The Experts below are selected from a list of 882 Experts worldwide ranked by ideXlab platform
John O L Delancey - One of the best experts on this subject based on the ideXlab platform.
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KEY WORDS Pelvic floor Posture
2015Co-Authors: Daniel M. Morgan, JAMES ANTHONY ASHTON-MILLER, Dee E Fenner, Kenneth E. Guire, Gurpreet Kaur, Yvonne A Hsu, Janis A Miller, John O L DelanceyAbstract:Vaginal closure force Objective: This study was undertaken to quantify resting Vaginal closure force (VCFREST), maximum Vaginal closure force (VCFMAX), and augmentation of Vaginal closure force augmentation (VCFAUG) when supine and standing and to determine whether the change in intra-abdominal pressure associated with change in posture accounts for differences in VCF. Study design: Thirty-nine asymptomatic, continent women were recruited to determine, when supine and standing, the Vaginal closure force (eg, the force closing the vagina in the mid-sagittal plane) and bladder pressures at rest and at maximal voluntary contraction. VCF was measured with an instrumented Vaginal Speculum and bladder pressure was determined with a microtip catheter. VCFREST was the resting pelvic floor tone, and VCFMAX was the peak pelvic floor force during a maximal voluntary contraction. VCFAUG was the difference between VCFMAX and VCFREST. T tests and Pearson correlation coefficients were used for analysis. Results: VCFREST when supine was 3.6 G 0.8 N and when standing was 6.9 G 1.5 Nda 92% difference (P!.001). The VCFMAX when supine was 7.5G 2.9 N and when standing was 10.1G 2.4 Nda 35 % difference (P!.001). Bladder pressure when supine (10.5 G 4.7 cm H2O) wa
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Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse
Obstetrical & Gynecological Survey, 2007Co-Authors: John O L Delancey, Rohna Kearney, Wolfgang Umek, Janis M Miller, Dee E Fenner, Yvonne Hsu, Daniel M. Morgan, Kenneth E. Guire, Hero K. Hussain, JAMES ANTHONY ASHTON-MILLERAbstract:The levator ani muscles are critical for providing upward support to the pelvic organs and minimizing the load on the connective tissue that attaches these organs to the pelvis. When the muscles fail, pelvic organ prolapse may ensue, making surgery necessary. Vaginal birth substantially increases the risk of prolapse in occurring in parous women, but it is not clear whether levator ani defects lead to prolapse later in life. The possibility that this may be the case has lent support to cesarean delivery on request. This case-control study compared the structure and function of the levator ani muscle in 151 women with prolapse and 135 control subjects matched for age, race, and hysterectomy status. Case patients had prolapse of a Vaginal wall, a hysterectomy scar, or the cervix extending at least 1 cm above the hymen during a Valsalva maneuver. MR imaging served to identify major defects with more than half the levator ani missing, and minor defects with less than half the muscle missing. An instrumented Vaginal Speculum was used to quantify Vaginal closure force at rest and during maximum pelvic muscle contraction. The incidence of major levator ani defects was 55% in cases and 16% in controls, for an adjusted odds ratio (OR) of 7.3 (95% confidence interval [CI], 3.9-13.6). Women in the two groups were, however, about equally likely to have minor defects. Incidence rates of major defects were 53% for women reporting having had a forceps delivery and 28% for the others (adjusted OR, 3.4; 95% CI, 1.95-5.78). Women with prolapse had lower estimates of Vaginal closure force during pelvic muscle contraction than did control subjects (2.0 versus 3.2 Newtons). Women with levator ani defects generated less force than those lacking defects (2.0 versus 3.1 Newtons). The genital hiatus was 50% longer in case women than in controls (4.7 versus 3.1 cm). In both the case and control groups, women without levator ani defects had higher maximal contraction force estimates than those with defects. This case-control study showed that women having pelvic organ prolapse more often have defective levator ani muscles than control women, and generate less Vaginal closure force during maximal muscle contraction.
