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

Abstract

Introduction and hypothesis: Major 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).

Methods: A 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.

Results: LAA 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.

Conclusion: An underactive pfmC is associated with increased prevalence of LAA and FI.

Fig. 1

Antero-posterior measurements in 2D at the level of minimal hiatal dimension in rest position (left panel) and during contraction (right panel)

Fig. 2

Antero-posterior, transverse LR and hiatal area measurements in 3D at the level of the minimal hiatal dimension in rest position (left panel) and during contraction (right panel)

Fig. 3

Tomographic ultrasound imaging (TUI) imaging of the levator hiatus with an obvious unilateral defect on the right side (TUI score 8 for the right and 0 for left)