Aging effects on pelvic floor support: a pilot study comparing young versus older nulliparous women

Swenson, Carolyn W.; Masteling, Mariana; DeLancey, John O.L.; Nandikanti, Lahari; Schmidt, Payton; Chen, Luyun

doi:10.1007/s00192-019-04063-z

Cited by 32 publications

(20 citation statements)

References 32 publications

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“…Our understanding of the mechanical effects that result from LAM trauma, and why that is linked to the development of pelvic floor dysfunction (PFD), is at present poor. Recent advances in magnetic resonance imaging (MRI) have proved that knowledge of the pelvic floor muscles and connective tissue (CT) can help understanding the etiology of PFD 3,4 . MRI measurements and comparisons are possible because of the use of a standardized investigation technique.…”

Section: Introductionmentioning

confidence: 99%

Multilevel musculo‐fascial defect magnetic resonance study of female pelvic floor: retrospective case control study in women with pelvic floor dysfunction after the first vaginal delivery

Krčmář

Horcicka

Nemec

et al. 2022

Acta Obstet Gynecol Scand

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Introduction: Magnetic resonance imaging (MRI) provides a detailed display of the pelvic floor structures responsible for normal pelvic floor anatomy. The aim of the study is to assess the appearance of musculo-fascial defects in women with pelvic floor dysfunction following first vaginal delivery.Material and methods: Analysis of axial T3 (Tesla 3) MRI scans from a case control study of symptomatic (n = 149) and asymptomatic (n = 60) women after first vaginal delivery. Presence and severity of pelvic organ support and attachment system defects in three axial pelvic planes were assessed. Results:In the symptomatic group, major muscular defects were found in 67.1% (for pubovisceral muscle complex) and 87.9% (for iliococcygeal muscle). Only 6.7% of major pubovisceral and 35.0% of major iliococcygeal defects were identified in the controls (p = 0.000). Prolapse patients had an odds ratio (OR) of 22.1 (95% CI 8.94-54.67) to have major pubovisceral muscle complex defect and OR of 4.9 (95% CI 1.51-15.71) to have major iliococcygeal muscle defect. Fascial defects were found in 60.4% and 83.2% the symptomatic group, respectively. Those with prolapse had an OR of 29.1 (95% CI 9.77-86.31) to have facial defect at the level of pubovisceral muscle complex and an OR of 16.9 (95% CI 7.62-37.69) to have fascial defect at the level of iliococcygeal muscle. Uterosacral ligaments detachment was associated with prolapse with an OR of 10.1 (95% CI 4. 01-25.29). For the model based on combination on all MRI markers, the area under the receiver operating characteristic curve is 0.921. Conclusions:This study provides comprehensive data about first vaginal deliveryinduced changes in the levator ani muscle and endopelvic fascial attachment system.

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Section: Introductionmentioning

confidence: 99%

Multilevel musculo‐fascial defect magnetic resonance study of female pelvic floor: retrospective case control study in women with pelvic floor dysfunction after the first vaginal delivery

Krčmář

Horcicka

Nemec

et al. 2022

Acta Obstet Gynecol Scand

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“…However, changes in the spectral content of the sEMG signal can also be triggered by alterations of other factors [ 37 ]. Different authors have reported morphological changes in the female pelvic floor with ageing [ 55 , 56 , 57 ], including a significant transition of PFM shape from V-like to U-like. Alterations in PFM shape or morphology have also been found in the case of parity [ 58 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography

Albaladejo-Belmonte

Tarazona-Motes

Nohales-Alfonso

et al. 2021

Sensors

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Chronic pelvic pain (CPP) is a highly disabling disorder in women usually associated with hypertonic dysfunction of the pelvic floor musculature (PFM). The literature on the subject is not conclusive about the diagnostic potential of surface electromyography (sEMG), which could be due to poor signal characterization. In this study, we characterized the PFM activity of three groups of 24 subjects each: CPP patients with deep dyspareunia associated with a myofascial syndrome (CPP group), healthy women over 35 and/or parous (>35/P group, i.e., CPP counterparts) and under 35 and nulliparous (<35&NP). sEMG signals of the right and left PFM were recorded during contractions and relaxations. The signals were characterized by their root mean square (RMS), median frequency (MDF), Dimitrov index (DI), sample entropy (SampEn), and cross-correlation (CC). The PFM activity showed a higher power (>RMS), a predominance of low-frequency components (<MDF, >DI), greater complexity (>SampEn) and lower synchronization on the same side (<CC) in CPP patients, with more significant differences in the >35/P group. The same trend in differences was found between healthy women (<35&NP vs. >35/P) associated with aging and parity. These results show that sEMG can reveal alterations in PFM electrophysiology and provide clinicians with objective information for CPP diagnosis.

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“…Age is known to affect pelvic floor anatomy and functional symptoms [ 13 ]. Inherent differences in pelvic floor anatomy have been demonstrated in young versus older nulliparous women without any known or symptomatic prolapse [ 14 ]. A longitudinal Irish study of primiparous young women just 1 year after birth showed a 70% (142/202) prevalence of asymptomatic prolapse [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Anal canal to pubis angle: a novel clinical ultrasound technique for the assessment of the anorectal region

et al. 2021

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Introduction and hypothesis Posterior compartment prolapse is associated with severe morbidity including faecal incontinence and defaecation dysfunction. The aim of this study was to develop and validate a novel ultrasound marker (anal canal to pubis angle) for the assessment of the anal axis in the context of posterior compartment prolapse in women and in controls (healthy, nulliparous, non-pregnant volunteers). Methods Anal canal to pubis (AC/Pubis) angle is measured with 2D transperineal ultrasound in precisely the midsagittal plane. The image was inverted and zoomed out and the angle opened to 107° (maximum). The image includes the pubis, urethra and anal canal. The angle measurement starts from the anal canal, pivots on the anorectal junction and ends at the shadow of the pubis. Inter- and intra-observer agreement in AC/Pubis angle measurement was assessed and the angles measured in the two groups compared. Results Forty women with posterior prolapse and 17 controls were included. Close agreement was observed in inter- and intra-observer AC/Pubis angle measurements assessed with Bland-Altman analysis. AC/Pubis angle is significantly wider in prolapse patients compared to controls (t-test, p < 0.001), with mean AC/Pubis angle in prolapse patients 122.9° (SD 15.6°) and controls 98.2° (SD 15.9°). Conclusion The AC/Pubis angle is a novel validated 2D ultrasound technique for the assessment of the anorectal axis that potentially can be performed using equipment that is widely available in routine clinical practice. The AC/Pubis angle is significantly wider in prolapse patients compared to controls.

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Aging effects on pelvic floor support: a pilot study comparing young versus older nulliparous women

Cited by 32 publications

References 32 publications

Multilevel musculo‐fascial defect magnetic resonance study of female pelvic floor: retrospective case control study in women with pelvic floor dysfunction after the first vaginal delivery

Multilevel musculo‐fascial defect magnetic resonance study of female pelvic floor: retrospective case control study in women with pelvic floor dysfunction after the first vaginal delivery

Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography

Anal canal to pubis angle: a novel clinical ultrasound technique for the assessment of the anorectal region

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