Prevalence of major levator abnormalities in symptomatic patients with an underactive pelvic floor contraction.
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.
Steensma
Anneke B
AB
Department of Gynaecology and Gynaecooncology, Erasmus Medical Center, Rotterdam, The Netherlands. a.b.steensma@erasmusmc.nl
Konstantinovic
Maja L
ML
Burger
Curt W
CW
de Ridder
Dirk
D
Timmerman
Dirk
D
Deprest
Jan
J
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