Comparison of Levator Ani Muscle Defects and Function in Women With and Without Pelvic Organ Prolapse
Abstract
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 (4.7+/-1.4 cm compared with 3.1+/-1.0 cm, P<.001). CONCLUSION: Women with prolapse more often have defects in the levator ani and generate less vaginal closure force during a maximal contraction than controls. LEVEL OF EVIDENCE: II.
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Women with POP have pelvic floor muscle impairment.
“Women with POP have shown to have PFM impairment [4, 6, 8–16]”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [14]
Women with POP-Q stage II or more have 40-62% reduced pelvic floor muscle strength compared to matched controls with normal supports (POP-Q stage 0 and I).
“Women with Pelvic Organ Prolapse Quantification system (POP-Q) stage II or more have 40–62% reduced PFM strength [14, 19]”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [14]
Cites
The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction
Bump, R. C., Mattiasson, A., Bø, K., Brubaker, L. P., DeLancey, J. O. L., Klarskov, P., Shull, B. L., & Smith, A. R. B. (1996) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(96)70243-0 · Cited by 4,275 · see citing works
Self-citationEpidemiology of surgically managed pelvic organ prolapse and urinary incontinence
OLSEN, A., SMITH, V, BERGSTROM, J., COLLING, J., & CLARK, A. (1997) · Obstetrics & Gynecology · doi:10.1016/s0029-7844(97)00058-6 · Cited by 3,335 · see citing works
Human aging, muscle mass, and fiber type composition.
Evans, W. J., & Lexell, J. (1995) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/50a.special_issue.11 · Cited by 1,308 · see citing works
Pelvic floor damage and childbirth: a neurophysiological study
Allen, R. E., Hosker, G. L., Smith, A. R. B., & Warrell, D. W. (1990) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1990.tb02570.x · Cited by 802 · see citing works
Epidemiology of genital prolapse: observations from the Oxford Family Planning Association study
Mant, J., Painter, R., & Vessey, M. P. (1997) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1997.tb11536.x · Cited by 780 · see citing works
DeLancey, J. O. L. (2003) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(02)02465-1 · Cited by 585 · see citing works
Self-citationLevator Trauma After Vaginal Delivery
Dietz, H. P., & Lanzarone, V. (2005) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000178779.62181.01 · Cited by 555 · see citing works
Procedures for pelvic organ prolapse in the United States, 1979-1997
Boyles, S. H., Weber, A. M., & Meyn, L. (2003) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2003.101 · Cited by 501 · see citing works
Levator Ani Muscle Stretch Induced by Simulated Vaginal Birth
Lien, K.-C., Mooney, B., DeLancey, J. O. L., & Ashton‐Miller, J. A. (2004) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000109207.22354.65 · Cited by 463 · see citing works
Self-citationObstetric Factors Associated With Levator Ani Muscle Injury After Vaginal Birth
Kearney, R., Miller, J. M., Ashton‐Miller, J. A., & DeLancey, J. O. L. (2006) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000194063.63206.1c · Cited by 457 · see citing works
Self-citationSmith, A. R. B., Hosker, G. L., & Warrell, D. W. (1989) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1989.tb01571.x · Cited by 453 · see citing works
Changes in metabolism of collagen in genitourinary prolapse
Jackson, S. R., Eckford, S. D., Abrams, P., Avery, N. C., Tarlton, J. F., & Bailey, A. J. (1996) · The Lancet · doi:10.1016/s0140-6736(96)91489-0 · Cited by 399 · see citing works
The Standardization of Terminology for Researchers in Female Pelvic Floor Disorders
Weber, A., Abrams, P., Brubaker, L. T., Cundiff, G. W., Davis, G., Dmochowski, R. R., Fischer, J. R., Hull, T. L., Nygaard, I., & Weidner, A. C. (2001) · International Urogynecology Journal · doi:10.1007/pl00004033 · Cited by 372 · see citing works
Gilpin, S. A., GOSLING, J. A., Smith, A. R. B., et al. (1989) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1989.tb01570.x · Cited by 266 · see citing works
Hoyte, L. P. J., Schierlitz, L., Zou, K. H., Flesh, G., & Fielding, J. R. (2001) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2001.116365 · Cited by 247 · see citing works
Obstetricians' personal choice and mode of delivery
Al‐Mufti, R., McCarthy, A., & Fisk, N. (1996) · The Lancet · doi:10.1016/s0140-6736(96)91176-9 · Cited by 227 · see citing works
Collagen Metabolism and Turnover in Women with Stress Urinary Incontience and Pelvic Prolapse
Chen, B. H., Wen, Y., Li, H., & Polan, M. L. (2002) · International Urogynecology Journal · doi:10.1007/s001920200020 · Cited by 178 · see citing works
Boreham, M. K., Wai, C. Y., Miller, R. T., et al. (2002) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2002.124843 · Cited by 176 · see citing works
Pudendal nerve stretch during vaginal birth: A 3D computer simulation
Lien, K.-C., Morgan, D. M., DeLancey, J. O. L., & Ashton‐Miller, J. A. (2005) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2005.01.032 · Cited by 162 · see citing works
Self-citationPatel, D. A., Xu, X. J., Thomason, A. D., Ransom, S. B., Ivy, J. S., & DeLancey, J. O. L. (2006) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2006.01.042 · Cited by 146 · see citing works
Self-citationStudy of the supportive structures of the uterus by levator myography.
