title: Sonographic predictors of obstructive defecatory dysfunction.
abstract: OBJECTIVE
  We aimed to evaluate the association between obstructive defecatory symptoms in women with levator ani deficiency (LAD), worsened minimum levator hiatus measurements, widened anorectal angle (ARA), and increased levator-plate descent angle (LPDA).
  
  
  METHODS
  Using a cross-sectional study design, patients who had undergone 3D endovaginal ultrasound (3D EVUS) imaging of the pelvic floor were sampled and categorized into two groups: those with and those without obstructive defecatory symptoms (ODS) based on their Colorectal and Anal Distress Index (CRADI-8) questionnaire. The levator ani (LA) muscle was scored based on severity of defect. ARA and LPDA were measured and dichotomized (ARA ± 170°; LPDA ± 9°.
  
  
  RESULTS
  One hundred patients were analyzed: 52 asymptomatic and 48 with ODS. The mean (standard deviation ) age was 59 years (SD ±14.97). There was no difference in the distribution of LAD severity between groups (p = 0.1438) or mean minimal levator hiatus (MLH) (p = 0.3326). ARA and LPDA were significantly different in those with ODS compared with their asymptomatic counterparts (p < 0.0001 and 0.0004, respectively) (Table 1). On multivariable logistic regression, ARA and LPDA were included in the final model. Patients with an ARA >170° had seven times the odds of ODS than those with ARA ≤170° [odds ratio (OR) = 7.01, 95 % confidence interval (CI) 2.30-21.35; p = 0.0006). Patients with an LPDA <9° had 3 times the odds of ODS than those with an LPDA ≥9° (OR = 3.30, 95 % CI 1.22, 8.96, p = 0.0190).
  
  
  CONCLUSIONS
  This study demonstrates that increased levator plate descent and widened ARA as measured on 3D endovaginal ultrasound imaging are associated with ODS.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, P.O. Box 26901, WP2410, Oklahoma City, OK, 73190, USA, dena-oleary@ouhsc.edu.
authors.forename: D
authors.initials: D
authors.lastname: O'Leary
authors.forename: G
authors.initials: G
authors.lastname: Rostaminia
authors.forename: L H
authors.initials: LH
authors.lastname: Quiroz
authors.forename: S A
authors.initials: SA
authors.lastname: Shobeiri
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging; D003248:Constipation / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D019160:Endosonography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012007:Rectum / Q000000981:diagnostic imaging; D011795:Surveys and Questionnaires