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effects of aging on lower urinary tract and pelvic floor function in nulliparous women
Obstetrics & Gynecology, 2007Co-Authors: Elisa R Trowbridge, John T Wei, Dee E Fenner, James A Ashtonmiller, John O L DelanceyAbstract:OBJECTIVE: To evaluate the effects of aging, independent of parity, on pelvic organ and urethral support, urethral function, and levator function in a sample of nulliparous women. METHODS: A cohort of 82 nulliparous women, aged 21–70 years, were recruited from the community through advertisements. Subjects underwent pelvic examination using pelvic organ prolapse quantification, urethral angles by cotton-tipped swab, and multichannel urodynamics and uroflow. Vaginal closure force was quantified using an instrumented Vaginal Speculum. Subjects were grouped into five age categories and analyses performed using t tests, Fisher exact tests, Kruskal-Wallace, and Pearson correlation coefficients. Multiple linear regression modeling was performed to adjust for factors that might confound the results of our primary outcomes. RESULTS: Increasing age was associated with decreasing maximal urethral closure pressure (r–0.758, P<.001) with a 15-cm-H2O decrease in pressure per decade. Pelvic organ support as measured by pelvic organ prolapse quantification did not differ by age group. Levator function as measured by resting Vaginal closure force and augmentation of Vaginal closure force also did not change with increasing age. CONCLUSION: In a sample of nulliparous women between 21 and 70 years of age maximal urethral closure pressure in the senescent urethra was 40% of that in the young urethra; increasing age did not affect clinical measures of pelvic organ support, urethral support, and levator function. (Obstet Gynecol 2007;109:715–20) LEVEL OF EVIDENCE: III
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comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse
Obstetrics & Gynecology, 2007Co-Authors: John O L Delancey, Rohna Kearney, Wolfgang Umek, Janis M Miller, Dee E Fenner, Yvonne Hsu, Daniel M. Morgan, Kenneth E. Guire, Hero K. Hussain, James A AshtonmillerAbstract:BACKGROUND: To compare levator ani defects and pelvic floor function among women with prolapse and controls. METHODS: Levator ani structure and function were measured in a case–control study with group matching for age, race, and hysterectomy status among 151 women with prolapse (cases) and 135 controls with normal support (controls) determined by pelvic organ prolapse quantification examination. Magnetic resonance imaging was used to determine whether there were “major” (more than half missing), “minor” (less than half of the muscle missing), or no defects in the levator ani muscles. Vaginal closure force at rest and during maximal pelvic muscle contraction was measured with an instrumented Vaginal Speculum. RESULTS: Cases were more likely to have major levator ani defects than controls (55% compared with 16%), with an adjusted odds ratio of 7.3 (95% confidence interval 3.9–13.6, P<.001) but equally likely to have minor defects (16% compared with 22%). Of women who reported delivery by forceps, 53% had major defects compared with 28% for the nonforceps women, adjusted odds ratio 3.4 (95% confidence interval 1.95–5.78). Women with prolapse generated less Vaginal closure force during pelvic muscle contraction than controls (2.0 Newtons compared with 3.2 Newtons P<.001), whereas those with defects generated less force than women without defects (2.0 Newtons compared with 3.1 Newtons, P<.001). The genital hiatus was 50% longer in cases than controls (4.71.4 cm compared with 3.11.0 cm, P<.001).
James A Ashtonmiller - One of the best experts on this subject based on the ideXlab platform.
