Levator Ani Muscle Contraction Research Articles

Enhancement of Levator Ani Muscle Strength in Postpartum Women: The Impact of Pelvic Floor Muscle Training.

BACKGROUND Levator ani muscle injuries during vaginal childbirth can lead to pelvic organ prolapse (POP). Pelvic floor muscle training (PFMT) is an effective conservative approach to alleviate these symptoms. This study aimed to compare outcomes with and without 3 months of PFMT in 34 women with levator ani muscle injury following vaginal delivery. MATERIAL AND METHODS In a quasi-experimental study, 34 postpartum women were divided into 2 groups: one received PFMT along with home-based materials and regular follow-ups, while the other served as the control. We measured basal tone and maximal levator ani muscle contraction using the Peritron perineometer and assessed changes after 3 months. RESULTS The basal tone and maximal contraction of the levator ani muscle significantly increased following a 3-month intervention period both in PFMT and control group (P=0.0001). The maximal contraction of the levator ani muscle after a 3-month intervention period was significantly higher in PFMT group compared with control group (36.59±1.45 vs 27.76±13.35, P=0.0001), respectively. A significant positive correlation was found between basal tone and maximal contraction (r=0.806, P=0.0001). CONCLUSIONS A 3-month PFMT program effectively increased levator ani muscle strength in postpartum women compared to those who did not undergo PFMT.

Assessment of the bearing-down manoeuvre in pregnancy and detection of paradoxical levator ani muscle contraction using 2D transperineal ultrasound and vaginal palpation: a concurrent validity and inter-rater reliability study.

To examine the concurrent validity and inter-rater reliability of vaginal palpation as a measure of the quality of the bearing-down manoeuvre (BDM) and the detection of a paradoxical levator ani muscle contraction (LAM) in pregnant women, compared with 2D transperineal ultrasound (TPUS). Concurrent validity and inter-rater reliability study. Physiotherapy clinic. Twenty pregnant women in their third trimester. The anterior posterior diameter (APD) was measured during the BDM using TPUS by one experienced physiotherapist. An APD that shortened by >2 mm from rest was described as LAM shortening, an APD that moved by 0-2 mm was described as no change and an APD that lengthened by >2 mm was described as LAM lengthening. Vaginal palpation described the LAM during the BDM as no movement, shortening or lengthening. Participants were allowed two attempts and the best attempt was measured. APD using TPUS and the assessor's subjective description of LAM during the BDM using vaginal palpation. TPUS detected more paradoxical LAM contractions during the BDM than palpation. Agreement between vaginal palpation and TPUS assessment for BDM was poor. The Fleiss kappa coefficients were 0.457 (90% CI 0.16-0.71) between TPUS and one assessor and 0.326 (90% CI 0.01-0.6) between TPUS and the other assessor. In addition, inter-rater reliability was poor between observers palpating the BDM, with a Fleiss kappa coefficient of 0.375 (90% CI 0.13-0.64). This study did not find vaginal palpation of the BDM in pregnant women to have concurrent validity or inter-rater reliability. Clinicians should be aware of potential inaccuracies when palpating the BDM, and, where possible, seek an assessment via TPUS.

Evaluation of the effect of levator ani muscle contraction on post-prostatectomy urinary incontinence using cine MRI.

Post-prostatectomy urinary incontinence (PPI) is the greatest concern for urologists after radical prostatectomy (RP). It is thought that PPI is composed of multiple factors including static and dynamic components. The purpose of this study is to show visually levator ani muscle (LAM) contraction during pelvic floor muscle contraction and to evaluate the dynamic differences in its contraction between men with and without PPI. This study was a case-control study of the urinary continent or incontinent men. It investigated whether LAM contraction was involved in urinary leakage based on examination of LAM contraction by cine magnetic resonance imaging. The LAM contracted from the coccyx to the pubis in the same manner before and after surgery. The degree of contraction of the LAM in post-prostatectomy groups was smaller than that in the healthy adult group. The contraction distances of each part of the pelvic floor were decreased by 50%-70% in the incontinence group compared to those in the continence group. The bladder neck moved 2.5-fold further in the continence group and the direction of movement was more vertical than in the incontinence group. Urethral compression was attenuated by about 40% in the incontinence group compared to that in the continence group. RP can cause damage to the LAM. LAM contraction is reduced after RP compared with that in healthy adult men. In men with PPI, the reduced muscle contraction might not compress the urethra sufficiently when abdominal pressure is raised. Pelvic floor muscle training might provide a meaningful method for the recovery of LAM contraction in patients with PPI.

