MRI comparative study of levator ani muscle changes in nulliparous and multiparous females

Abstract

Background: Pelvic floor dysfunction is known to be among the principal factors influencing public health, regarding frequency, cost and effect on women's quality of life. Radiographic assessment of the pelvic floor function and anatomy plays a vital role in the recognition of pelvic floor defects. The aim of this study is to detect the postpartum-related levator ani muscle changes thus defining the relationship between the vaginal deliveries and the etiology of pelvic floor dysfunction in order to provide guidelines to decrease the incidence of pelvic floor injuries during parturition and guide the treatment plan. Results: There was a significant difference in the puborectalis muscle thickness between the case and control groups in the right puborectalis (P value ≤ 0.001) and in the left puborectalis (P value (≤ 0.001) as well as significant midpoint thickness (P value = 0.03) with 46.2% puborectalis muscle injury in the case group compared with none in the control group. Conclusion: Pelvic floor MRI is highly recommended as it is a contrast-free modality that allows for both anatomical and functional analysis. Its incorporation in the routine postpartum assessment will allow early detection of abnormalities even in asymptomatic cases thus ensuring proper management and preventing the development of pelvic floor dysfunction predisposed to by repeated vaginal deliveries.

The variation in shape and thickness of the pelvic floor musculature in males and females: a geometric-morphometric analysis

“…In this study, we assessed for the first time the association of the 3D morphology of pelvic floor muscles with several biometric variables in men and women. Most clinical investigations concentrated on 2D measurements from MRI, for example, the position of the internal organs above the pubococcygeal axis, the muscle thickness on transverse, coronal or sagittal views of MRI [ 26 ], thicknesses of adjacent musculature by ultrasound [ 27 ] or thickness and micro-morphology of prepared cadaver tissue [ 28 ]. We proposed a novel approach for a comprehensive quantification of the 3D morphology of the pelvic floor muscles in males and females, which may also be applicable in clinical practice.…”