Skip to main content

Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction

International Urogynecology Journal volume 16, pages 468–474 (2005)Cite this article

Abstract

To assess the occurrence of pelvic floor dysfunction (PFD) in pregnancy- related low back and pelvic pain (PLBP) patients, a cross-sectional study was performed, comprising 77 subjects. Each subject underwent physical assessment, and filled in the Urogenital Distress Inventory completed with gynaecological questions. Differences in the presence of PFD between PLBP patients and healthy controls as well as differences in pelvic floor muscle activity were tested for significance. Interaction by age and vaginal delivery were tested. PFD occurred in 52% of all PLBP patients, significantly more than in the healthy control group. In PLBP patients a significantly increased activity of the pelvic floor muscles could be demonstrated with respect to healthy controls. The occurrence of PFD and PLBP was influenced by a confounding effect of age. Clinicians should be aware of the relation between PLBP and PFD and hence address both problems at the same time.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Östgaard HC, Roos-Hansson E, Zetherstrom G (1996) Regression of back and posterior pelvic pain after pregnancy. Spine 21:2777–2780

    Google Scholar 

  2. Wu WH, Meijer OG, Uegaki K, Mens JM, Van Dieen JH, Wuisman PI, Ostgaard HC (2004) Pregnancy related pelvic girdle pain (PPP),1: Terminology, clinical presentation and prevalence. Eur Spine J 27 (on line)

  3. Mens JMA, Vleeming A, Snijders CJ, Stam HJ, Ginai AZ (1999) The active straight leg raising test and mobility of the pelvic joints. Eur Spine J 8:468–473

    Google Scholar 

  4. Östgaard HC, Zetherstrom G, Roos Hansson E (1997) Back pain in relation to pregnancy: a 6-year follow-up. Spine 24:2945–2950

    Google Scholar 

  5. Mens JMA, Vleeming A, Snijders A, Koes BW, Stam HJ (2001) Validity and reliability of the active straight leg raising test in posterior pelvic pain since pregnancy. Spine 26:1167–1171

    Article  CAS  PubMed  Google Scholar 

  6. Östgaard HC, Zetherström G, Roos-Hansson E, Svanberg B (1994) Reduction of back and posterior pelvic pain in pregnancy. Spine 19:894–900

    Google Scholar 

  7. O’Sullivan PB, Beales D, Beetham J, Cripps J, Graf F, Lin I, Tucker B, Avery A (2002) Altered motor control strategies in subjects with sacroiliac joint pain during the active straight leg raise test. Spine 27:E1–E8

    Article  PubMed  Google Scholar 

  8. Dietrichs E, Kogstad O (1991) “Pelvic girdle relaxation”- suggested new nomenclature. Scan J Rheum suppl 88:3

    Google Scholar 

  9. Mens JMA, Vleeming A, Stoeckart R, Stam HJ, Snijders CJ (1996) Understanding peripartum pelvic pain, Implications of a patient survey. Spine 21:1363–1370

    Google Scholar 

  10. Pool-Goudzwaard AL, Vleeming A, Stoeckart R, Snijders CJ, Mens JMA (1998) Insufficient lumbopelvic stability- a clinical, anatomical and biomechanical approach to a-specific low back pain. Man Ther 3:12–20

    Google Scholar 

  11. Council for organizations of medical sciences (2002) The committee on the Spine. American Academy of orthopaedic surgeons, Chicago, Document 675–680

  12. Snijders CJ, Snijder JGN, Hoedt HET (1984) Biomechanische modellen in het bestek van rugklachten tijdens de zwangerschap. T Soc Gezondheidszorg 62:141–147

    Google Scholar 

  13. Damen L, Spoor CW, Snijders CJ, Stam HJ (2002) Does a pelvic belt influence sacroiliac joint laxity? Clin Biomech (Bristol, Avon) 17:495–498

    Google Scholar 

  14. Vleeming A, Buyruk HM, Stoeckart R, Karamursel S, Snijders CJ (1992) An integrated therapy for peripartum pelvic instability: a study of the biomechanical effects of pelvic belts. Am J Obstet Gynecol 66:1243–1247

    Google Scholar 

  15. Pool-Goudzwaard AL, Hoek van Dijke G, Gurp van M, Mulder P, Snijders CJ, Stoeckart R (2004) Contribution of pelvic floor muscles to stiffness of the pelvic ring. Clin Biomech 19:564–571

    Google Scholar 

  16. Avery AF, O’Sullivan PB, McCallum MJ (2000) Evidence of pelvic floor muscle dysfunction in subjects with chronic sacro-iliac joint pain syndrome. In: Proceedings of the 7th scientific conference of the IFOMT. Perth 35–38

  17. Velde van der F (1999) Psychophysiological investigation of the pelvic floor. The mechanism of vaginismus. Thesis, Free University of Amsterdam

