title: Prevalence of major levator abnormalities in symptomatic patients with an underactive pelvic floor contraction.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  An underactive pfmC is associated with increased prevalence of LAA and FI.
authors.affiliation: Department of Gynaecology and Gynaecooncology, Erasmus Medical Center, Rotterdam, The Netherlands. a.b.steensma@erasmusmc.nl
authors.forename: Anneke B
authors.initials: AB
authors.lastname: Steensma
authors.forename: Maja L
authors.initials: ML
authors.lastname: Konstantinovic
authors.forename: Curt W
authors.initials: CW
authors.lastname: Burger
authors.forename: Dirk
authors.initials: D
authors.lastname: de Ridder
authors.forename: Dirk
authors.initials: D
authors.lastname: Timmerman
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D009119:Muscle Contraction; D017773:Pelvic Floor / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D056887:Pelvic Organ Prolapse / Q000209:etiology / Q000503:physiopathology*; D015995:Prevalence; D012189:Retrospective Studies; D014463:Ultrasonography; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000503:physiopathology*; D055815:Young Adult