Application of pelvic floor ultrasound during pregnancy to detect patients at risk of cesarean section due to failure of labor progression in a Spanish population

ObjectiveOur study is aimed at evaluating the characteristics of the pelvic floor, assessed through transperineal ultrasound, since it may influence or increase the possibility of having a cesarean delivery, with the objective of acting on those variables that can be modified during pregnancy. Study DesignTransperineal ultrasound was performed on 109 primiparous pregnant women in their first trimester of pregnancy, recruited between May 2018 and February 2019, with the purpose of studying the hiatus area at rest, retention and Valsalva. We have reassessed them at the end of pregnancy and delivery data were recorded. We selected 8 patients as case-study, who had cesarean section delivery due to failure of labor progression. We selected 4 control-cases for each, reaching the total of 32 controls, with similar age and body mass index, to avoid obtaining a biased result from these data. ResultsIn the study of hiatal areas, patients who delivered by cesarean section had a smaller hiatal area at rest, during levator ani muscle contraction and during Valsalva maneuver, at all visits. In early pregnancy, the range of the resting hiatal area was 13.8 ± 2.0 cm2 for cesarean sections, compared to 16.2 ± 2.7 cm2 for vaginal deliveries with an OR of 0.57 (0.34–0.95, 95% CI). For hiatal area on Valsalva, the OR was 0.55 (0.35–0.88, 95% CI). Therefore, the smaller the hiatal area, the greater the possibility of cesarean section. At the end of pregnancy, between 34 and 36 weeks of gestation, the OR of hiatal area on Valsalva was 0.78 (0.60–1.00, 95% CI). ConclusionThe hiatus area measured by transperineal ultrasonography at the beginning and at the end of the pregnancy may be useful to identify the patients who are at a higher risk of cesarean delivery due to failure of labor progression.

Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement.

To evaluate the association between pelvic floor dimensions in nulliparous women at term and fetal head engagement, as assessed by transperineal ultrasound. This was a prospective observational study of nulliparous women at term. Before the onset of labor, transperineal ultrasound was used to measure the anteroposterior diameter (APD) of the levator hiatus and the angle of progression (AoP) at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver (before and after visual feedback). We assessed the correlation between pelvic floor static and dynamic dimensions (levator hiatal APD and levator ani muscle coactivation) and AoP, which is an objective index of fetal head engagement. In total, 282 women were included in the analysis. Among these, 211 (74.8%) women had a vaginal delivery while 71 (25.2%) had a Cesarean delivery. AoP was narrower in the Cesarean-delivery group at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva, whereas no differences in levator hiatal APD were found between the two groups. We found a negative correlation between levator hiatal APD at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva and the duration of the second stage of labor. There was a positive correlation between AoP and levator hiatal APD on maximum Valsalva maneuver after visual feedback (r = 0.15, P = 0.01). Women with levator ani muscle contraction on Valsalva maneuver (i.e. coactivation), both pre and post visual feedback, had a narrower AoP at rest and on maximum Valsalva. After visual feedback, women with levator ani muscle coactivation had a longer second stage of labor than did those without (80.8 ± 61.4 min vs 62.9 ± 43.4 min (P = 0.04)). Smaller pelvic floor dimensions and levator ani muscle coactivation are associated with higher fetal head station and with a longer second stage of labor in nulliparous women at term. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

The Effect of Vitamin D3 Supplementation on Increases of Levator Ani Contraction Strength in Women with Uterine Prolapse