  18. Freese M, Levitt EE (1984) Relationships among intravaginal pressure, orgasmic function, parity factors and urinary leakage. Arch Sex Behav 13:261–268

    Google Scholar 

  19. Bernstein IT (1997) The pelvic floor muscles: muscle thickness in healthy and urinary- incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Neurour Urodyn 16:237–275

    Google Scholar 

  20. Meyer S, Schreyer A, De Grandi P, Hohlfield P (1998) The effects of birth on urinary incontinence mechanisms and other pelvic floor characteristics. Obstet Gynecol 92:613–618

    Article  CAS  PubMed  Google Scholar 

  21. Handa, VL, Harris TA, Ostergard DR (1996) Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse. Obstet Gynecol 88:470–478

    Article  CAS  PubMed  Google Scholar 

  22. Östgaard HC, Zetherström GBJ, Roos-Hansson E (1994) The posterior pelvic pain provocation test in pregnant women. Eur Spine J 3:258–260

    Google Scholar 

  23. Laycock J (1992). The development and validation of a pelvic floor digital assessment scheme. Assessment and treatment of pelvic floor dysfunction. Thesis, University of Bradford

  24. Shumaker SA, Wyman JF, Ubersax JS, McClish D, Fantl JA (1994) Health related quality of life measures for women with urinary incontinence: the icontinence impact questionnair and the urogenital distress inventory. Qual Life Res 3:291–306

    CAS  PubMed  Google Scholar 

  25. Vaart van der CH, Leeuw de RJ, Roovers JPWR, Heintz APM (2001) Measuring health related quality of life in women with urogenital dysfunction: The urogenital distress inventory and incontinence impact questionnair revisited, Thesis, University of Utrecht

    Google Scholar 

  26. Heitner CP (1999) Valideringsonderzoek naar palpatie en myofeedback bij vrouwen met stress-urine incontinentie. Maastricht University

  27. Binnie NR, Kawimbe BM, Pfapachrysostomou N (1991) The importance of the orientation of the electrode plates in recording the external sphincter EMG by non invasive anal plug electrodes. Int J Colorect Dis 6:5–9

    Google Scholar 

  28. Katz MH (2003) Multivariable analysis: a primer for readers of medical research. Ann Int Med 138:644–650

    Google Scholar 

  29. Vereecken RH, Verduin H (1970) The electrical activity of the paraurethral and perineal muscles in normal and pathological conditions. Br J Urol 42:457–463

    Google Scholar 

  30. Loenen NTVM, Vierhout ME (1997) De invloed van een bekkenbodem contractie op het urethradruk profiel. Profundum 2:9–15

    Google Scholar 

  31. Sapsford R, Bullock-Sanxton J, Markwell S (1988) Women’s health. Saunders, London

    Google Scholar 

Download references

Acknowledgements

The authors would like to express their gratitude to all physiotherapists who participated in the study, the Dutch Association of Pelvic Physical Therapists (NVFB) for their financial support and to Ria van Kruining.

Author information

Affiliations

  1. Department of Biomedical Physics and Technology, Faculty of Medicine and Allied Health Sciences, Erasmus Medical Center, Rotterdam, Netherlands

    Annelies L Pool-Goudzwaard & Chris J Snijders

  2. Centre for Pelvic reconstructive Surgery, Faculty of Medicine and Allied Health Sciences, Erasmus Medical Center, Rotterdam, Netherlands

    Marijke C. P. H. Slieker ten Hove & Mark E Vierhout

  3. Department of Epidemiology and Biostatistics, Faculty of Medicine and Allied Health Sciences, Erasmus Medical Center, Rotterdam, Netherlands

    Paul. H. Mulder

  4. Department of Neuroscience, Faculty of Medicine and Allied Health Sciences, Erasmus Medical Center, Rotterdam, Netherlands

    Rob Stoeckart

  5. EMGO institute, VU medical Center, Amsterdam, Netherlands

    Jan J. M. Pool

  6. Medical Center Impact, Zoetermeer, Netherlands

    Annelies L Pool-Goudzwaard & Jan J. M. Pool

  7. Department of Biomedical Physics and Technology, Erasmus Medical Centre, PO Box 1738, 3000, Rotterdam, Netherlands

    Annelies L Pool-Goudzwaard

Authors
  1. Annelies L Pool-Goudzwaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marijke C. P. H. Slieker ten Hove
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark E Vierhout
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul. H. Mulder
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan J. M. Pool
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chris J Snijders
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rob Stoeckart
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Annelies L Pool-Goudzwaard.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Pool-Goudzwaard, A.L., Slieker ten Hove, M.C.P.H., Vierhout, M.E. et al. Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction. Int Urogynecol J 16, 468–474 (2005). https://doi.org/10.1007/s00192-005-1292-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-005-1292-7

Keywords

  • Pelvic floor muscles
  • Pelvic floor dysfunction
  • Urine incontinence
  • Pelvic pain
  • Low back pain
  • Sacroiliac joint