Impaired Function of the Levator Ani Muscle in the Grand Multipara and Great Grand Multipara

Abstract

Repeated deliveries might disturb the levator function and increase defecation disorders. In this prospective study, we determined the electric activity of the levator ani muscle (LAM) in nullipara, multipara, grand multipara, and great grand multipara (20 subjects for each group). Multiparity, grand multiparity, and great grand multiparity were defined as women having 2 -5, 6 -9, and 10 and over deliveries, respectively. The number of deliveries of multipara, grand multipara and great grand multipara were 4.05 ± 1.14 (2 -5), 7.55 ± 1.23 (6 -9) and 12.2 ± 2.16 (10 -17), respectively. All women were asked whether they had experienced constipation, fecal or urinary incontinence, and/or pelvic pain. All women were also evaluated for pelvic organ prolapse. Electromyography (EMG) of the LAM at rest and on contraction was recorded. EMG is an electrical recording of muscle activity. Constipation, incontinence and pelvic organ prolapse were encountered in multipara, grandmultipara and great grand multipara women. The LAM EMG at rest and on contraction in the nullipara was accepted as control. Both the resting and contractile activities of the LAM were as follows: nullipara > multipara > grand multipara > great grand multipara. These findings indicate that levator dysfunction and defecation disorders are increased with repeated deliveries because of pudendal and/or levator ani nerve injury and traumatic injury to the LAM occurred with the mechanical stresses of vaginal deliveries.

Transcatheter closure of aortic sinus to left atrial fistula caused by erosion of amplatzer septal occluder

“…The impact of childbirth and parity on bowel disorders is currently unclear. Both have been associated with AI and constipation in women,12 and, levator dysfunction and defecation disorders have been reported to increase with repeated deliveries 23. Other studies show no association between FI and parity 24…”

Chronic Female Pelvic Pain—Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region

“…Both layers are surrounded by fascia that is connected to the fascia surrounding the pelvic organs, thus lending to their support. Weakening of the levator ani muscles, as well as the support structures of the rectum, vagina, uterus, and the bladder, can lead to structural prolapse 38–40 …”

“…Weakening of the levator ani muscles, as well as the support structures of the rectum, vagina, uterus, and the bladder, can lead to structural prolapse. [38][39][40] The predisposition to prolapse appears to be multifactorial. Soderberg et al 41 reported a 30% lower collagen concentration in younger women with vaginal prolapse and an age-related decrease in collagen concentration in support structures.…”

Outcome of vaginal mesh reconstructive surgery in multiparous compared with grand multiparous women: Retrospective long-term follow-up

“…Each added vaginal delivery results in added trauma to the pelvic floor connective tissue and an increased degree of POP [6]. Higher parity women have extensive pelvic damage and will present with third- and fourth-degree POP when compared to lower parity counterparts [7–9]. …”