Objective: To investigate the differences of levator muscle contraction strength after vitamin D3 supplementation, thus it is expected that the administration of vitamin D3 can reduce the incidence of uterine prolapse recurrence after reconstructive surgery.Methods: This study is a quasi-experimental study with pre-and-post vitamin D3 supplementation on uterine prolapse patient. Participants in this study were patient with uterine prolapse and fulfilled inclusion criteria (n=19). Serum vitamin D3 levels, levator ani muscle contraction strength (perineometer peritron TM), gastrocnemius soleus muscle contraction strength (hand held dynamometer) were measured prior to and after vitamin D3 1000 IU supplementation. This study was conducted in Gynecology Clinic, Physical Medicine and Rehabilitation Clinic, and The Department of Clinical Pathology Dr. Hasan Sadikin General Hospital/ Faculty of Medicine Universitas Padjadjaran on January-April 2019Results: This study showed an increase in levator ani muscle contraction strength with a significant P value of <0.001 and an increase in gastrocnemius soleus muscle contraction strength with a significant P value of <0.001 after vitamin D3 supplementation.Conlusions: Vitamin D3 supplementation can increase levator ani and gastrocnemius soleus muscle contraction strength in uterine prolapse patient.Keywords: gastrocnemius soleus muscle contraction strength, handheld dynamometer, vitamin D, levator ani muscle contraction strength, perineometer peritronTM, uterine prolapse.
 
 Abstrak
 Tujuan: Melihat perbedaan kekuatan kontraksi otot levator ani setelah suplementasi vitamin D3, dengan demikian diharapkan pemberian vitamin ini dapat mengurangi insidensi rekurensi prolapsus uteri pasca operasi rekonstruksi.Metode: Penelitian ini merupakan penelitian eksperimental quasi dengan rancangan sebelum dan sesudah pemberian vitamin D3 pada pasien prolapsus uteri. Subjek penelitian adalah pasien prolapsus uteri yang memenuhi kriteria inklusi penelitian (n=19). Dilakukan pemeriksaan kadar vitamin D serum, pengukuran kekuatan otot levator ani (perineometer peritronTM) dan otot lurik gastrocnemius soleus (hand held dynamometer) sebagai otot pembanding sebelum dan sesudah pemberian 3 bulan vitamin D3 1000 IU. Penelitian dilakukan di Poliklinik Ginekologi FKUP/RSHS, Poliklinik Kedokteran Fisik dan Rehabilitasi FKUP/RSHS dan Laboratorium serologi Klinik Patologi Klinik FKUP/RSHS pada bulan Januari – April 2019Hasil: Penelitian ini memperlihatkan peningkatan kekuatan kontraksi otot levator ani dengan nilai signifikan p<0,001, dan peningkatan kekuatan kontraksi otot gastrocnemius soleus dengan nilai signifikan p<0,001 setelah subjek mendapatkan suplemen vitamin D3.Kesimpulan: Penelitian ini menyimpulkan bahwa suplementasi vitamin D3 dapat meningkatkan kekuatan kontraksi otot levator ani dan otot gastrocnemius soleus pada penderita prolapsus uteri.Kata kunci: kekuatan kontraksi otot levator ani, kekuatan kontraksi otot gastrocnemius soleus, hand held dynamometer, perineometer peritronTM, prolapsus uteri , vitamin D

Contraction of the levator ani muscle during Valsalva maneuver (coactivation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor

The Valsalva maneuver is normally accompanied by relaxation of the levator ani muscle, which stretches around the presenting part, but in some women the maneuver is accompanied by levator ani muscle contraction, which is referred to as levator ani muscle coactivation. The effect of such coactivation on labor outcome in women undergoing induction of labor has not been previously assessed. The aim of the study was to assess the effect of levator ani muscle coactivation on labor outcome, in particular on the duration of the second and active second stage of labor, in nulliparous women undergoing induction of labor. Transperineal ultrasound was used to measure the anteroposterior diameter of the levator hiatus, both at rest and at maximum Valsalva maneuver, in a group of nulliparous women undergoing induction of labor in 2 tertiary-level university hospitals. The correlation between anteroposterior diameter of the levator hiatus values and levator ani muscle coactivation with the mode of delivery and various labor durations was assessed. In total, 138 women were included in the analysis. Larger anteroposterior diameter of the levator hiatus at Valsalva was associated with a shorter second stage (r= -0.230, P= .021) and active second stage (r= -0.338, P= .001) of labor. Women with levator ani muscle coactivation had a significantly longer active second stage duration (60 ± 56 vs 28 ± 16 minutes, P < .001). Cox regression analysis, adjusted for maternal age and epidural analgesia, demonstrated an independent significant correlation between levator ani muscle coactivation and a longer active second stage of labor (hazard ratio, 2.085; 95% confidence interval, 1.158-3.752; P= .014). There was no significant difference between women who underwent operative delivery (n= 46) when compared with the spontaneous vaginal delivery group (n= 92) as regards anteroposterior diameter of the levator hiatus at rest and at Valsalva maneuver, nor in the prevalence of levator ani muscle coactivation (10/46 vs 15/92; P= .49). Levator ani coactivation is associated with a longer active second stage of labor.

