{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T07:50:04Z","timestamp":1793692204414,"version":"4.5.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,8]],"date-time":"2022-08-08T00:00:00Z","timestamp":1659916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Previous studies mainly focused on the relationship between the size of the prolapse and injury to the supporting tissues, but the strain and stress distributions of the supporting tissues as well as high-risk areas of injury are still unknown. To further investigate the effect of supporting tissues on organs and the interactions between organs, this study focused on the relationship between high intra-abdominal pressure and the compliance of the pelvic floor support system in a normal woman without pelvic organ prolapse (POP), using a finite element model of the whole pelvic support system. A healthy female volunteer (55 years old) was scanned using magnetic resonance imaging (MRI) during rest and Valsalva maneuver. According to the pelvic structure contours traced by a gynecologist and anatomic details measured from dynamic MRI, a finite element model of the whole pelvic support system was established, including the uterus, vagina with cavity, cardinal and uterosacral ligaments, levator ani muscle, rectum, bladder, perineal body, pelvis, and obturator internus and coccygeal muscles. This model was imported into ANSYS software, and an implicit iterative method was employed to simulate the biomechanical response with increasing intra-abdominal pressure. Stress and strain distributions of the vaginal wall showed that the posterior wall was more stable than the anterior wall under high intra-abdominal pressure. Displacement at the top of the vagina was larger than that at the bottom, especially in the anterior\u2013posterior direction. These results imply potential injury areas with high intra-abdominal pressure in non-prolapsed women, and provide insight into clinical managements for the prevention and surgical repair plans of POP.<\/jats:p>","DOI":"10.3389\/fmed.2022.820016","type":"journal-article","created":{"date-parts":[[2022,8,8]],"date-time":"2022-08-08T07:08:08Z","timestamp":1659942488000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["Relationship between high intra-abdominal pressure and compliance of the pelvic floor support system in women without pelvic organ prolapse: A finite element analysis"],"prefix":"10.3389","volume":"9","author":[{"given":"Xiaode","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiguo","family":"Rong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianliu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.clinimag.2014.10.007","article-title":"Vaginal shape at resting pelvic MRI: predictor of pelvic floor weakness?","volume":"39","author":"Tillack","year":"2015","journal-title":"Clin Imaging."},{"key":"B2","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1136\/bmj.324.7348.1258","article-title":"Management of genital prolapse.","volume":"324","author":"Thakar","year":"2002","journal-title":"Br Med J."},{"key":"B3","first-page":"1111","article-title":"Pelvic organ prolapse.","volume":"81","author":"Kuncharapu","year":"2010","journal-title":"Am Fam Physic."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1016\/j.jbiomech.2009.04.043","article-title":"A 3D finite element model of anterior vaginal wall support to evaluate mechanisms underlying cystocele formation.","volume":"42","author":"Chen","year":"2009","journal-title":"J Biomech."},{"key":"B5","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1097\/01.aog.0000227786.69257.a8","article-title":"Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse.","volume":"108","author":"Chen","year":"2006","journal-title":"Obstetr Gynecol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1016\/j.jbiomech.2015.02.041","article-title":"A multi-compartment 3-D finite element model of rectocele and its interaction with cystocele.","volume":"48","author":"Luo","year":"2015","journal-title":"J Biomech."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/845985","article-title":"Three-dimensional modeling of the pelvic floor support systems of subjects with and without pelvic organ prolapse.","volume":"2015","author":"Ren","year":"2015","journal-title":"Biomed Res Int."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1016\/j.jbiomech.2015.02.056","article-title":"In vivo estimation of perineal body properties using ultrasound quasistatic elastography in nulliparous women.","volume":"48","author":"Chen","year":"2015","journal-title":"J Biomech."},{"key":"B9","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1080\/10255840903251270","article-title":"Experiments and finite element modelling for the study of prolapse in the pelvic floor system.","volume":"13","author":"Venugopala Rao","year":"2010","journal-title":"Comput Methods Biomech Biomed Engin."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1016\/j.jbiomech.2015.02.062","article-title":"Effects of fetal head shape variation on the second stage of labour.","volume":"48","author":"Yan","year":"2015","journal-title":"J Biomech."