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 ,Revised 18 October 2009 ,Accepted 4 January 2010.

References 

  1. DeLancey JO, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003;101:46–53
  2. Kearney R, Miller JM, Ashton-Miller JA, DeLancey JO. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006;107:144–149
  3. Shek KL, Dietz HP. The effect of childbirth on hiatal dimensions. Obstet Gynecol. 2009;113:1272–1278
  4. DeLancey JO, Trowbridge ER, Miller JM, et al. Stress urinary incontinence: relative importance of urethral support and urethral closure pressure. J Urol. 2008;179:2286–2290discussion 90
  5. Handa VL, Lockhart ME, Kenton KS, et al. Magnetic resonance assessment of pelvic anatomy and pelvic floor disorders after childbirth. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:133–139
  6. Borello-France D, Burgio KL, Richter HE, et al. Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 2006;108:863–872
  7. Richter HE, Fielding JR, Bradley CS, et al. Endoanal ultrasound findings and fecal incontinence symptoms in women with and without recognized anal sphincter tears. Obstet Gynecol. 2006;108:1394–1401
  8. Lockhart ME, Fielding JR, Richter HE, Brubaker L, Salomon CG, Ye W, et al. Reproducibility of dynamic MR imaging pelvic measurements: a multi-institutional study. Radiology. 2008;249:534–540
  9. Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–17
  10. Herzog AR, Diokno AC, Brown MB, Normolle DP, Brock BM. Two-year incidence, remission, and change patterns of urinary incontinence in noninstitutionalized older adults. J Gerontol. 1990;45:M67–M74
  11. Rockwood TH, Church JM, Fleshman JW, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum. 1999;42:1525–1532
  12. Bradley CS, Nygaard IE. Vaginal wall descensus and pelvic floor symptoms in older women. Obstet Gynecol. 2005;106:759–766
  13. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001;185:1332–1337discussion 7-8
  14. Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse?. Am J Obstet Gynecol. 2003;189:372–377discussion 7-9
  15. Tan JS, Lukacz ES, Menefee SA, Powell CR, Nager CW. Predictive value of prolapse symptoms: a large database study. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:203–209discussion 9
  16. DeLancey JO, Morgan DM, Fenner DE, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109(2 Pt 1):295–302
  17. Morgan DM, Umek W, Stein T, Hsu Y, Guire K, DeLancey JO. Interrater reliability of assessing levator ani muscle defects with magnetic resonance images. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:773–778
  18. Kearney R, Miller JM, Delancey JO. Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging. Neurourol Urodyn. 2006;25:50–54
  19. Terra MP, Beets-Tan RG, Vervoorn I, et al. Pelvic floor muscle lesions at endoanal MR imaging in female patients with faecal incontinence. Eur Radiol. 2008;18:1892–1901
  20. Feinstein AR, Cicchetti DV. High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol. 1990;43:543–549

 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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