Measurement the thickness of the transverse abdominal muscle in different tasks.

[Purpose] This study examined the measurement of the thickness of the transverse abdominal muscle in different tasks. [Subjects and Methods] The subjects were eleven healthy adult females. Thicknesses of transverse abdominal muscle were measured in seven tasks in the supine position. The tasks were: 1) Resting state, 2) Maximal contraction of transverse abdominal muscle, 3) Maximal contraction of levator ani muscle, 4) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle, 5) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle with front side resistance added to both knee, 6) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle with diagonal resistance added to both knees, and 7) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle with lateral resistance added to both knees. [Results] The thicknesses of transverse abdominal muscle during maximal simultaneous contraction and maximal simultaneous contraction with resistance were greater than during the resting state. [Conclusion] The muscle output during simultaneous contraction and resistance movement were larger than that of each individual muscle.

Evaluating Maternal Recovery From Labor and Delivery

Objective We sought to describe occurrence, recovery, and consequences of musculoskeletal (MSK) injuries in women at risk for childbirth-related pelvic floor injury at first vaginal birth. Study Design Evaluating Maternal Recovery from Labor and Delivery is a longitudinal cohort design study of women recruited early postbirth and followed over time. We report here on 68 women who had birth-related risk factors for levator ani (LA) muscle injury, including long second stage, anal tears, and/or older maternal age, and who were evaluated by MSK magnetic resonance imaging at both 7 weeks and 8 months' postpartum. We categorized magnitude of injury by extent of bone marrow edema, pubic bone fracture, LA muscle edema, and LA muscle tear. We also measured the force of LA muscle contraction, urethral pressure, pelvic organ prolapse, and incontinence. Results In this higher-risk sample, 66% (39/59) had pubic bone marrow edema, 29% (17/59) had subcortical fracture, 90% (53/59) had LA muscle edema, and 41% (28/68) had low-grade or greater LA tear 7 weeks' postpartum. The magnitude of LA muscle tear did not substantially change by 8 months' postpartum ( P = .86), but LA muscle edema and bone injuries showed total or near total resolution ( P P P > .05). Conclusion Pubic bone edema and subcortical fracture and LA muscle injury are common when studied in women with certain risk factors. The bony abnormalities resolve, but levator tear does not, and is associated with levator weakness and posterior-vaginal wall descent.

Levator hiatus dimensions in late pregnancy and the process of labor: a 3- and 4-dimensional transperineal ultrasound study