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effects of aging on lower urinary tract and pelvic floor function in nulliparous women
Obstetrics & Gynecology, 2007Co-Authors: Elisa R Trowbridge, John T Wei, Dee E Fenner, James A Ashtonmiller, John O L DelanceyAbstract:OBJECTIVE: To evaluate the effects of aging, independent of parity, on pelvic organ and urethral support, urethral function, and levator function in a sample of nulliparous women. METHODS: A cohort of 82 nulliparous women, aged 21–70 years, were recruited from the community through advertisements. Subjects underwent pelvic examination using pelvic organ prolapse quantification, urethral angles by cotton-tipped swab, and multichannel urodynamics and uroflow. Vaginal closure force was quantified using an instrumented Vaginal Speculum. Subjects were grouped into five age categories and analyses performed using t tests, Fisher exact tests, Kruskal-Wallace, and Pearson correlation coefficients. Multiple linear regression modeling was performed to adjust for factors that might confound the results of our primary outcomes. RESULTS: Increasing age was associated with decreasing maximal urethral closure pressure (r–0.758, P<.001) with a 15-cm-H2O decrease in pressure per decade. Pelvic organ support as measured by pelvic organ prolapse quantification did not differ by age group. Levator function as measured by resting Vaginal closure force and augmentation of Vaginal closure force also did not change with increasing age. CONCLUSION: In a sample of nulliparous women between 21 and 70 years of age maximal urethral closure pressure in the senescent urethra was 40% of that in the young urethra; increasing age did not affect clinical measures of pelvic organ support, urethral support, and levator function. (Obstet Gynecol 2007;109:715–20) LEVEL OF EVIDENCE: III
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comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse
Obstetrics & Gynecology, 2007Co-Authors: John O L Delancey, Rohna Kearney, Wolfgang Umek, Janis M Miller, Dee E Fenner, Yvonne Hsu, Daniel M. Morgan, Kenneth E. Guire, Hero K. Hussain, James A AshtonmillerAbstract:BACKGROUND: To compare levator ani defects and pelvic floor function among women with prolapse and controls. METHODS: Levator ani structure and function were measured in a case–control study with group matching for age, race, and hysterectomy status among 151 women with prolapse (cases) and 135 controls with normal support (controls) determined by pelvic organ prolapse quantification examination. Magnetic resonance imaging was used to determine whether there were “major” (more than half missing), “minor” (less than half of the muscle missing), or no defects in the levator ani muscles. Vaginal closure force at rest and during maximal pelvic muscle contraction was measured with an instrumented Vaginal Speculum. RESULTS: Cases were more likely to have major levator ani defects than controls (55% compared with 16%), with an adjusted odds ratio of 7.3 (95% confidence interval 3.9–13.6, P<.001) but equally likely to have minor defects (16% compared with 22%). Of women who reported delivery by forceps, 53% had major defects compared with 28% for the nonforceps women, adjusted odds ratio 3.4 (95% confidence interval 1.95–5.78). Women with prolapse generated less Vaginal closure force during pelvic muscle contraction than controls (2.0 Newtons compared with 3.2 Newtons P<.001), whereas those with defects generated less force than women without defects (2.0 Newtons compared with 3.1 Newtons, P<.001). The genital hiatus was 50% longer in cases than controls (4.71.4 cm compared with 3.11.0 cm, P<.001).
Dee E Fenner - One of the best experts on this subject based on the ideXlab platform.
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KEY WORDS Pelvic floor Posture
2015Co-Authors: Daniel M. Morgan, JAMES ANTHONY ASHTON-MILLER, Dee E Fenner, Kenneth E. Guire, Gurpreet Kaur, Yvonne A Hsu, Janis A Miller, John O L DelanceyAbstract:Vaginal closure force Objective: This study was undertaken to quantify resting Vaginal closure force (VCFREST), maximum Vaginal closure force (VCFMAX), and augmentation of Vaginal closure force augmentation (VCFAUG) when supine and standing and to determine whether the change in intra-abdominal pressure associated with change in posture accounts for differences in VCF. Study design: Thirty-nine asymptomatic, continent women were recruited to determine, when supine and standing, the Vaginal closure force (eg, the force closing the vagina in the mid-sagittal plane) and bladder pressures at rest and at maximal voluntary contraction. VCF was measured with an instrumented Vaginal Speculum and bladder pressure was determined with a microtip catheter. VCFREST was the resting pelvic floor tone, and VCFMAX was the peak pelvic floor force during a maximal voluntary contraction. VCFAUG was the difference between VCFMAX and VCFREST. T tests and Pearson correlation coefficients were used for analysis. Results: VCFREST when supine was 3.6 G 0.8 N and when standing was 6.9 G 1.5 Nda 92% difference (P!.001). The VCFMAX when supine was 7.5G 2.9 N and when standing was 10.1G 2.4 Nda 35 % difference (P!.001). Bladder pressure when supine (10.5 G 4.7 cm H2O) wa
