American Journal of Obstetrics & Gynecology
Volume 202, Issue 5 , Pages 488.e1-488.e6, May 2010

Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women

Presented at the 30th Annual Scientific Meeting of the American Urogynecologic Society, Hollywood, FL, Sept. 24-26, 2009, and the 95th Scientific Assembly and Annual Meeting of the Radiologic Society of North America, Chicago, IL, Nov. 29-Dec. 4, 2009.

  • Marta E. Heilbrun, MD

      Affiliations

    • Department of Radiology, University of Utah, Salt Lake City, UT
    • ,
  • Ingrid E. Nygaard, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
    • ,
  • Mark E. Lockhart, MD, MPH

      Affiliations

    • Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Holly E. Richter, PhD, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Morton B. Brown, PhD

      Affiliations

    • School of Public Health, University of Michigan, Ann Arbor, MI
    • ,
  • Kimberley S. Kenton, MD, MS

      Affiliations

    • Department of Obstetrics and Gynecology, Loyola University, Maywood, IL
    • ,
  • David D. Rahn, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • John V. Thomas, MD

      Affiliations

    • Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Alison C. Weidner, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Duke University, Durham, NC
    • ,
  • Charles W. Nager, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, CA; for the Pelvic Floor Disorders Network
    • ,
  • John O. Delancey, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI

Received 3 August 2009; received in revised form 18 October 2009; accepted 4 January 2010. published online 11 March 2010.

Objective

The objective of the study was to correlate the presence of major levator ani muscle (LAM) injuries on magnetic resonance imaging (MRI) with fecal incontinence (FI), pelvic organ prolapse (POP), and urinary incontinence (UI) in primiparous women 6-12 months postpartum.

Study Design

A published scoring system was used to characterize LAM injuries on MRI dichotomously (MRI negative, no/mild vs MRI positive, major).

Results

Major LAM injuries were observed in 17 of 89 (19.1%) women who delivered vaginally with external anal sphincter (EAS) injuries, 3 of 88 (3.5%) who delivered vaginally without EAS injury, and 0 of 29 (0%) who delivered by cesarean section before labor (P = .0005). Among women with EAS injuries, those with major LAM injuries trended toward more FI, 35.3% vs 16.7% (P = .10) and POP, 35.3% vs 15.5% (P = .09), but not UI (P = 1.0).

Conclusion

These data support the growing body of literature suggesting that both EAS and LAM are important for fecal continence and that multiple injuries contribute to pelvic floor dysfunction.

Key words: fecal incontinence, levator ani muscle, magnetic resonance imaging, pelvic floor muscle, pelvic organ prolapse, urinary incontinence

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 Cite this article as: Heilbrun ME, Nygaard IE, Lockhart ME, et al. Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women. Am J Obstet Gynecol 2010;202:488.e1-6.

 Reprints not available from the authors.

 Supported by Grants (U01 HD41249, U10 HD41268, U10 HD41248, U10 HD41250, U10 HD41261, U10 HD41263, U10 HD41269, and U10 HD41267) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of Research on Women's Health.

PII: S0002-9378(10)00003-7

doi:10.1016/j.ajog.2010.01.002

American Journal of Obstetrics & Gynecology
Volume 202, Issue 5 , Pages 488.e1-488.e6, May 2010

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