The objectives of the investigation were to study the association between levator hiatus dimensions in late pregnancy and both the length of second stage of labor and also the delivery mode in women delivering their first child. In this cohort study, 231 nulliparous women were examined with 3- and 4-dimensional transperineal ultrasonography at 37 weeks of gestation. The anteroposterior, transverse diameter, and the area of levator hiatus were measured at rest, during levator ani muscle contraction, and during Valsalva maneuver. The second stage of labor was divided into passive and active second stage and delivery modes into normal vaginal or instrumental deliveries. Spearman correlation coefficient, independent-sample t test, and standard logistic regression were used for analysis. Larger levator hiatus dimensions at rest and during contraction at 37 weeks of gestation correlated with a shorter duration of the active second stage in women with normal vaginal delivery (Spearman correlation coefficient, -0.13 to -0.35, P ≤ .08). Women having normal vaginal deliveries had significantly larger transverse diameter at rest, during contraction, and during Valsalva maneuver compared with women having instrumental deliveries (mean difference, 0.29; 95% confidence interval (CI), 0.16-0.41; mean difference, 0.33; 95% CI, 0.21-0.44 and mean difference, 0.24; 95% CI, 0.06-0.42; P < .05). The same was true for the levator hiatus area at rest and during contraction (mean difference, 1.22; 95% CI, 0.37-2.07 and mean difference, 0.84; 95% CI, 0.22-1.46; P < .01). These estimates were unchanged by adjustments in the logistic regression analysis. Larger levator hiatus dimensions in late pregnancy had a significant association with a shorter active second stage of labor and normal vaginal delivery.

The Urethral Rhabdosphincter, Levator Ani Muscle, and Perineal Membrane: A Review

Detailed knowledge of the anatomy of the rhabdosphincter and adjacent tissues is mandatory during urologic surgery to ensure reliable oncologic and functional outcomes. To characterize the levator ani (LA) function for the urethral sphincter, we described connective tissue morphology between the LA and urethral rhabdosphincter. The interface tissue between the LA and rhabdosphincter area in males contained abundant irregularly arrayed elastic fibers and smooth muscles. The male rhabdosphincter was positioned alongside the LA to divide the elevation force and not in-series along the axis of LA contraction. The male perineal membrane was thin but solid and extends along the inferior margin or bottom of the rhabdosphincter area. In contrast, the female rhabdosphincter, including the compressor urethrae and urethrovaginal sphincter muscles, was embedded in the elastic fiber mesh that is continuous with the thick, multilaminar perineal membrane. The inferomedial edge of the female LA was attached to the upper surface of the perineal membrane and not directly attached to the rhabdosphincter. We presented new diagrams showing the gender differences in topographical anatomy of the LA and rhabdosphincter.

Size of Urogenital Hiatus as a Potential Risk Factor for Emptying Disorders After Pelvic Prolapse Repair

We correlated urogenital hiatus size and levator ani contraction strength with early postoperative emptying disorders. We also determined whether postoperative emptying disorders could be predicted before anti-incontinence procedures and pelvic organ prolapse repair. We retrospectively reviewed the charts of 225 consecutive patients after surgery for pelvic organ prolapse and/or stress urinary incontinence. Urogenital hiatus size was evaluated using pelvic organ prolapse quantification. Levator contraction strength was determined by the Oxford 0 to 5 classification scale. Emptying disorders were defined as post-void residual urine volume greater than 100 ml 48 hours postoperatively and/or discharge home with a Foley catheter or on intermittent self-catheterization. Median patient age, post-void residual urine volume and urogenital hiatus size were significantly related to levator contraction strength (each p <0.05). Univariate logistic regression analysis revealed a significant association of urogenital hiatus size (p = 0.001), post-void residual urine volume (p = 0.005) and levator contraction strength (p = 0.001) with emptying disorder status. Multivariate logistic regression analysis showed that levator contraction strength (p = 0.001) and post-void residual urine (p = 0.01) were independent predictors of emptying disorders. A wide urogenital hiatus, decreased levator ani contraction strength, increasing age and increased post-void residual urine correlated with an increased chance of early postoperative emptying disorders. The most independent predictors of early emptying disorders were decreased levator contraction strength and increased post-void residual urine.

Novel Insight into the Dynamics of Male Pelvic Floor Contractions Through Transperineal Ultrasound Imaging