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Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse
Obstetrical & Gynecological Survey, 2007Co-Authors: John O L Delancey, Rohna Kearney, Wolfgang Umek, Janis M Miller, Dee E Fenner, Yvonne Hsu, Daniel M. Morgan, Kenneth E. Guire, Hero K. Hussain, JAMES ANTHONY ASHTON-MILLERAbstract:The levator ani muscles are critical for providing upward support to the pelvic organs and minimizing the load on the connective tissue that attaches these organs to the pelvis. When the muscles fail, pelvic organ prolapse may ensue, making surgery necessary. Vaginal birth substantially increases the risk of prolapse in occurring in parous women, but it is not clear whether levator ani defects lead to prolapse later in life. The possibility that this may be the case has lent support to cesarean delivery on request. This case-control study compared the structure and function of the levator ani muscle in 151 women with prolapse and 135 control subjects matched for age, race, and hysterectomy status. Case patients had prolapse of a Vaginal wall, a hysterectomy scar, or the cervix extending at least 1 cm above the hymen during a Valsalva maneuver. MR imaging served to identify major defects with more than half the levator ani missing, and minor defects with less than half the muscle missing. An instrumented Vaginal Speculum was used to quantify Vaginal closure force at rest and during maximum pelvic muscle contraction. The incidence of major levator ani defects was 55% in cases and 16% in controls, for an adjusted odds ratio (OR) of 7.3 (95% confidence interval [CI], 3.9-13.6). Women in the two groups were, however, about equally likely to have minor defects. Incidence rates of major defects were 53% for women reporting having had a forceps delivery and 28% for the others (adjusted OR, 3.4; 95% CI, 1.95-5.78). Women with prolapse had lower estimates of Vaginal closure force during pelvic muscle contraction than did control subjects (2.0 versus 3.2 Newtons). Women with levator ani defects generated less force than those lacking defects (2.0 versus 3.1 Newtons). The genital hiatus was 50% longer in case women than in controls (4.7 versus 3.1 cm). In both the case and control groups, women without levator ani defects had higher maximal contraction force estimates than those with defects. This case-control study showed that women having pelvic organ prolapse more often have defective levator ani muscles than control women, and generate less Vaginal closure force during maximal muscle contraction.
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effects of aging on lower urinary tract and pelvic floor function in nulliparous women
Obstetrics & Gynecology, 2007Co-Authors: Elisa R Trowbridge, John T Wei, Dee E Fenner, James A Ashtonmiller, John O L DelanceyAbstract:OBJECTIVE: To evaluate the effects of aging, independent of parity, on pelvic organ and urethral support, urethral function, and levator function in a sample of nulliparous women. METHODS: A cohort of 82 nulliparous women, aged 21–70 years, were recruited from the community through advertisements. Subjects underwent pelvic examination using pelvic organ prolapse quantification, urethral angles by cotton-tipped swab, and multichannel urodynamics and uroflow. Vaginal closure force was quantified using an instrumented Vaginal Speculum. Subjects were grouped into five age categories and analyses performed using t tests, Fisher exact tests, Kruskal-Wallace, and Pearson correlation coefficients. Multiple linear regression modeling was performed to adjust for factors that might confound the results of our primary outcomes. RESULTS: Increasing age was associated with decreasing maximal urethral closure pressure (r–0.758, P<.001) with a 15-cm-H2O decrease in pressure per decade. Pelvic organ support as measured by pelvic organ prolapse quantification did not differ by age group. Levator function as measured by resting Vaginal closure force and augmentation of Vaginal closure force also did not change with increasing age. CONCLUSION: In a sample of nulliparous women between 21 and 70 years of age maximal urethral closure pressure in the senescent urethra was 40% of that in the young urethra; increasing age did not affect clinical measures of pelvic organ support, urethral support, and levator function. (Obstet Gynecol 2007;109:715–20) LEVEL OF EVIDENCE: III
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comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse
