Levator Ani Function Research Articles

Association between 2D trans-perineal ultrasound and physical examination in evaluation of ani function.

To compare the correlation between 2D transperineal ultrasonography and physical examination (intravaginal palpation) for assessing pelvic floor and levator ani function. Due to symptoms of pelvic floor disorder, 40 women between the ages of 29 and 75 were enrolled in this study as candidates for urodynamic and structural evaluation of the pelvic floor. A pelvic floor gynaecologist and radiologist assessed the levator ani function via physical examination (graded based on the Oxford Grading System) and transperineal 2D ultrasound, respectively. The ultrasound parameters for calculating the Levator Ani Index (LAI) demonstrate a difference between the anteroposterior dimension of the levator hiatus (r = 0.691, p < 0.001) and the cranial shift of muscle (r = 0.499, p < 0.001) at rest and during a squeezing manoeuvre in the mid-sagittal plane. Reduced anteroposterior diameter of the hiatus and increased cranial shift were associated with a higher Oxford Physical Examination Score (OPES). The association between LAI and OPES was independent of baseline variables such as age, BMI, number of births, and the presence of incontinence symptoms. Measures such as the LAI can be used to quantify the function of the levator ani muscle, which may be useful for evaluating the efficacy of pelvic floor physiotherapy and exercise.

Explorations fonctionnelles avant chirurgie du prolapsus génital (bilan urodynamique, IRM dynamique)

The evaluation of genital prolapse is essentially clinical; however imaging tests such as dynamic MRI or urodynamic explorations may be useful in complex cases, especially before surgical management. Dynamic MRI allows morphological and dynamic analysis of pelvic floor and levator ani function. It can also detect post-obstetric injuries, although the long-term significance of these injuries remains to be discovered. Quantification of the severity of prolapse is possible with MRI; however, the correlation of these measures with clinical examination seems poor. Its interest lies mainly in the qualitative assessment of the three stages of prolapse and the detection of elytroceles, which can be difficult to clinical examination. Urodynamics provides useful information on vesico-sphincteric function, but none of these parameters seems to be decisive in the management of prolapse.

Is Bariatric Surgery a Prophylaxis for Pelvic Floor Disorders?

IntroductionObesity is one of the well-documented risk factors of pelvic floor disorders (PFDs). The PFDs include urinary and fecal incontinence (UI, FI) and pelvic organ prolapse (POP). Surgery-induced weight loss improves different kinds of incontinence as well as POP symptoms. However, there is a lack of evidence how bariatric surgery influences pelvic floor anatomy and function in women without previous PFDs and whether it may be concerned as PFD prophylaxis tool.Materials and MethodsThe present analysis is a prospective, non-randomized case-control study from January 2014 to September 2017. Participants underwent pelvic floor ultrasound examination with bladder neck position estimation at rest, during levator ani tension, and at Valsalva maneuver before surgery and 12–18 months after. Pelvic organ prolapse quantification (POPQ) > 2 stage and PFD complaints were the exclusion criteria.ResultsFifty-nine patients underwent bariatric surgery (57 sleeve gastrectomy and 2 gastric bypass). Mean BMI decreased from 43.8 ± 5.9 to 29 ± 4.6 kg/m2 after surgery (p < 0.001). Statistically significant higher position of the bladder neck at rest, during tension, and at Valsalva maneuver (p < 0.05) was shown after surgery. We did not demonstrate differences in bladder neck mobility and bladder neck elevation at tension after weight loss.ConclusionsBariatric surgery is associated with a betterment of bladder neck position at rest, tension, and Valsalva maneuver in women without PFDs. We postulate that bariatric surgery may be a tool for PFD prevention. It does not improve levator ani function and does not limit bladder neck mobility, which implicates that it has no influence on preexisting pelvic dysfunction.

Pelvic floor dysfunction—Does menopause duration matter?

