Direct imaging of the pelvic floor muscles using two‐dimensional ultrasound: a comparison of women with urogenital prolapse versus controls

Abstract

Objective To evaluate the anatomy of the levator ani muscle in women with urogenital prolapse versus matched controls without prolapse using real-time two-dimensional (2-D) ultrasound.Design Prospective observational study.Setting Tertiary referral urogynaecology unit.Population Forty-three women with pelvic organ prolapse (POP) and 24 women (controls) attending a gynaecology clinic without prolapse.Methods All participants completed a standardised symptom questionnaire.Main outcome measures The morphology of the vagina and paravaginal tissue was recorded at different levels. The thickness of the levator ani and the hiatal area were measured at rest. Reproducibility of the method was assessed by repeated measurements to assess intra-observer variability and interobserver variability.Results This method showed good intra-observer and inter-observer reproducibility and reliability. In controls, the pubococcygeus muscle showed more regular echogenicity with no evidence of trauma, whereas in women with prolapse the muscle had mixed echogenicity. (P = 0.002). The mean thickness of the pubococcygeus did not differ between groups. The levator hiatal area was significantly larger in women with pelvic floor prolapse versus controls (17.8 cm 2 versus 13.5 cm 2 , P < 0.001). This increase in hiatal area positively and significantly correlated with prolapse severity (P < 0.001).Conclusions Morphology and hiatal area can be reliably imaged using 2-D ultrasound. Prolapse was related to changes in pelvic floor morphology and increased levator hiatal area. The use of 2-D ultrasound provides an important insight into the pathophysiology of prolapse.

Morphological Changes After Pelvic Floor Muscle Training Measured by 3-Dimensional Ultrasonography

“…In one study the urogenital hiatus was measured with a ruler and calculated to be 1 cm 2 larger for stage II compared with stage I prolapse, 10 and in another study, a difference of 4.3 cm 2 between women with and without prolapse was measured using ultrasonography. 11 We demonstrated a decrease in the levator hiatus area by 1.5 cm 2 after pelvic floor muscle training. In women with unilateral defects the cross-sectional area of the levator ani muscle has shown to be 13.7% lower on the affected side.…”

Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial

“…Ultrasonography has been widely used to detect dysfunction in the pelvic floor muscles (PFM), [1][2][3][4] to determine the effect of childbirth in these muscles and to evaluate the effectiveness of muscle training. 4,5 Three-dimensional ultrasound is the most common type; however, two-dimensional ultrasound may be useful for evaluating the pelvic floor.…”

The effect of mode of delivery on pelvic floor functional anatomy

“…Changes in the area of the levator hiatus as a result of childbirth may have a clinical significance in the subsequent development of urogenital prolapse. Delancey and Hurd [14] and Athanasiou et al [15] have demonstrated that the size of the levator hiatus correlates with the severity of urogenital prolapse and that successful corrective surgery for prolapse is associated with a reduction in the size of the urogenital hiatus.…”