Levator hiatus dimensions and pelvic floor function in women with and without major defects of the pubovisceral muscle

Introduction and hypothesis

The aim of present study was to compare pelvic floor morphology and function in women with and without major defects of the pubovisceral muscle.

Methods

One hundred fifty-seven women with pelvic organ prolapse participated in this cross-sectional study. Participants answered a symptom questionnaire and underwent clinical and three- and four-dimensional transperineal ultrasound examination. Pelvic floor muscle maximum voluntary contraction (MVC), endurance, and resting vaginal pressure were registered with a vaginal balloon catheter. Offline analyses were performed for the presence of major pubovisceral muscle defects (PVMD) and hiatal dimensions.

Results

The levator hiatus dimensions at rest and contraction were significantly larger in women with than without major PVMD. Mean differences in levator hiatus area between women with and without major PVMD were: rest 1.9?cm² 95% confidence intervals (CI) 0.21–3.7, P?=?0.028 and contraction 2.75?cm² 95% CI 1.0–4.5, P =0.002; and Valsalva maneuver mean difference was 0.82?cm² 95% CI 2.18–3.83, P?=?0.543. Women with major PVMD had lower MVC and endurance measurements as compared with women without major PVMD, but the differences were not statistically significant.

Conclusions

Women with major pubovisceral muscle defects have larger hiatal dimensions at rest and at contraction than women without PVMD. We were unable to prove the corresponding relationship for hiatal dimensions on Valsalva.