Obstetrics & Gynecology, 2007Co-Authors: John O L Delancey, Rohna Kearney, Wolfgang Umek, Janis M Miller, Dee E Fenner, Yvonne Hsu, Daniel M. Morgan, Kenneth E. Guire, Hero K. Hussain, James A AshtonmillerAbstract:BACKGROUND: To compare levator ani defects and pelvic floor function among women with prolapse and controls. METHODS: Levator ani structure and function were measured in a case–control study with group matching for age, race, and hysterectomy status among 151 women with prolapse (cases) and 135 controls with normal support (controls) determined by pelvic organ prolapse quantification examination. Magnetic resonance imaging was used to determine whether there were “major” (more than half missing), “minor” (less than half of the muscle missing), or no defects in the levator ani muscles. Vaginal closure force at rest and during maximal pelvic muscle contraction was measured with an instrumented Vaginal Speculum. RESULTS: Cases were more likely to have major levator ani defects than controls (55% compared with 16%), with an adjusted odds ratio of 7.3 (95% confidence interval 3.9–13.6, P<.001) but equally likely to have minor defects (16% compared with 22%). Of women who reported delivery by forceps, 53% had major defects compared with 28% for the nonforceps women, adjusted odds ratio 3.4 (95% confidence interval 1.95–5.78). Women with prolapse generated less Vaginal closure force during pelvic muscle contraction than controls (2.0 Newtons compared with 3.2 Newtons P<.001), whereas those with defects generated less force than women without defects (2.0 Newtons compared with 3.1 Newtons, P<.001). The genital hiatus was 50% longer in cases than controls (4.71.4 cm compared with 3.11.0 cm, P<.001).
Kenneth E. Guire - One of the best experts on this subject based on the ideXlab platform.
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KEY WORDS Pelvic floor Posture
2015Co-Authors: Daniel M. Morgan, JAMES ANTHONY ASHTON-MILLER, Dee E Fenner, Kenneth E. Guire, Gurpreet Kaur, Yvonne A Hsu, Janis A Miller, John O L DelanceyAbstract:Vaginal closure force Objective: This study was undertaken to quantify resting Vaginal closure force (VCFREST), maximum Vaginal closure force (VCFMAX), and augmentation of Vaginal closure force augmentation (VCFAUG) when supine and standing and to determine whether the change in intra-abdominal pressure associated with change in posture accounts for differences in VCF. Study design: Thirty-nine asymptomatic, continent women were recruited to determine, when supine and standing, the Vaginal closure force (eg, the force closing the vagina in the mid-sagittal plane) and bladder pressures at rest and at maximal voluntary contraction. VCF was measured with an instrumented Vaginal Speculum and bladder pressure was determined with a microtip catheter. VCFREST was the resting pelvic floor tone, and VCFMAX was the peak pelvic floor force during a maximal voluntary contraction. VCFAUG was the difference between VCFMAX and VCFREST. T tests and Pearson correlation coefficients were used for analysis. Results: VCFREST when supine was 3.6 G 0.8 N and when standing was 6.9 G 1.5 Nda 92% difference (P!.001). The VCFMAX when supine was 7.5G 2.9 N and when standing was 10.1G 2.4 Nda 35 % difference (P!.001). Bladder pressure when supine (10.5 G 4.7 cm H2O) wa
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Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse
Obstetrical & Gynecological Survey, 2007Co-Authors: John O L Delancey, Rohna Kearney, Wolfgang Umek, Janis M Miller, Dee E Fenner, Yvonne Hsu, Daniel M. Morgan, Kenneth E. Guire, Hero K. Hussain, JAMES ANTHONY ASHTON-MILLERAbstract:The levator ani muscles are critical for providing upward support to the pelvic organs and minimizing the load on the connective tissue that attaches these organs to the pelvis. When the muscles fail, pelvic organ prolapse may ensue, making surgery necessary. Vaginal birth substantially increases the risk of prolapse in occurring in parous women, but it is not clear whether levator ani defects lead to prolapse later in life. The possibility that this may be the case has lent support to cesarean delivery on request. This case-control study compared the structure and function of the levator ani muscle in 151 women with prolapse and 135 control subjects matched for age, race, and hysterectomy status. Case patients had prolapse of a Vaginal wall, a hysterectomy scar, or the cervix extending at least 1 cm above the hymen during a Valsalva maneuver. MR imaging served to identify major defects with more than half the levator ani missing, and minor defects with less than half the muscle missing. An instrumented Vaginal Speculum was used to quantify Vaginal closure force at rest and during maximum pelvic muscle contraction. The incidence of major levator ani defects was 55% in cases and 16% in controls, for an adjusted odds ratio (OR) of 7.3 (95% confidence interval [CI], 3.9-13.6). Women in the two groups were, however, about equally likely to have minor defects. Incidence rates of major defects were 53% for women reporting having had a forceps delivery and 28% for the others (adjusted OR, 3.4; 95% CI, 1.95-5.78). Women with prolapse had lower estimates of Vaginal closure force during pelvic muscle contraction than did control subjects (2.0 versus 3.2 Newtons). Women with levator ani defects generated less force than those lacking defects (2.0 versus 3.1 Newtons). The genital hiatus was 50% longer in case women than in controls (4.7 versus 3.1 cm). In both the case and control groups, women without levator ani defects had higher maximal contraction force estimates than those with defects. This case-control study showed that women having pelvic organ prolapse more often have defective levator ani muscles than control women, and generate less Vaginal closure force during maximal muscle contraction.