},{"key":"B11","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1080\/10255842.2010.482045","article-title":"An approach on determining the displacements of the pelvic floor during voluntary contraction using numerical simulation and MRI.","volume":"14","author":"Saleme","year":"2011","journal-title":"Comp Methods Biomech Biomed Engine."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1007\/s00192-010-1161-x","article-title":"Magnetic resonance imaging-based three-dimensional model of anterior vaginal wall position at rest and maximal strain in women with and without prolapse.","volume":"21","author":"Larson","year":"2010","journal-title":"Int Urogynecol J."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1067\/mob.2002.123819","article-title":"Pelvic organ prolapse in the women\u2019s health initiative: gravity and gravidity.","volume":"186","author":"Hendrix","year":"2002","journal-title":"Am J Obstetr Gynecol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1007\/s00192-013-2298-1","article-title":"Relationship between intra-abdominal pressure and vaginal wall movements during Valsalva in women with and without pelvic organ prolapse: technique development and early observations.","volume":"25","author":"Spahlinger","year":"2014","journal-title":"Int Urogynecol J."},{"key":"B15","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1007\/s00192-004-1196-y","article-title":"Paravaginal defects: prevalence and accuracy of preoperative detection.","volume":"15","author":"Segal","year":"2004","journal-title":"Int Urogynecol J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1016\/0002-9378(76)90751-1","article-title":"A new look at pelvic relaxation.","volume":"126","author":"Richardson","year":"1976","journal-title":"Am J Obstetr Gynecol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1007\/s00192-006-0079-9","article-title":"Cystocele\u2014vaginal approach to repairing paravaginal fascial defects.","volume":"17","author":"Viana","year":"2006","journal-title":"Int Urogynecol J Pelvic Floor Dysfunct."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1007\/s10439-016-1788-y","article-title":"Pubovisceralis muscle fiber architecture determination: comparison between biomechanical modeling and diffusion tensor imaging.","volume":"45","author":"Brand\u00e3o","year":"2017","journal-title":"Ann Biomed Engine."},{"key":"B19","doi-asserted-by":"publisher","first-page":".e1","DOI":"10.1016\/j.ajog.2008.07.057","article-title":"The internal innervation and morphology of the human female levator ani muscle.","volume":"199","author":"Shobeiri","year":"2008","journal-title":"Am J Obstetr Gynecol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.jmwh.2007.08.015","article-title":"It\u2019s not all about birth: biomechanics applied to pelvic organ prolapse prevention.","volume":"53","author":"O\u2019Dell","year":"2008","journal-title":"J Midwifery Women\u2019s Health."},{"key":"B21","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/S0889-8545(05)70039-5","article-title":"Epidemiology and natural history of pelvic floor dysfunction.","volume":"25","author":"Bump","year":"1998","journal-title":"Obstetr Gynecol Clin North Am."},{"key":"B22","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1080\/10255842.2017.1304542","article-title":"Biomechanical properties of the pelvic floor muscles of continent and incontinent women using an inverse finite element analysis.","volume":"20","author":"Silva","year":"2017","journal-title":"Comp Methods Biomech Biomed Engine."},{"key":"B23","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1016\/j.jbiomech.2014.11.039","article-title":"Female patient-specific finite element modeling of pelvic organ prolapse (POP).","volume":"48","author":"Chen","year":"2015","journal-title":"J Biomech."},{"key":"B24","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.jbiomech.2013.11.033","article-title":"Passive biomechanical properties of human cadaveric levator ani muscle at low strains.","volume":"47","author":"Nagle","year":"2014","journal-title":"J Biomech."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1016\/j.jbiomech.2012.04.001","article-title":"Dynamic material properties of the pregnant human uterus.","volume":"45","author":"Manoogian","year":"2012","journal-title":"J Biomech."},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1063\/1.1714811","article-title":"Biomechanical properties of human pelvic organs.","volume":"79","author":"Rubod","year":"2012","journal-title":"Urology."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.820016\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,8]],"date-time":"2022-08-08T07:08:10Z","timestamp":1659942490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.820016\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,8]]},"references-count":26,"alternative-id":["10.3389\/fmed.2022.820016"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.820016","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,8]]},"article-number":"820016"}}