Berglas, B., & RUBIN, I. C. (1953) · PubMed · Cited by 145 · see citing works
Singh, K., Jakab, M., Reid, W. M. N., Berger, L. A., & Hoyte, L. (2003) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2003.254 · Cited by 139 · see citing works
Damaser, M. S., BROXTON-KING, C., Ferguson, C. L., et al. (2003) · The Journal of Urology · doi:10.1097/01.ju.0000079492.09716.43 · Cited by 126 · see citing works
Morphometric properties of the posterior vaginal wall in women with pelvic organ prolapse
Boreham, M. K., Wai, C. Y., Miller, R. T., et al. (2002) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2002.130005 · Cited by 105 · see citing works
Hoyte, L., Jakab, M., Warfield, S. K., Shott, S., Flesh, G., & Fielding, J. R. (2004) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.06.067 · Cited by 92 · see citing works
Short-term urogenital effects of raloxifene, tamoxifen, and estrogen
Vardy, M. D., Lindsay, R., Scotti, R. J., Mikhail, M. S., Richart, R. M., Nieves, J. W., Zion, M., & Cosman, F. (2003) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2003.374 · Cited by 91 · see citing works
Interrater reliability of assessing levator ani muscle defects with magnetic resonance images
Morgan, D. M., Umek, W. H., Stein, T. A., Hsu, Y., Guire, K. E., & DeLancey, J. O. L. (2006) · International Urogynecology Journal · doi:10.1007/s00192-006-0224-5 · Cited by 80 · see citing works
Self-citationWeidner, A. C., Barber, M. D., Visco, A. G., Bump, R. C., & Sanders, D. B. (2000) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2000.111073 · Cited by 79 · see citing works
Shafik, A., Doss, S., & Asaad, S. (2003) · World Journal of Surgery · doi:10.1007/s00268-002-6584-1 · Cited by 63 · see citing works
Anatomie und Ätiologie der Genitalprolapse beim Weibe
Halban, J., & Tandler, J. (1907) · Braumüller eBooks · Cited by 55 · see citing works
Does vaginal closure force differ in the supine and standing positions?
Morgan, D. M., Kaur, G., Hsu, Y., Fenner, D. E., Guire, K. E., Miller, J. M., Ashton‐Miller, J. A., & DeLancey, J. O. (2005) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.11.050 · Cited by 54 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Haylen, B. T., Maher, C. F., Barber, M. D., Camargo, S., Dandolu, V., Digesu, A., Goldman, H. B., Huser, M., Milani, A. L., Moran, P. A., et al. (2016) · International Urogynecology Journal · doi:10.1007/s00192-015-2932-1 · Cited by 461 · see citing works
Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth
Handa, V. L., Blomquist, J. L., Knoepp, L. R., Hoskey, K. A., McDermott, K. C., & Muñoz, A. (2011) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e3182267f2f · Cited by 345 · see citing works
Conservative prevention and management of pelvic organ prolapse in women
Hagen, S., & Stark, D. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003882.pub4 · Cited by 326 · see citing works
Association of Delivery Mode With Pelvic Floor Disorders After Childbirth.
Blomquist, J. L., Muñoz, A., Carroll, M., & Handa, V. L. (2018) · JAMA · doi:10.1001/jama.2018.18315 · Cited by 328 · see citing works
Brækken, I. H., Majida, M., Engh, M. E., & Bø, K. (2010) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2010.02.037 · Cited by 241 · see citing works
Pelvic floor function is independently associated with pelvic organ prolapse
Brækken, I., Majida, M., Ellström Engh, M., Holme, I., & Bø, K. (2009) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2009.02379.x · Cited by 146 · see citing works
DIETZ, H. P., FRANCO, A. V. M., SHEK, K. L., & KIRBY, A. (2012) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/j.1600-0412.2011.01315.x · Cited by 158 · see citing works
What's new in the functional anatomy of pelvic organ prolapse?