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comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse
Obstetrics & Gynecology, 2007Co-Authors: John O L Delancey, Rohna Kearney, Wolfgang Umek, Janis M Miller, Dee E Fenner, Yvonne Hsu, Daniel M. Morgan, Kenneth E. Guire, Hero K. Hussain, James A AshtonmillerAbstract:BACKGROUND: To compare levator ani defects and pelvic floor function among women with prolapse and controls. METHODS: Levator ani structure and function were measured in a case–control study with group matching for age, race, and hysterectomy status among 151 women with prolapse (cases) and 135 controls with normal support (controls) determined by pelvic organ prolapse quantification examination. Magnetic resonance imaging was used to determine whether there were “major” (more than half missing), “minor” (less than half of the muscle missing), or no defects in the levator ani muscles. Vaginal closure force at rest and during maximal pelvic muscle contraction was measured with an instrumented Vaginal Speculum. RESULTS: Cases were more likely to have major levator ani defects than controls (55% compared with 16%), with an adjusted odds ratio of 7.3 (95% confidence interval 3.9–13.6, P<.001) but equally likely to have minor defects (16% compared with 22%). Of women who reported delivery by forceps, 53% had major defects compared with 28% for the nonforceps women, adjusted odds ratio 3.4 (95% confidence interval 1.95–5.78). Women with prolapse generated less Vaginal closure force during pelvic muscle contraction than controls (2.0 Newtons compared with 3.2 Newtons P<.001), whereas those with defects generated less force than women without defects (2.0 Newtons compared with 3.1 Newtons, P<.001). The genital hiatus was 50% longer in cases than controls (4.71.4 cm compared with 3.11.0 cm, P<.001).
Daniel M. Morgan - One of the best experts on this subject based on the ideXlab platform.
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KEY WORDS Pelvic floor Posture
2015Co-Authors: Daniel M. Morgan, JAMES ANTHONY ASHTON-MILLER, Dee E Fenner, Kenneth E. Guire, Gurpreet Kaur, Yvonne A Hsu, Janis A Miller, John O L DelanceyAbstract:Vaginal closure force Objective: This study was undertaken to quantify resting Vaginal closure force (VCFREST), maximum Vaginal closure force (VCFMAX), and augmentation of Vaginal closure force augmentation (VCFAUG) when supine and standing and to determine whether the change in intra-abdominal pressure associated with change in posture accounts for differences in VCF. Study design: Thirty-nine asymptomatic, continent women were recruited to determine, when supine and standing, the Vaginal closure force (eg, the force closing the vagina in the mid-sagittal plane) and bladder pressures at rest and at maximal voluntary contraction. VCF was measured with an instrumented Vaginal Speculum and bladder pressure was determined with a microtip catheter. VCFREST was the resting pelvic floor tone, and VCFMAX was the peak pelvic floor force during a maximal voluntary contraction. VCFAUG was the difference between VCFMAX and VCFREST. T tests and Pearson correlation coefficients were used for analysis. Results: VCFREST when supine was 3.6 G 0.8 N and when standing was 6.9 G 1.5 Nda 92% difference (P!.001). The VCFMAX when supine was 7.5G 2.9 N and when standing was 10.1G 2.4 Nda 35 % difference (P!.001). Bladder pressure when supine (10.5 G 4.7 cm H2O) wa
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Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse
