Evaluating pelvic floor muscle contractility using two‐dimensional transperineal ultrasonography in patients with pelvic organ prolapse

Abstract

Aim The hiatal anterior‐posterior distance (APD), as measured by two‐dimensional (2D) transperineal ultrasonography, is an indicator of pelvic floor muscle (PFM) contractility. The function of the pelvic floor is independently related to pelvic organ prolapse (POP) severity. However, little evidence concerning the APD for patients with POP before and after PFM training (PFMT) has been published. Therefore, we analyzed 2D transperineal ultrasonography in women with POP. Methods Twenty‐eight women with POP completed a physiotherapist‐led PFMT regimen that consisted of 4 months of one‐on‐one PFMT and lifestyle advice. The APD was measured using 2D transperineal ultrasonography immediately before and after the PFMT period and used to calculate ΔAPD (APD at rest—APD during contraction). Vaginal squeeze pressure during maximum voluntary contractions was also assessed using a manometer. We then analyzed the reliability and the correlation between ΔAPD as measured using 2D transperineal ultrasonography and vaginal squeeze pressure before and after PFMT. Results The APD at rest and during PFM contractions demonstrated intraclass correlation coefficients (ICCs) of 0.89 and 0.88, respectively. The ICC of maximal vaginal squeeze pressure was 0.97 during PFM contractions. Both ΔAPD (P < 0.01) and PFM strength (P < 0.05) increased significantly after PFMT. PFM strength and ΔAPD were correlated before (R = 0.53) and after (R = 0.68) PFMT (P < 0.01). Conclusions We demonstrated that dynamic 2D transperineal ultrasonography could be used for studying functional changes in patients with POP. The ΔAPD of the levator hiatus has potential as an anatomical surrogate marker for evaluating PFM function in hospitals.

The correlation between transperineal ultrasound assessment of the levator ani muscle and postpartum urinary incontinence

“…The role of pelvic floor muscle training in the prevention and treatment of antenatal and postpartum UI remains a matter of debate. Whereas some studies have found a beneficial effect, others have failed to demonstrate it 26 . Further studies are necessary to better understand the influence of pelvic floor muscle training on postpartum UI prevention and treatment.…”

“…In the present study, we found that only women with SUI had a reduced pelvic floor muscle strength, as shown by a less reduction in LHA under contraction. This suggests that this subgroup may benefit more from pelvic floor training 26 . The role of pelvic floor muscle training in the prevention and treatment of antenatal and postpartum UI remains a matter of debate.…”

The Effect of Pelvic Floor Muscle Training on Pelvic Floor Dysfunction in Pregnant and Postpartum Women

“…The pelvic floor muscles can be protected if women perform the PFMT during pregnancy, and, it has a significant effect on preventing the injury of levator ani muscle. The size of the hiatus of levator ani muscle is related to the symptoms and signs of POP (Dietz et al 2008), so it can be used as an anatomical alternative indicator for evaluating PFM function (Ouchi et al 2019). The area of hiatus of levator ani muscle is bounded by pubic muscle, symphysis pubis and inferior branch of pubis.…”