Assessment of pubovisceral muscle defects and levator hiatal dimensions in women with faecal incontinence after vaginal delivery: is there a correlation with severity of symptoms?

Murad-Regadas, Sthela M.; Fernandes, Graziela Olívia da Silva; Regadas, Francisco Sérgio Pinheiro; Rodrigues, Lusmar Veras; Pereira, João R.; Dealcanfreitas, Iris Daiana; Filho, Francisco L. de Caldas

doi:10.1111/codi.12740

Cited by 21 publications

(19 citation statements)

References 28 publications

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“…We chose EDF combined with the endovaginal approach as the standard for comparison with TLUS because it has been standardized [5] in comparison with defecography, and validated in a multicenter study [20]. Previous studies have demonstrated the anatomy of the PVM and identified defects in patients who had a vaginal delivery, using 3D endovaginal ultrasound, as well as positive correlation between sphincter and/or PVM defect and the severity of the CCF incontinence score in females with FI [14]. Therefore, the techniques (EDF with of the patients of this study had a vaginal delivery and 7 (24%) had isolated or combined sphincter defects and/or PVM defects.…”

Section: Discussionmentioning

confidence: 99%

“…All patients who had a vaginal delivery underwent 3D endovaginal ultrasound to evaluate the anatomical integrity of the pubovisceral muscles (PVM) (including the puborectalis and pubococcygeus muscles) ( Fig. 2) or defects [13,14]. Patients were placed in the dorsal lithotomy position.…”

Section: Echodefecography Combined With the Endovaginal Approachmentioning

confidence: 99%

“…In 2004, Beer-Gabel et al [4] reported using dynamic transperineal ultrasound to evaluate pelvic floor dysfunctions and compared it with defecography, demonstrating a high degree of concordance, and a series of studies followed their lead [9][10][11][12]. The other dynamic ultrasound options, such as dynamic three-dimensional (3D) anorectal ultrasound [Echodefecography (EDF)] [5] combined with the endovaginal approach [13,14], have the advantage of making it easier to identify anatomical and dynamic pelvic floor abnormalities.…”

Section: Introductionmentioning

confidence: 99%

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Dynamic translabial ultrasound versus echodefecography combined with the endovaginal approach to assess pelvic floor dysfunctions: How effective are these techniques?

et al. 2017

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Both modalities can be used as a method to assess pelvic floor dysfunction. The EDF using 3D anorectal and endovaginal approaches showed advantages in identification of the anal sphincters and pubodefects (partial or total). There was good correlation between the two techniques, and a TLUS rectocele classification based on size that corresponds to the established classification using EDF was established.

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Section: Discussionmentioning

confidence: 99%

Section: Echodefecography Combined With the Endovaginal Approachmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dynamic translabial ultrasound versus echodefecography combined with the endovaginal approach to assess pelvic floor dysfunctions: How effective are these techniques?

et al. 2017

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“…It is capable of diagnosing occult sphincter defects, pelvic floor abnormal motion during straining, anismus, anorectocele, enterocele and anal/rectal prolapse. More recently, transvaginal scan was added to evaluate pubovisceral muscle injuries and urogenital hiatus measurement, as described below [37].…”

Section: D Eaus Dynamic Scan Ecodefecographymentioning

confidence: 99%

“…Recently, a transvaginal scanning has been added to the regular echodefecography exam, in order to address the pelvic floor muscle anatomy alongside the measurement of urogenital hiatus, mainly focusing on middle and posterior compartments [35][36][37].…”

Section: Pelvic Organ Prolapsementioning

confidence: 99%

The Role of Three-Dimensional Endoanal Ultrasound in Preoperative Evaluation of Anorectal Diseases

Coura¹

2018

Proctological Diseases in Surgical Practice

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Three-dimensional endoanal ultrasound (3D EAUS) has increased its application in coloproctology, both in pre-or in post-operative settings, since it provides more detailed information about anorectal anatomy and function. Perianal fistula complex, internal opening location and fistula tract relation with anal canal muscles are easily viewed on 3D EAUS. Moreover, hemorrhoidectomy, sphincterotomy and transanal rectal excisions hold potential in damaging anal sphincters and should be taken into account by the surgeon. Likewise, 3D EAUS has also a significant role in staging locoregional anal and rectal tumors with comparable accuracy to pelvic magnetic resonance imaging (MRI), particularly in regard to T staging in early lesions and tumor response after neoadjuvant therapy. Finally, patients with pelvic floor dysfunction or pelvic organ prolapse (POP) may benefit from 3D EAUS dynamic evaluation in order to rule out an occult sphincter defect or to unveil unsuspected anatomical multi-compartment dysfunction. Therefore, this review will address the current role of 3D EAUS as a valuable tool in modern colorectal surgical practice, highlighting its application in evaluating benign anorectal diseases, anal canal and rectal tumors and evacuation disorders, namely echodefecography.

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The association between levator plate integrity and pelvic floor defaecatory dysfunction

Hainsworth

Solanki

Ferrari

et al. 2023

Neurourology and Urodynamics

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Aims: Levator ani deficiency has been implicated in anterior pelvic floor pathology but its association with pelvic floor defaecatory dysfunction is less clear. The aim was to examine the relationship of levator ani deficiency with anatomical abnormalities (rectocoele, intussusception, enterocoele, perineal descent) and patient symptoms (bowel, vagina) in patients with pelvic floor defaecatory dysfunction. Methods: The prospective observational case series of 223 women presenting to a tertiary colorectal pelvic floor unit with defaecatory dysfunction. Each underwent assessment with symptom severity and quality of life (QoL) scores, integrated total pelvic floor ultrasound (PFUS) (transvaginal, transperineal) and defaecation proctography (DP). Rectocoele, intussusception, enterocoele and perineal descent were assessed on both. Levator ani deficiency was scored using endovaginal ultrasound (score 0-18; mild [0-6], moderate [>6-12], severe [>12-18]). Results:The proportion of patients with rectocoele, enterocoele, and intussusception increased with increasing levator ani damage (mild, moderate, severe). There was a weakly positive correlation between size of rectocoele and levator ani deficiency. On PFUS, there was a weakly positive correlation between severity of intussusception and enterocoele with levator ani deficiency. On DP, there was a weakly positive correlation between perineal descent and levator ani deficiency. There was no association between bowel symptom and QoL scores and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency. Conclusions: Anatomical abnormalities which are implicated in pelvic floor defaecatory dysfunction (rectocoele, intussusception, enterocoele, perineal descent) were associated with worsening levator ani deficiency. There was no association between bowel symptoms and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency.

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Assessment of pubovisceral muscle defects and levator hiatal dimensions in women with faecal incontinence after vaginal delivery: is there a correlation with severity of symptoms?

Cited by 21 publications

References 28 publications

Dynamic translabial ultrasound versus echodefecography combined with the endovaginal approach to assess pelvic floor dysfunctions: How effective are these techniques?

Dynamic translabial ultrasound versus echodefecography combined with the endovaginal approach to assess pelvic floor dysfunctions: How effective are these techniques?

The Role of Three-Dimensional Endoanal Ultrasound in Preoperative Evaluation of Anorectal Diseases

The association between levator plate integrity and pelvic floor defaecatory dysfunction

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