title: Levator hiatus dimensions and pelvic floor function in women with and without major defects of the pubovisceral muscle.
abstract: OBJECTIVE
  The aim of present study was to compare pelvic floor morphology and function in women with and without major defects of the pubovisceral muscle.
  
  
  METHODS
  One hundred fifty-seven women with pelvic organ prolapse participated in this cross-sectional study. Participants answered a symptom questionnaire and underwent clinical and three- and four-dimensional transperineal ultrasound examination. Pelvic floor muscle maximum voluntary contraction (MVC), endurance, and resting vaginal pressure were registered with a vaginal balloon catheter. Offline analyses were performed for the presence of major pubovisceral muscle defects (PVMD) and hiatal dimensions.
  
  
  RESULTS
  The levator hiatus dimensions at rest and contraction were significantly larger in women with than without major PVMD. Mean differences in levator hiatus area between women with and without major PVMD were: rest 1.9 cm(2) 95% confidence intervals (CI) 0.21-3.7, P = 0.028 and contraction 2.75 cm(2) 95% CI 1.0-4.5, P =0.002; and Valsalva maneuver mean difference was 0.82 cm(2) 95% CI 2.18-3.83, P = 0.543. Women with major PVMD had lower MVC and endurance measurements as compared with women without major PVMD, but the differences were not statistically significant.
  
  
  CONCLUSIONS
  Women with major pubovisceral muscle defects have larger hiatal dimensions at rest and at contraction than women without PVMD. We were unable to prove the corresponding relationship for hiatal dimensions on Valsalva.
authors.affiliation: Department of Obstetrics and Gynaecology, Akershus University Hospital, Post-Box 24, 1478, Lørenskog, Norway. memona.majida@medisin.uio.no
authors.forename: Memona
authors.initials: M
authors.lastname: Majida
authors.forename: Ingeborg H
authors.initials: IH
authors.lastname: Brækken
authors.forename: Kari
authors.initials: K
authors.lastname: Bø
authors.forename: Marie Ellström
authors.initials: ME
authors.lastname: Engh
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D015994:Incidence; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology*; D009664:Norway / Q000453:epidemiology; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000503:physiopathology*; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D010502:Perineum / Q000000981:diagnostic imaging; D011446:Prospective Studies; D015203:Reproducibility of Results; D014463:Ultrasonography; D014636:Valsalva Maneuver