes in the supportive structures of the female pelvic cavity, specifically the widening of the levator hiatus and laxity of the pelvic floor. These changes may be influenced by factors such as obesity, menopause, pregnancy, and childbearing.
Conservative treatment options are important to explore before considering surgery due to potential complications and healthcare costs. Kegel exercises, for example, can be beneficial in educating patients on how to manage their condition.
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Urinary incontinence (UI)
To treat UI, it is recommended to maintain a healthy weight, manage constipation, and avoid bladder-irritating foods and drinks. Pelvic floor exercises, also known as Kegel exercises, can help strengthen the pelvic floor muscles and reduce leaks. These exercises involve short and long squeezes of the pelvic floor muscles, with gradual increases in hold time. It is important to perform these exercises correctly and consistently for several months to see improvements.
In addition to lifestyle changes and exercises, there are other treatment options for UI. Timed voiding, or peeing according to a schedule, can help prevent leaks. Using absorbent pads or underwear can catch any accidental leaks. For more severe cases, medical procedures such as botulinum toxin (Botox) injections, neuromodulation devices, sling procedures, and artificial urinary sphincters may be recommended. It is important to consult with a healthcare provider to determine the most suitable treatment option for UI.
While UI can be a challenging condition, it is manageable through a combination of lifestyle modifications, exercises, and medical interventions. Seeking professional advice and adhering to recommended treatments can help individuals effectively cope with UI and improve their quality of life.
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Pubovisceralis muscle (PVM)
The pubovisceral muscle, also known as the pubovisceralis muscle (PVM), is a V-shaped muscle that encloses the urethra, vagina, and anal canal. The PVM originates bilaterally from the pubic bone and is subject to an increased risk of injury during difficult vaginal births. The muscle is thin and transparent as it attaches tangentially to the pubic periosteum, with its morphology changing from medial to lateral regions.
The PVM is a fibrous enthesis, with muscle fibres terminating in collagenous fibres that insert onto the periosteum of the pubic bone. The detailed fibre orientation and junction between the PVM and the pubic bone have been examined using magnification. The PVM is also referred to as the pubococcygeal muscle in Terminologia Anatomica.
The PVM is associated with pelvic organ prolapse (POP), a common female pelvic floor impairment that can lead to surgical treatment. During vaginal delivery, the pelvic floor can be irreversibly traumatised, resulting in PVM avulsions. These avulsions can be detected using magnetic resonance (MR) imaging, which provides detailed visualisation of the pelvic floor.
The PVM is studied using inverse finite element analysis (FEA) to understand its passive and active behaviour during the Valsalva maneuver and muscle active contraction, respectively. The Yeoh hyperelastic constitutive model and the hyperplastic Mooney-Rivlin constitutive model are applied to analyse the material properties of the PVM.
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Pelvic organ prolapse (POP)
The condition is often associated with changes in the mechanical properties of the supportive structures in the female pelvic cavity. The risk factors for POP include pregnancy and vaginal delivery, which can lead to direct pelvic floor muscle and connective tissue injury. Prior pelvic surgeries or conditions associated with sustained episodes of increased intra-abdominal pressure, such as heavy lifting, obesity, chronic cough, and constipation, can also increase the risk of developing POP.
The symptoms of POP include pelvic discomfort or pain, pressure, and a bulge of tissue or organs that protrude to or past the vaginal opening. Other symptoms include urinary, bowel, and sexual dysfunction. The impact of POP on a woman's life can be significant, affecting her sexual activity, body image, and quality of life.
The diagnosis of POP involves a detailed medical history and a thorough physical examination, including a pelvic examination. The Baden-Walker grading system or the pelvic organ prolapse quantification system can be used to quantify the degree of prolapse and aid in clinical assessment. Treatment options for POP include both nonsurgical and surgical approaches. Nonsurgical treatments, such as pelvic floor exercises (Kegels) and the use of a pessary, can be effective in managing the condition. However, in some cases, surgery may be recommended to address the prolapse or to prevent or decrease urine leakage (incontinence).
The management of POP requires a collaborative approach by an interprofessional team, including specialists in pelvic health. Early access to specialist treatment and conservative treatment options are important considerations in the care of patients with POP.
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Yeoh hyperelastic constitutive model
The Yeoh hyperelastic constitutive model is a polynomial model with only three parameters. It is used to describe nearly incompressible hyperelastic materials, such as rubber. The model is named after Oon Hock Yeoh, who completed his doctoral studies under Graham Lake at the University of London.
The Yeoh model has been generalized to account for creep, plasticity, and viscoelasticity of polymers. It is particularly useful for materials that exhibit a non-linear increase in stress at higher stress levels, which is known as strain hardening. This characteristic is common in many polymers and cannot be captured by simpler sub-models such as neo-Hookean or Mooney-Rivlin.
The Yeoh model uses the strain energy density function, which can be simplified to the neo-Hookean model for incompressible materials. The model has been applied in various fields, including the modelling of elastomeric bridge bearings and the selection of hyperelastic constitutive models for carbon black-filled rubber.
The Yeoh-Revised hyperelastic constitutive model is an improvement on the original Yeoh model, considering the volume almost incompressible premise for rubber materials. This revised model improves the prediction of equibiaxial tension (ET) stress and enhances the forecast accuracy of overall R^2. The Yeoh-Revised model has been tested through compression deformation analysis of packer rubber cylinders and has been found to provide more accurate results for rubber materials' tensile test data.
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