Prevalence of major levator abnormalities in symptomatic patients with an underactive pelvic floor contraction

Abstract

Introduction and hypothesisMajor levator ani abnormalities (LAA) may lead to abnormal pelvic floor muscle contraction (pfmC) and secondarily to stress urinary incontinence (SUI), prolapse, or fecal incontinence (FI).MethodsA retrospective observational study included 352 symptomatic patients to determine prevalence of LAA in underactive pfmC and the relationship with symptoms. On 2D/3D transperineal ultrasound, PfmC was subjectively assessed as underactive (UpfmC) or normal (NpfmC) and quantified. LAA, defined as a complete avulsion of the pubic bone, was analyzed using tomographic ultrasound imaging.ResultsLAA were found in 53.8% of women with UpfmC versus 16.1% in NpfmC (P < 0.001). Patients with UpfmC were less likely to reduce hiatal area on pfmC (mean 7% reduction vs 25% in NpfmC (P < 0.001)). An UpfmC was associated with FI (P = 0.002), not with SUI or prolapse of the anterior and central compartment.ConclusionAn underactive pfmC is associated with increased prevalence of LAA and FI.

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

“…Previous studies in prolapse patients have revealed a reduced PFMS in women with LAM avulsion. 11,12 Moreover, supervised pelvic floor muscle training to increase PFMS in women with POP can improve severity of prolapse and reduce prolapse symptoms. 44 Postnatal hiatus area was significantly larger in women with major LAM avulsion (except at rest), compared with women without LAM avulsion.…”

“…7 A 2.4-2.9 fold increase of anatomical cystocele recurrence has been shown in women with LAM avulsion, although not all women were symptomatic. 8,9 In addition to POP, 5,6,10 women with LAM avulsion are at risk of a reduction in pelvic floor muscle strength (PFMS) [11][12][13] and an increased vaginal hiatus. [14][15][16] Although the literature is ambiguous, these anatomical changes may lead to symptoms of pelvic floor dysfunction (PFD).…”

Levator hiatus dimensions and pelvic floor function in women with and without major defects of the pubovisceral muscle

“…We have also shown a strong association between stage of POP and MVC, PFM endurance, and vaginal resting pressure [12]. When strength was subjectively assessed by palpation using the Oxford grading scale and 2D ultrasound images or, more objectively, using an instrumented vaginal speculum, women with intact muscle have been shown to have stronger PFM [21,24,26]. Hence our results may be explained by small sample size within the subgroups.…”

“…In the current study, the prevalence of major PVMD was 34%, which is similar to or somewhat higher than reported in studies where the study population was women seeking help for pelvic floor dysfunction (21-37%) [20,21]. The only way of determining the true rate of defects is to examine a sample of the normal population which, to our knowledge, remains to be done.…”

Alteration of anal sphincter function in patients with levator avulsion: observational study

“…The correlation of LAM injury with POP and risk of POP recurrence after surgery has been proven, but no association with FI or UI has been found [16,17,26]. Although for years it was thought that the LAM was fundamental to the anal continence mechanism, this is currently a controversial topic [2,17,27].…”