Transperineal ultrasound imaging enables the minimally invasive assessment of pelvic floor muscle function. Although commonly used in women, the approach has rarely been reported in men. This approach has advantages because the midsagittal view visualizes a bony landmark and the entire urethral length. This allows investigation of the displacement of multiple points along the urethra and the unique mechanical actions of multiple muscles that could influence continence. We used a new transperineal ultrasound technique to compare the relative displacement of urethrovesical junction, anorectal junction and distal urethra during voluntary pelvic floor muscle contractions in continent men. We performed measurement and comparison of urethral displacement at specific urethral regions in 10 continent men (age range 28 to 41 years). Measures made on 2-dimensional midsagittal plane ultrasound images included the displacements of specific points along the urethra. Anatomical considerations suggest that these are caused by contraction of the levator ani, striated urethral sphincter and bulbocavernosus muscles. Pearson's correlation coefficient was used to investigate the relationship between displacements of pairs of points. Data show individual variation in displacement of the distal urethra (striated urethral sphincter contraction) and urethrovesical junction (levator ani contraction). A strong inverse linear relationship (0.723) between displacements of these points indicates 2 alternative strategies of urethral movement. Transperineal ultrasound imaging allows the simultaneous investigation of multiple pelvic floor muscles by measuring urethral displacement. The data provide evidence of different but coordinated strategies of urethral displacement in men.

Urethral instability.

Urethral instability is still evolving as a clinical entity. Using pressure variation of 15 cm water or more at the point of maximum urethral pressure (MUP), urethral pressure profilometry on patients referred for urodynamic assessment for lower urinary tract symptoms revealed urethral instability in 6.4% of 608 patients. The close association between urethral and detrusor instability was noted. Urethral instability appears to be a cause of frequency and urgency of micturition, and its presence increase the risk of urinary incontinence.

Levator contraction strength and genital hiatus as risk factors for recurrent pelvic organ prolapse

To correlate levator ani contraction strength and genital hiatus measurements with surgical failure in prolapse. This retrospective study involved chart review for documentation of levator contraction strength, genital hiatus measurement, and recurrent pelvic floor disorders in women who underwent surgery for prolapse. The recurrent prolapse rate was 34.6%. Median follow-up interval was 5 months. Diminished levator strength was associated with recurrent prolapse (35.8% versus 0%; P = .017). A genital hiatus 5 cm or greater was associated with recurrent prolapse (44.2% vs 27.8%; P = .034). Inability to contract the levator ani was associated with urinary incontinence (35.1% vs 18.8%; P = .023). Increasing levator contraction strength was associated with a decreased reoperation rate for pelvic floor disorders, whereas genital hiatus correlated best with recurrent prolapse. Diminished levator ani contraction strength and a widened genital hiatus correlate with an increase in surgical failures in the early postoperative period. These tools are useful for counseling a patient concerning surgery for prolapse.

Significance of pelvic floor muscles in anal incontinence

Background & Aims: The pathophysiology of anal incontinence may be elusive using current parameters. Our aim was to establish the role of the levator ani in anal continence. Methods: In 53 patients with anal incontinence, 30 with constipation as disease controls, and 15 healthy controls, we evaluated incontinence severity by a 0–12 scale, anorectal function by standard manometric tests, and levator ani contraction by a perineal dynamometer. Results: Patients with incontinence exhibited various physiologic abnormalities (3.2 ± 0.3 per patient), but multiple regression analysis showed that levator ani contraction was the independent variable with strongest relation to the severity of incontinence (R = −0.84; P < 0.0001), as well as a predictive factor of the response to treatment (R = 0.53; P < 0.01). Furthermore, in contrast to other physiologic parameters, clinical improvement in response to treatment (4.4 ± 0.5 score vs. 7.9 ± 0.5 score pre; P < 0.001) was associated with a marked and significant strengthening of levator ani contraction (448 ± 47 g vs. 351 ± 35 g pre; P < 0.05). Conclusions: We have shown the importance of levator ani failure in understanding the etiology of anal incontinence and in predicting response to treatment.GASTROENTEROLOGY 2002;123:1441-1450

Relationship between levator ani contraction and motor unit activation in the urethral sphincter

