title: Fecal incontinence in older women: are levator ani defects a factor?
abstract: 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.
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Lewicky-Gaupp
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brincat
authors.forename: Aisha
authors.initials: A
authors.lastname: Yousuf
authors.forename: Divya A
authors.initials: DA
authors.lastname: Patel
authors.forename: John O L
authors.initials: JO
authors.lastname: Delancey
authors.forename: Dee E
authors.initials: DE
authors.lastname: Fenner
mesh_terms: 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
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