Is There a Correlation Between Levator Ani Muscle Defects, Symptoms Related to Anorectal and Urinary Disorders, and Anatomic and Dynamic Abnormalities in Women with Previous Vaginal Deliveries?

• Published in: SN comprehensive clinical medicine Vol. 6; no. 1
• Main Authors: Murad-Regadas, Sthela M., Regadas, Francisco Sergio P., de Oliveira, Maura Tarciany Coutinho Cajazeiras, da Silva Vilarinho, Adjra, da Silva Fernandes, Graziela O., dos Reis Lima, Doryane Maria, de Souza, Milena Macedo
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 08-08-2024
• Subjects: Medicine; Medicine & Public Health; Original Paper; Topical Collection on Imaging; Pelvic floor; Incontinence; Sphincter defect; Ultrasound
• ISSN: 2523-8973; 2523-8973
• DOI: 10.1007/s42399-024-01702-5

Studies have demonstrated the relationships among abnormalities found on imaging, dysfunction, and symptoms remain unclear in female with levator ani muscle damage/avulsion. Therefore, the aim of this study was to investigate correlations among defects in the levator ani muscles, symptoms related to anorectal and/or urinary disorders, dynamic dysfunctions, anatomic abnormalities of sphincter muscles, and hiatus dimensions in women who previously underwent vaginal delivery using dynamic anorectal and endovaginal 3D ultrasound. This prospective cohort study included women who previously underwent vaginal delivery and were being evaluated for symptoms, dynamic anorectal (echodefecography), and endovaginal 3D ultrasound. Women with a levator ani defect were compared to those with intact muscles in regard to symptoms, anatomic abnormalities, and abnormal dynamic conditions. A total of 108 women were included and divided into two groups: 38 (35%) with a levator ani defect and 70 (65%) with intact muscles. The prevalence and severity of fecal incontinence were greater in patients with levator ani defects. In contrast, the prevalence of constipation/obstructed defecation was greater in subjects with intact muscles. The sphincter defect was more common in subjects with a levator ani defect. The prevalence of dysfunctions according to echodefecography was similar in both groups. Compared with defects in the intact levator ani muscle, defects in the levator ani muscle were associated with an increased rate and severity of fecal incontinence symptoms. Women with levator ani muscle defects were also likely to have sphincter defects. Levator ani defects were not related to the presence of cystocele, rectocele, intussusception, anismus, perineal descent, or entero-sigmoidocele.