Objective: The purpose of this study was to evaluate the relationship between levator ani contraction and motor unit action potential activation in the striated urethral sphincter. Study Design: One hundred eight women who underwent preoperative evaluation at our referral center were studied. All women gave a urogynecologic history and underwent physical examination, multichannel urodynamic testing, and urethral sphincter electromyography. Manual muscle testing was used to grade levator ani contractions as poor, moderate, or strong; quantitative electromyography software was used to analyze motor unit action potential activation in the urethral sphincter. Results: Levator ani contractions were graded as poor in 46% of the women, moderate in 31% of the women, and strong in 23% of the women. Manual muscle grade was not related to quantitative electromyography values in the urethral sphincter at rest or with voluntary pelvic floor contraction. Poor manual muscle grade was associated with detrusor instability (P =.004) and more advanced stages of prolapse (P =.037). Levator ani strength was not significantly related to age, genuine stress incontinence, urethrovesical junction hypermobility, menopausal status, or surgical cure rates. Conclusion: The ability to contract the levator ani does not appear to be related to the ability to activate motor unit action potentials in the urethral sphincter, which suggests that the function of the levator ani in maintaining urinary continence is independent from the role of the urethral sphincter. (Am J Obstet Gynecol 2002;187:403-6.)

Effect of Levator Ani Muscle Contraction on Urethrovesical and Anorectal Pressures and Role of the Muscle in Urination and Defecation

Effect of Levator Ani Muscle Contraction on Urethrovesical and Anorectal Pressures and Role of the Muscle in Urination and Defecation

Effect of Levator Ani Muscle Contraction on Urethrovesical and Anorectal Pressures and Role of the Muscle in Urination and Defecation

No AccessJournal of UrologyUROLOGICAL SURVEY: Pediatric Urology: Abstracts1 Jul 2002Effect of Levator Ani Muscle Contraction on Urethrovesical and Anorectal Pressures and Role of the Muscle in Urination and Defecation Douglas A. CanningM.D. Douglas A. CanningDouglas A. Canning More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64951-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Effect of Levator Ani Muscle Contraction on Urethrovesical and Anorectal Pressures and Role of the Muscle in Urination and Defecation." The Journal of Urology, 168(1), pp. 388–389 © 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 168Issue 1July 2002Page: 388-389 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.MetricsAuthor Information Douglas A. Canning More articles by this author Expand All Advertisement PDF DownloadLoading ...

Study of the levator ani muscle in the multipara: role of levator dysfunction in defecation disorders

The levator ani muscle (LAM) shares in the mechanism of defecation and urination as well as in visceral support. Levator dysfunction occurs in conditions of chronic straining or increased intra-abdominal pressure. Studies have shown that the gravid uterus, by virtue of its weight and associated increased intraabdominal pressure, might disturb the levator function. It is postulated that this effect is augmented with repeated pregnancies. The current study investigated the functional activity of the LAM in 50 multipara, 30 primipara and 20 nullipara (controls). The 50 multipara (age 46·4 years, 4-7 deliveries) were divided into group A (28 women with normal deliveries) and group B (22 women with a prolonged 2nd stage of labour). Of the 30 primipara (age 44·2 years) 18 had normal delivery (group A) and 12 prolonged 2nd stage of labour (group B). The mean age of the nullipara was 45·3 - 7·6. The LAM activity at rest and on contraction was recorded. The rectal and anal canal pressure response to LAM stimulation was also registered. In group A of the multipara, the LAM EMG activity at rest was similar to ( P >0·05), and on contraction lower ( P <0·05) than the LAM EMG of the controls (nullipara). Group B exhibited a lower activity at rest and on contraction ( P <0·01, both). Primipara group A had a resting and contractile EMG activity similar to the controls, while group B showed diminished activity in both conditions ( P <0·05, both) which was significantly higher ( P <0·05, P <0·01, respectively) than that of group B multipara. The rectal pressure in the multipara and primipara did not differ from the nullipara ( P >0·05, both). In groups A and B of multiparous women, the anal canal pressure at rest was significantly lower and on LAM contraction significantly higher than that of nullipara. Group A of the primipara showed no significant difference against the controls, while group B exhibited a decline at rest ( P <0·05) and no difference on LAM contraction ( P >0·05). In conclusion, levator dysfunction might occur in the parous women. It was more common in the multipara than the primipara and in particular those with a history of a prolonged 2nd stage of labour. Levator dysfunction may lead to constipation and faecal or urinary incontinence as a result of pudendal neuropathy and the development of pudendal canal syndrome.