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. 2022 Apr-Jun;46(2):100-108.
doi: 10.1097/jwh.0000000000000224.

Pelvic Floor Mobility measured by Transperineal Ultrasound Imaging in Women with and without Urgency and Frequency Predominant Lower Urinary Tract Symptoms

Stefanie N Foster  1 , Theresa M Spitznagle  1   2 , Lori J Tuttle  3 , Jerry L Lowder  2   4 , Siobhan Sutcliffe  5   2 , Karen Steger-May  6 , Chiara Ghetti  2   4 , Jinli Wang  6 , Taylor Burlis  1 , Melanie R Meister  2   4 , Michael J Mueller  1   7 , Marcie Harris-Hayes  1   8
Affiliations

Pelvic Floor Mobility measured by Transperineal Ultrasound Imaging in Women with and without Urgency and Frequency Predominant Lower Urinary Tract Symptoms

Stefanie N Foster et al. J Womens Health Phys Therap. 2022 Apr-Jun.

Abstract

Background: Women with urgency/frequency predominant lower urinary tract symptoms (UF-LUTS) may have elevated pelvic floor muscle (PFM) position at rest and limited mobility with PFM contraction and bearing down, but this has not been quantified.

Objectives: To compare PFM position and mobility using transperineal ultrasound (TPUS) at rest, maximal PFM contraction (perineal elevation), and bearing down (perineal descent) in women with and without UF-LUTS. We hypothesized that women with UF-LUTS would demonstrate elevated resting position and decreased excursion of pelvic landmarks during contraction and bearing down as compared to women without UF-LUTS.

Study design: Case-control study.

Methods: Women with UF-LUTS were matched 1:1 on age, body mass index and vaginal parity to women without UF-LUTS. TPUS videos were obtained during 3 conditions: rest, PFM contraction, and bearing down. Levator plate angle (LPA) and puborectalis length (PR length), were measured for each condition. Paired t-tests or Wilcoxon signed rank tests compared LPA and PR length between cases and controls.

Results: 21 case-control pairs (42 women): Women with UF-LUTS demonstrated greater LPA at rest (66.8 ± 13.2 degrees vs 54.9 ± 9.8 degrees; P=0.006), and less PR lengthening from rest to bearing down (0.2 ± 3.1 mm vs 2.1 ± 2.9 mm; P=.03).

Conclusion: Women with UF-LUTS demonstrated more elevated (cranioventral) position of the PFM at rest and less PR muscle lengthening with bearing down. These findings highlight the importance of a comprehensive PFM examination and possible treatment for women with UF-LUTS to include PFM position and mobility.

Keywords: Female Urogenital Diseases; case-control study; pelvic floor muscle; puborectalis; urinary frequency; urinary urgency.

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Figures

FIGURE 1
FIGURE 1
Transperineal Ultrasound Midsagittal View and Measurements PS, pubic symphysis; U, urethra; V, vagina; REF, horizontal reference line perpendicular to sound head; LPA, levator plate angle; B, bladder; PR, puborectalis length; A, anus; R, rectum
See this image and copyright information in PMC

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