ObjectiveTo explore the effect of menopause and hormone replacement therapy on pelvic organ prolapse and pelvic floor muscle function. MethodsThe records of patients who attended a tertiary urogynaecological center were reviewed retrospectively. A standardised interview included menopausal age, i.e. years since last period or onset of menopausal symptoms, current or previous hormone use. The clinical examination included prolapse assessment (POP-Q) and palpation of the levator ani muscle. 4D transperineal ultrasound, supine and after voiding, was performed in all patients. Volume data sets were analysed for pelvic organ descent and measures of contractility and distensibility of the pelvic floor at a later date, blinded to all clinical data. ResultsOf 311 women seen during the inclusion period, 65% were postmenopausal. Current systemic or local hormone use was reported by 7% and 6%, respectively. 163 women (52%) reported prolapse symptoms with a mean bother of 5.7/10. Significant pelvic organ prolapse was found on clinical examination (POP-Q stage≥2) in 77%, and diagnosed on ultrasound in 61%. On multivariate analysis, controlling for calendaric age, parity and levator avulsion, there was no evidence for menopausal age as an independent predictor of any symptom and sign of pelvic organ prolapse and pelvic floor muscle function. Local oestrogen use and past or present hormone replacement therapy had no detectable effect on any pelvic floor parameter. ConclusionsHormone deficiency following menopause is unlikely to play a major role in pelvic organ support and levator ani function. Hence, both do not appear to be substantially influenced by local or systemic hormone replacement therapy.

Assessment of levator ani morphology and function in asymptomatic nulliparous women via static and dynamic magnetic resonance imaging

ObjectiveTo evaluate levator ani morphology and function in healthy nulliparous women using static and dynamic magnetic resonance imaging. MethodsEighty asymptomatic, healthy nulliparous Chinese women (mean age, 25.3±3.5years) volunteered for the present study. Static T2-weighted fast spin-echo images were employed to evaluate levator ani morphology; dynamic T2-weighted fast imaging employing steady-state acquisition was used to evaluate its function. A 2 samples t test was employed to compare groups. ResultsNo morphologic abnormality was detected in the 80 healthy nulliparous women. However, 15% (12/80) of women had various degrees of pelvic organ descent below the pubococcygeal line. In these women, the width of the pubic portion of the levator ani was significantly reduced during straining, whereas the levator plate angle, the levator hiatus area, and the H and M line lengths were enlarged. These changes were associated with weakened levator ani function and pelvic floor laxity. ConclusionFunctional abnormality of the levator ani muscle was noted in nulliparous women at static and dynamic magnetic resonance imaging. Further follow-up investigation is needed to confirm whether women with functional abnormality are more likely to develop a prolapse after vaginal birth.

A prospective study evaluating emotional disturbance in subjects undergoing defecating proctography

To investigate the prevalence of psychiatric illness in association with functional gastrointestinal disorders using defecating proctography (DP) and validated questionnaires. We prospectively evaluated 45 subjects referred for DP using hospital anxiety and depression scale (HADS), state trait anxiety inventory (STAI), patient health questionnaire 15-item somatic symptom severity scale (PHQ-15), validated questionnaires for sexual or physical abuse; post-traumatic stress disorder questionnaire (PTSD) and ROME-III questionnaires for gastrointestinal complaints. DP results were considered negative if levator ani function was normal, rectoceles (if any) were < 4 cm and there was no evidence of intussusception, rectal prolapse, or other anatomic abnormality demonstrated. Subjects were subsequently divided into those with structural defects seen on DP (DP positive group) and those with a normal defecography study (DP negative group). Forty five subjects were included in the study of which 20 subjects were classified as DP negative (44.4%). There was a striking prevalence of a history of sexual abuse in DP negative group compared to the DP positive group (n = 9, 5 respectively; P = 0.036). Further, subjects in the DP negative group scored significantly higher on the HADS anxiety (6.60 ± 1.00 vs 4.72 ± 0.40, P = 0.04) and depression scales (5.72 ± 1.00 vs 3.25 ± 0.46, P = 0.01). This correlated well with significantly higher scores on the STAI state anxiety scale (42.75 ± 3.16 vs 35.6 ± 2.00, P = 0.027), PHQ-15 questionnaire (13.15 ± 0.82 vs 10.76 ± 0.97, P = 0.038) and prevalence of PTSD (20% vs 4%, P = 0.045) among DP negative subjects. There was no difference between the groups in terms of STAI trait anxiety. The findings of this prospective study demonstrate a significantly high degree of psychiatric ailments in patients with negative findings on DP who should be appropriately screened for a history of sexual abuse and symptoms of psychosocial distress.

Rehabilitative Ultrasound Imaging of Pelvic Floor Muscle Function

This commentary provides an overview of the current concepts and evidence related to rehabilitative ultrasound imaging of pelvic floor (levator ani) function. As this is an emerging topic, the goal is to provide a basic understanding of ultrasound imaging applications related to levator ani function: the available quantitative and qualitative information, the limitations, as well as how ultrasound imaging can be incorporated as a form of biofeedback during rehabilitation. Furthermore, as the ability to compile and compare existing evidence depends on the degree of similarity in methodology by investigators, this commentary highlights points of consideration and provides guidelines, as well as an agenda, for future investigation.

