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

Athanasiou S., Chaliha, C., Toozs-Hobson, P., Salvatore, S., Khullar, V., and Cardozo, L.

This study used real-time two-dimensional (2-D) ultrasound imaging to evaluate the anatomy of the levator ani muscle in women with urogenital prolapse compared with controls who did not have prolapse.  The study was conducted in a tertiary referral urogynaecology unit, and sampled 43 women with pelvic organ prolapse, and 24 women attending a gynaecology clinic without prolapse (control group).  All subjects completed a standardised symptom questionnaire before starting the study.

The outcome measures used were the morphology of the vaginal and paravaginal tissue, and the thickness of the levator ani muscle and hiatal area at rest.  These were assessed by repeated measurements to assess intra-observer variability and inter-observer variability which was shown to be good.  In control subjects the study identified that the pubococcygeus muscle showed more regular echogenicity with no evidence of trauma, whereas in women who had experienced prolapse, the muscle had mixed echogenicity (p=0.002).  The mean thickness of the pubococcygeus did not, however, vary between groups.  The levator hiatal area was significantly larger in women with pelvic floor prolapse versus controls (17.8 cm2 versus 13.5cm2, p < 0.001).  This was found to be positively and significantly correlated with prolapse severity (p < 0.001).

In conclusion, prolapse was found to be significantly related to changes in the morphology of the pelvic floor and increased levator hiatal area.

BJOG: An International Journal of Obstetrics and Gynaecology, 2007,     114(7), 882-888

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