Magnetic resonance imaging of normal levator ani anatomy and function

Singh, Kavita; Reid, Wendy; Berger, Leslie

doi:10.1016/s0029-7844(01)01743-4

Cited by 60 publications

(37 citation statements)

References 12 publications

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“…It is conceivable that pregnancy may have resulted in significant changes compared to the nonpregnant state, which would confound our analysis. The thickness measurements obtained by us (mean of about 10 mm both before and after childbirth) are somewhat higher than those obtained by other researchers in nulliparae 18,33 which may be due to our methodology (that is, measurement of muscle thickness on pelvic floor muscle contraction), the population, or a pregnancy effect. However, any such confounding effect would strengthen rather than weaken the conclusions of this study.…”

Section: Discussioncontrasting

confidence: 80%

How common is pelvic floor muscle atrophy after vaginal childbirth?

Dixit

Shek

Dietz

2013

Ultrasound Obstet Gynecol

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Section: Discussioncontrasting

confidence: 80%

How common is pelvic floor muscle atrophy after vaginal childbirth?

Dixit

Shek

Dietz

2013

Ultrasound Obstet Gynecol

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“…This results in acquiring axial images along the pelvic axis similar to those obtained by pelvic floor MRI. 16,8 Women with prolapse have a significantly larger levator ani hiatal area compared with women of similar age and parity without prolapse. Furthermore, in women with prolapse, the greater the prolapse (as assessed by the maximum descent of the leading organ) the greater the hiatal area; this holds true for descent of any part of the pelvic organs.…”

Section: Discussionmentioning

confidence: 99%

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

Athanasiou

Chaliha

Toozs‐Hobson

et al. 2007

BJOG

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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.

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“…Although there continues to be confusion surrounding nomenclature, it seems fair to assume that the structure that forms the levator hiatus, i.e. the puborectalis muscle, is of particular significance because it defines a potential hernial portal and constitutes a sphincteric mechanism affecting the urethra, vagina and anorectum 3 . In childbirth, it is these components of the levator ani that are exposed to the most strain, having to distend by a factor of over three during crowning of the fetal head 4 .…”

Section: Introductionmentioning

confidence: 99%