Indices for studying urinary incontinence and levator ani function in primiparous women.

Urinary incontinence (UI) is a complex phenomenon that is prevalent in pregnant and parous women and requires the use of sophisticated measures to adequately reflect functioning of the continence system. The purpose of this study was to develop reliable and valid measures of UI and levator ani function for use in research and clinical settings. A Leakage Index (LI) and a Levator Ani Function Index (LAFI) were developed using data from a longitudinal study of primiparous women. Reliability and validity tests were conducted to: (i) estimate the internal consistency reliability of each index, (ii) determine whether the indices captured change in continence status and pelvic floor function during pregnancy through 1 year postpartum, and (iii) estimate association between the indices as a test of predictive validity. Cronbach's alpha ranged from 0.72 to 0.84 for the LI and from 0.53 to 0.79 for the LAFI across the six data collection time points of the study. Average LI scores increased late in pregnancy and decreased postpartum, though not significantly. Average LAFI scores decreased significantly at 35 weeks gestation (t = 4.84, P = 0.000) and increased significantly at 12 months postpartum (t = -3.51, P = 0.002) relative to baseline. The LI and LAFI were significantly associated at 20 weeks gestation (Pearson r = -0.40, P = 0.007) and at 6 weeks postpartum (Pearson r = -0.33, P = 0.029). The findings suggest the LI and LAFI are reliable and valid measures of UI and levator ani function in primiparous women, which can be used with confidence in clinical and research settings.

Pelvic floor's response to childbirth under investigotion: Pcschers UM, Schaer GN, DeLancey JOL, Schuessler B. Levator ani function before and after childbirth. Br J Obstet Gynaecol 1997;104:1004–8

Pelvic floor's response to childbirth under investigotion: Pcschers UM, Schaer GN, DeLancey JOL, Schuessler B. Levator ani function before and after childbirth. Br J Obstet Gynaecol 1997;104:1004–8

Levator Ani Function Before and After Childbirth

Objective To evaluate pelvic floor muscle strength before and after vaginal birth. Design Prospective repeated measures study. Setting Main district hospital. Population Fifty-five women: 25 primiparae and 20 multiparae following vaginal birth, and 10 women following elective caesarean delivery as a control group. Methods Pelvic muscle strength was evaluated by palpation, perineometry and perineal ultrasound before childbirth in the 36th to 42nd week of pregnancy, three to eight days postpartum and six to ten weeks postpartum. Main outcome measures Pelvic floor muscle strength on palpation, intravaginal squeeze pressure and vesical neck elevation during squeeze. Results Pelvic floor muscle strength is significantly reduced three to eight days postpartum in women following vaginal birth but not in women after caesarean delivery. Six to ten weeks later palpation and vesical neck elevation on perineal ultrasound do not show any significant differences to antepartum values, while intravaginal pressure on perineometry remains significantly lower in primiparae, but not in multiparae. Conclusions Pelvic floor muscle strength is impaired shortly after vaginal birth, but for most women returns within two months.

Levator ani function before and after childbirth.

To evaluate pelvic floor muscle strength before and after vaginal birth. Prospective repeated measures study. Main district hospital. Fifty-five women: 25 primiparae and 20 multiparae following vaginal birth, and 10 women following elective caesarean delivery as a control group. Pelvic muscle strength was evaluated by palpation, perineometry and perineal ultrasound before childbirth in the 36th to 42nd week of pregnancy, three to eight days postpartum and six to ten weeks postpartum. Pelvic floor muscle strength on palpation, intravaginal squeeze pressure and vesical neck elevation during squeeze. Pelvic floor muscle strength is significantly reduced three to eight days postpartum in women following vaginal birth but not in women after caesarean delivery. Six to ten weeks later palpation and vesical neck elevation on perineal ultrasound do not show any significant differences to antepartum values, while intravaginal pressure on perineometry remains significantly lower in primiparae, but not in multiparae. Pelvic floor muscle strength is impaired shortly after vaginal birth, but for most women returns within two months.

Comparison of Objective Measurement of Anal Sphincter Strength with Anal Sphincter Pressures and Levator Ani Function

The fidelity with which anal sphincter intraluminal pressure can assess the strength of that sphincter cannot be determined without a suitable objective measurement of sphincter strength. This study details such a measurement and compares it with sphincter pressure. Sphincter strength was defined as the force in grams required to pull a 3/4-inch diameter firm rubber ball from the rectum, through the sphincter, to the outside. Comparison of this value with simultaneously obtained sphincter pressure showed an excellent correlation (r = 0.955, P

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