Fecal incontinence in older women: are levator ani defects a factor?
OBJECTIVE
We sought to compare pelvic floor structure and function between older women with and without fecal incontinence (FI) and young continent (YC) women.


METHODS
YC (n=9) and older continent (OC) (n=9) women were compared to older women with FI (older incontinent [OI]) (n=8). Patients underwent a pelvic organ prolapse quantification, measurement of levator ani (LA) force at rest and with maximum contraction, and magnetic resonance imaging. Displacement of structures and LA defects were determined on dynamic magnetic resonance imaging.


RESULTS
LA defects were more common in the OI vs the YC (75% vs 11%, P=.01) and OC (22%, P=.14) groups; women with FI were more likely to have LA defects than women without (odds ratio, 14.0, 95% confidence interval, 1.8-106.5). OI women generated 27.0% and 30.1% less force during maximum contraction vs the OC (P=.13) and YC (P=.04) groups. During Kegel, OI absolute structural displacements were smaller than in the OC group (P=.01).


CONCLUSIONS
OI women commonly have LA defects, and cannot augment pelvic floor strength.
Lewicky-Gaupp
Christina
C
Division of Gynecology, Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA.
Brincat
Cynthia
C
Yousuf
Aisha
A
Patel
Divya A
DA
Delancey
John O L
JO
Fenner
Dee E
DE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000293:injuries*; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
Gut. 2002 Apr;50(4):480-4
11889066
Obstet Gynecol. 2005 Dec;106(6):1266-71
16319251
Radiology. 2008 Aug;248(2):518-30
18574134
Gut. 2005 Apr;54(4):546-55
15753542
Eur Radiol. 2008 Sep;18(9):1892-901
18389245
Obstet Gynecol. 1998 Mar;91(3):406-12
9491869
Obstet Gynecol. 2007 Feb;109(2 Pt 1):295-302
17267827
Am J Nurs. 2005 Jun;105(6):58-68; quiz 69
15930873
Am J Obstet Gynecol. 2005 Dec;193(6):2071-6
16325618
Obstet Gynecol. 2006 Jan;107(1):144-9
16394052
Gastroenterology. 2002 Nov;123(5):1441-50
12404218
Acta Obstet Gynecol Scand. 2006;85(12):1468-75
17260224
Int Urogynecol J Pelvic Floor Dysfunct. 2007 Jul;18(7):773-8
17043740
Am J Obstet Gynecol. 2006 May;194(5):1427-33
16579940
Am J Obstet Gynecol. 2009 May;200(5):559.e1-5
19136096
J Gastrointest Surg. 2004 Jan;8(1):73-82; discussion 82
14746838
Am J Obstet Gynecol. 2005 May;192(5):1637-42
15902170
Am J Obstet Gynecol. 2007 Nov;197(5):509.e1-6
17714680
Gastroenterology. 2004 Jan;126(1 Suppl 1):S3-7
14978632
Obstet Gynecol. 2007 Mar;109(3):715-20
17329525
Gastroenterology. 2004 Jan;126(1 Suppl 1):S14-22
14978634
J Magn Reson Imaging. 2001 Jun;13(6):923-9
11382954