title: Mean echogenicity and area of puborectalis muscle in women with stress urinary incontinence during pregnancy and after delivery.
abstract: OBJECTIVE
  Pregnancy and childbirth are risk factors for the development of stress urinary incontinence (SUI). Urinary continence depends on normal urethral support, which is provided by normal levator ani muscle function. Our objective was to compare mean echogenicity and the area of the puborectalis muscle between women with and those without SUI during and after their first pregnancy.
  
  
  METHODS
  We examined 280 nulliparous women at a gestational age of 12 weeks, 36 weeks, and 6 months after delivery. They filled out the validated Urogenital Distress Inventory and underwent perineal ultrasounds. SUI was considered present if the woman answered positively to the question "do you experience urine leakage related to physical activity, coughing, or sneezing?" Mean echogenicity of the puborectalis muscle (MEP) and puborectalis muscle area (PMA) were calculated. The MEP and PMA during pregnancy and after delivery in women with and without SUI were compared using independent Student's t test.
  
  
  RESULTS
  After delivery the MEP was higher in women with SUI if the pelvic floor was at rest or in contraction, with effect sizes of 0.30 and 0.31 respectively. No difference was found in the area of the puborectalis muscle between women with and those without SUI.
  
  
  CONCLUSIONS
  Women with SUI after delivery had a statistically significant higher mean echogenicity of the puborectalis muscle compared with non-SUI women when the pelvic floor was at rest and in contraction; the effect sizes were small. This higher MEP is indicative of a relatively higher intramuscular extracellular matrix component and could represent diminished contractile function.
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100 Huispostnummer F05.126, 3584 CX, Utrecht, The Netherlands. M.K.vandeWaarsenburg@umcutrecht.nl.
authors.forename: Maria K
authors.initials: MK
authors.lastname: van de Waarsenburg
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100 Huispostnummer F05.126, 3584 CX, Utrecht, The Netherlands.
authors.forename: Mariëlla I J
authors.initials: MI
authors.lastname: Withagen
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100 Huispostnummer F05.126, 3584 CX, Utrecht, The Netherlands.|MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands.
authors.forename: Anique T M
authors.initials: AT
authors.lastname: Grob
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100 Huispostnummer F05.126, 3584 CX, Utrecht, The Netherlands.
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: Schweitzer
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100 Huispostnummer F05.126, 3584 CX, Utrecht, The Netherlands.
authors.forename: Greetje A
authors.initials: GA
authors.lastname: van Veelen
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100 Huispostnummer F05.126, 3584 CX, Utrecht, The Netherlands.
authors.forename: Carl H
authors.initials: CH
authors.lastname: van der Vaart
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D005865:Gestational Age; D006801:Humans; D009119:Muscle Contraction; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000503:physiopathology*; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D014521:Urethra / Q000503:physiopathology; D001743:Urinary Bladder / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology*
keywords: 3D/4D; Echogenicity; Muscle area; Perineal ultrasound; Stress urinary incontinence