Fecal incontinence in older women: are levator ani defects a factor?

Lewicky-Gaupp, Christina; Brincat, Cynthia; Yousuf, Aisha; Patel, Divya; DeLancey, John O.L.; Fenner, Dee E.

doi:10.1016/j.ajog.2010.01.020

Cited by 51 publications

(36 citation statements)

References 22 publications

(28 reference statements)

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“…As shown previously we expected women with major avulsions to report more faecal incontinence, as the incidence of OASIS was higher (n = 8/30) (K. W. M. Van Delft, R. Thakar, A. H. Sultan, N. Schwertner-Tiepelmann, K. B. Kluivers [accepted]. Although two studies among older women showed an association between faecal incontinence and LAM avulsion, 17,19 another study in a tertiary referral centre showed the opposite. 20 The incidence of urinary incontinence prior to childbirth can be explained by the physiological changes that occur during pregnancy and the load of the gravid uterus predisposing women to urinary incontinence.…”

Section: Discussionmentioning

confidence: 92%

“…Although the relationship between LAM avulsion and faecal [17][18][19][20] and urinary incontinence [21][22][23][24][25] has been evaluated, sexual function has not been studied in relation to LAM avulsion. We are not aware of a study in the literature that has utilised validated methods for objective and subjective assessment of PFD in relation to LAM avulsion before and after childbirth.…”

Section: Introductionmentioning

confidence: 99%

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The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

Delft

Sultan

Thakar

et al. 2014

BJOG

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Objective To establish the relationship between postpartum levator ani muscle (LAM) avulsion and signs and/or symptoms of pelvic floor dysfunction (PFD).Design Observational longitudinal cohort study.Setting District General University Hospital, UK.Population or sample Primigravida at 36 weeks' gestation and 3 months postpartum.Methods Pelvic floor muscle strength (PFMS) and pelvic organ prolapse were assessed clinically using validated methods. Transperineal ultrasound was performed to identify LAM avulsion and measure hiatus dimensions. Validated questionnaires evaluated sexual function, urinary and faecal incontinence.Main outcome measures PFD signs and symptoms related to LAM avulsion.Results Two hundred and sixty nine primigravida without LAM avulsion participated and 71% (n = 191) returned postpartum. LAM avulsion was found in 21% of vaginal deliveries (n = 30, 95%CI 15.1-28.4%). Women with minor and major avulsion had worse PFMS (P < 0.038) and more anterior compartment prolapse (maximum stage 2; P < 0.024). Antenatal hiatus antero-posterior diameter on ultrasound was significantly smaller in women sustaining avulsion (P = 0.011). Postnatal measurements were significantly increased following avulsion. Women with major avulsion were less sexually active at both antenatal and postnatal periods (P < 0.030). These women had more postnatal urinary incontinence and symptoms such as reduced vaginal sensation and 'too loose vagina'. No postnatal differences were found for faecal incontinence, prolapse symptoms or quality of life. The correlation of differences in variables was only slight-fair with avulsion severity.Conclusions Twenty one percent of women sustain LAM avulsion during their first vaginal delivery with significant impact on signs and symptoms of PFD. As avulsion has been described as the missing link in the development of prolapse; longer term follow-up is vital.Keywords Childbirth, incontinence, levator ani avulsion, pelvic floor dysfunction, pelvic organ prolapse, transperineal ultrasound.Please cite this paper as: van Delft K, Sultan AH, Thakar R, Schwertner-Tiepelmann N, Kluivers K. The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

Delft

Sultan

Thakar

et al. 2014

BJOG

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“…On MRI, images are assessed for significant asymmetry, in the morphology of the right and left sides of the muscle in an individual patient, and excessive ballooning [78]. Larger genital hiatus and a greater fixed and dynamic perineal descent are seen in patients with abnormal levator muscle [79,80]. In addition, major muscle loss can be seen in combination with external anal sphincter injury on MRI in postpartum patients [61].…”

Section: Pelvic Floor Integritymentioning

confidence: 99%

ACR Appropriateness Criteria Pelvic Floor Dysfunction

Pannu

Javitt

Glanc

et al. 2015

Journal of the American College of Radiology

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“…44,45 Although there is variability in the appearance of the pelvic support structures even in asymptomatic nulliparous women, 46 significant differences in levator muscle volume, shape, and integrity have been shown between asymptomatic individuals and those with incontinence and pelvic prolapse. 47 The levator muscles should be assessed for areas of asymmetric thickening or atrophy (Fig.…”

Section: Anatomic Evaluationmentioning

confidence: 99%

Magnetic Resonance Imaging of Pelvic Floor Disorders

Khatri¹

2014

Topics in Magnetic Resonance Imaging

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Physical examination alone is often inadequate for evaluation of pelvic floor dysfunction. Magnetic resonance imaging (MRI) is a robust modality that can provide high-quality anatomic and functional evaluation of the pelvic floor. Although lack of standardized technique and radiologist inexperience may be relative deterrents in universal acceptance of pelvic floor MRI, the role of MRI is increasing as it is technically feasible on most magnets and offers some advantages over the traditional fluoroscopic defecography. This review focuses on the technical and interpretational aspects of anatomic and functional pelvic floor MRI.

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Fecal incontinence in older women: are levator ani defects a factor?

Cited by 51 publications

References 22 publications

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

ACR Appropriateness Criteria Pelvic Floor Dysfunction

Magnetic Resonance Imaging of Pelvic Floor Disorders

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