title: Assessment of pubovisceral muscle defects and levator hiatal dimensions in women with faecal incontinence after vaginal delivery: is there a correlation with severity of symptoms?
abstract: OBJECTIVE
  We assessed pubovisceral muscle (PVM) defects, levator hiatal dimensions and anal sphincter defects using three-dimensional (3D) endovaginal and anorectal ultrasonography in women with previous vaginal delivery and faecal incontinence to determine the relationship between anatomic/functional findings and severity of faecal incontinence symptoms.
  
  
  METHODS
  This was a prospective, observational study including 52 women with faecal incontinence symptoms who had undergone vaginal delivery. Asymptomatic nulliparous women (n = 17) served as controls to provide reference values for pelvic floor measurements. All participants underwent 3D endovaginal and anorectal ultrasonography. We used an ultrasound score to identify and quantify the extent of PVM defects and sphincter damage and to measure levator hiatal dimensions. Incontinence was assessed using the Cleveland Clinic Florida Incontinence Scoring System.
  
  
  RESULTS
  Defects of the PVM were identified with 3D endovaginal ultrasonography in 27% of women with faecal incontinence who had undergone vaginal delivery. The incontinence score and the ultrasound score were significantly higher in women with a PVM defect. A significant, positive correlation was found between the incontinence score and the ultrasound score. The levator hiatal dimensions were significantly greater, and the positions of the anorectal junction and bladder neck were lower, in women who had undergone vaginal delivery than in nulliparous women.
  
  
  CONCLUSIONS
  As determined by the 3D ultrasound score, severity of incontinence is related to the extent of damage of the PVM, as well as of the anal sphincters. Additionally, vaginal delivery results in enlargement of the levator hiatus and a lower position of the anorectal junction and bladder neck compared with nulliparous women.
authors.affiliation: Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Anorectal Physiology and Pelvic Floor Dysfunctions, Clinical Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: S M
authors.initials: SM
authors.lastname: Murad-Regadas
authors.forename: G O da S
authors.initials: GO
authors.lastname: Fernandes
authors.forename: F S P
authors.initials: FS
authors.lastname: Regadas
authors.forename: L V
authors.initials: LV
authors.lastname: Rodrigues
authors.forename: J de J R
authors.initials: Jde J
authors.lastname: Pereira
authors.forename: I D
authors.initials: ID
authors.lastname: Dealcanfreitas
authors.forename: F S P
authors.initials: FS
authors.lastname: Regadas Filho
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D036861:Delivery, Obstetric / Q000009:adverse effects*; D019160:Endosonography; D005242:Fecal Incontinence / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: Pelvic floor; anatomy; faecal incontinence; physiology; ultrasound