Obstetrical & Gynecological Survey, 2007Co-Authors: John O L Delancey, Rohna Kearney, Wolfgang Umek, Janis M Miller, Dee E Fenner, Yvonne Hsu, Daniel M. Morgan, Kenneth E. Guire, Hero K. Hussain, JAMES ANTHONY ASHTON-MILLERAbstract:The levator ani muscles are critical for providing upward support to the pelvic organs and minimizing the load on the connective tissue that attaches these organs to the pelvis. When the muscles fail, pelvic organ prolapse may ensue, making surgery necessary. Vaginal birth substantially increases the risk of prolapse in occurring in parous women, but it is not clear whether levator ani defects lead to prolapse later in life. The possibility that this may be the case has lent support to cesarean delivery on request. This case-control study compared the structure and function of the levator ani muscle in 151 women with prolapse and 135 control subjects matched for age, race, and hysterectomy status. Case patients had prolapse of a Vaginal wall, a hysterectomy scar, or the cervix extending at least 1 cm above the hymen during a Valsalva maneuver. MR imaging served to identify major defects with more than half the levator ani missing, and minor defects with less than half the muscle missing. An instrumented Vaginal Speculum was used to quantify Vaginal closure force at rest and during maximum pelvic muscle contraction. The incidence of major levator ani defects was 55% in cases and 16% in controls, for an adjusted odds ratio (OR) of 7.3 (95% confidence interval [CI], 3.9-13.6). Women in the two groups were, however, about equally likely to have minor defects. Incidence rates of major defects were 53% for women reporting having had a forceps delivery and 28% for the others (adjusted OR, 3.4; 95% CI, 1.95-5.78). Women with prolapse had lower estimates of Vaginal closure force during pelvic muscle contraction than did control subjects (2.0 versus 3.2 Newtons). Women with levator ani defects generated less force than those lacking defects (2.0 versus 3.1 Newtons). The genital hiatus was 50% longer in case women than in controls (4.7 versus 3.1 cm). In both the case and control groups, women without levator ani defects had higher maximal contraction force estimates than those with defects. This case-control study showed that women having pelvic organ prolapse more often have defective levator ani muscles than control women, and generate less Vaginal closure force during maximal muscle contraction.
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comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse
Obstetrics & Gynecology, 2007Co-Authors: John O L Delancey, Rohna Kearney, Wolfgang Umek, Janis M Miller, Dee E Fenner, Yvonne Hsu, Daniel M. Morgan, Kenneth E. Guire, Hero K. Hussain, James A AshtonmillerAbstract:BACKGROUND: To compare levator ani defects and pelvic floor function among women with prolapse and controls. METHODS: Levator ani structure and function were measured in a case–control study with group matching for age, race, and hysterectomy status among 151 women with prolapse (cases) and 135 controls with normal support (controls) determined by pelvic organ prolapse quantification examination. Magnetic resonance imaging was used to determine whether there were “major” (more than half missing), “minor” (less than half of the muscle missing), or no defects in the levator ani muscles. Vaginal closure force at rest and during maximal pelvic muscle contraction was measured with an instrumented Vaginal Speculum. RESULTS: Cases were more likely to have major levator ani defects than controls (55% compared with 16%), with an adjusted odds ratio of 7.3 (95% confidence interval 3.9–13.6, P<.001) but equally likely to have minor defects (16% compared with 22%). Of women who reported delivery by forceps, 53% had major defects compared with 28% for the nonforceps women, adjusted odds ratio 3.4 (95% confidence interval 1.95–5.78). Women with prolapse generated less Vaginal closure force during pelvic muscle contraction than controls (2.0 Newtons compared with 3.2 Newtons P<.001), whereas those with defects generated less force than women without defects (2.0 Newtons compared with 3.1 Newtons, P<.001). The genital hiatus was 50% longer in cases than controls (4.71.4 cm compared with 3.11.0 cm, P<.001).
