Perineal descent predicted by a pelvic bone factor: the pelvic incidence angle.
OBJECTIVE
By measuring the pelvic incidence angle, we assessed the relationship between pelvic floor disorders and pelvic morphology, which allowed us to document for the first time the hypothesis that pelvic incidence may be a predictive factor of perineal descent.


METHODS
In a retrospective study of 197 women, the perineal descent at rest and during straining was assessed by defecography. The pelvic incidence angle (53 degrees +/- 9 degrees , independent of the subject position) was defined as the angle between the line perpendicular to the sacral plate at its midpoint and the line connecting this point to the middle of the femoral heads axis. The pelvic incidence angle was correlated with the incidence of pelvic floor descent.


RESULTS
In those with pelvic floor descent at rest compared with those without, pelvic incidence angle was significantly larger (64 degrees vs. 53 degrees , P < 10E-06). As a predictive factor of perineal descent at rest, a great pelvic incidence (>62 degrees ) had a sensitivity (73 percent), specificity (82 percent), positive predictive value (81 percent), and negative predictive value (75 percent).


CONCLUSIONS
A large pelvic incidence (>62 degrees ) may be a predictive factor of perineal descent at rest before the apparition of other acquired factors. With pelvic incidence >62 degrees , a large overhang between the insertions increases the strains on the perineum, which is rather horizontal.
Boulay
Christophe
C
Département de Médecine Physique et de Réadaptation, Nîmes, France. c.boulay@libertysurf.fr
Prudhomme
Michel
M
Prat-Pradal
Dominique
D
Pouderoux
Philippe
P
Duval-Beaupère
Ginette
G
Pélissier
Jacques
J
D002675:Child, Preschool; D003672:Defecation; D019841:Defecography; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging*; D017773:Pelvic Floor / Q000503:physiopathology*; D010502:Perineum / Q000503:physiopathology*