Chronic pelvic pain and pelvic organ prolapse: a consequence of upright position?

Objective: The pathogenesis of chronic pelvic pain (CPP) is still incompletely understood. Generally accepted is, that soft tissue structures mutate with age, loose tension and by this can provoke CPP. This raises the question, of whether the bony pelvis underlies comparable age-dependent changes and if so, how this alteration has impact on the static anatomy of the pelvic floor and the suspension and supporting system. Materials and Methods: In order to answer this question we analysed the biological evolution of human beings and checked the historical literature regarding age-dependent static changes of the bony pelvis. Results: The vertical spine position is primarily due to an angulation of the lumbar spine against the sacrum causing a lordotic curve. The upright position of human beings forces the sacrum to curve, age dependent more and more. This leads to a descent of the promontorium causing a lifting of the coccyx and the pubic symphysis. This rotation causes a flatter pelvic floor. Conclusion: The age-dependent, now horizontal positioned pelvic floor provokes an unphysiological stretching on the soft-tissue-pelvic-floor structures causing and boosting a decompensation of the pelvic organ support and suspension system. Overstretched connective tissue, ligaments, nerves and muscles react with pain.