DeLancey, J. O. L. (2016) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0000000000000312 · Cited by 159 · see citing works
Self-citationWeemhoff, M., Vergeldt, T. F. M., Notten, K., Serroyen, J., Kampschoer, P. H. N. M., & Roumen, F. J. M. E. (2012) · International Urogynecology Journal · doi:10.1007/s00192-011-1524-y · Cited by 137 · see citing works
Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies
Giri, A., Hartmann, K. E., Hellwege, J. N., Velez Edwards, D. R., & Edwards, T. L. (2017) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2017.01.039 · Cited by 133 · see citing works
Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI
Hsu, Y., Chen, L., Summers, A., Ashton-Miller, J. A., & DeLancey, J. O. L. (2007) · International Urogynecology Journal · doi:10.1007/s00192-007-0405-x · Cited by 100 · see citing works
Self-citationPelvic organ prolapse as a function of levator ani avulsion, hiatus size, and strength
Handa, V. L., Roem, J., Blomquist, J. L., Dietz, H. P., & Muñoz, A. (2019) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2019.03.004 · Cited by 99 · see citing works
Pregnancy, labour and delivery as risk factors for pelvic organ prolapse: a systematic review
Cattani, L., Decoene, J., Page, A.-S., Weeg, N., Deprest, J., & Dietz, H. P. (2021) · International Urogynecology Journal · doi:10.1007/s00192-021-04724-y · Cited by 94 · see citing works
Genital hiatus size is associated with and predictive of apical vaginal support loss
Lowder, J. L., Oliphant, S. S., Shepherd, J. P., Ghetti, C., & Sutkin, G. (2016) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2015.12.027 · Cited by 83 · see citing works
Pelvic floor disorders after obstetric avulsion of the levator ani muscle
Handa, V. L., Blomquist, J. L., Roem, J., Muñoz, A., & Dietz, H. P. (2019) · Female Pelvic Medicine & Reconstructive Surgery · doi:10.1097/spv.0000000000000644 · Cited by 76 · see citing works
Resende, A. P. M., Bernardes, B. T., Stüpp, L., Oliveira, E., Castro, R. A., Girão, M. J. B. C., & Sartori, M. G. F. (2019) · Neurourology and Urodynamics · doi:10.1002/nau.23819 · Cited by 67 · see citing works
Bø, K., Anglès-Acedo, S., Batra, A., Brækken, I. H., Chan, Y. L., Jorge, C. H., Kruger, J., Yadav, M., & Dumoulin, C. (2022) · International Urogynecology Journal · doi:10.1007/s00192-022-05324-0 · Cited by 64 · see citing works
“Women with Pelvic Organ Prolapse Quantification system (POP-Q) stage II or more have 40–62% reduced PFM strength [14, 19], 53% reduced PFM endurance and lower vaginal resting pressure compared to matched controls with normal supports, defined as POP-Q stage 0 and I [19].”
Volløyhaug, I., Mørkved, S., Salvesen, Ø., & Salvesen, K. Å. (2015) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.14891 · Cited by 65 · see citing works
Association between pelvic floor muscle trauma and pelvic organ prolapse 20 years after delivery
Volløyhaug, I., Mørkved, S., & Salvesen, K. Å. (2016) · International Urogynecology Journal · doi:10.1007/s00192-015-2784-8 · Cited by 53 · see citing works
Brækken, I. H., Majida, M., Engh, M. E., & Bø, K. (2014) · Neurourology and Urodynamics · doi:10.1002/nau.22384 · Cited by 51 · see citing works
Early postpartum physical activity and pelvic floor support and symptoms 1 year postpartum
Nygaard, I. E., Wolpern, A., Bardsley, T., Egger, M. J., & Shaw, J. M. (2021) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2020.08.033 · Cited by 48 · see citing works
Notten, K. J. B., Kluivers, K. B., Fütterer, J. J., Schweitzer, K. J., Stoker, J., Mulder, F. E., Beets-Tan, R. G., Vliegen, R. F. A., Bossuyt, P. M., Kruitwagen, R. F. P. M., et al. (2014) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000000560 · Cited by 43 · see citing works
Family history and pelvic organ prolapse: a systematic review and meta-analysis
Samimi, P., Jones, S. H., & Giri, A. (2021) · International Urogynecology Journal · doi:10.1007/s00192-020-04559-z · Cited by 42 · see citing works
Siahkal, S. F., Iravani, M., Mohaghegh, Z., Sharifipour, F., Zahedian, M., & Nasab, M. B. (2021) · International Urogynecology Journal · doi:10.1007/s00192-020-04639-0 · Cited by 33 · see citing works
Hilde, G., Stær‐Jensen, J., Siafarikas, F., Gjestland, K., Ellström Engh, M., & Bø, K. (2013) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12321 · Cited by 32 · see citing works
van den Noort, F., Manzini, C., van der Vaart, C. H., van Limbeek, M. A. J., Slump, C. H., & Grob, A. T. M. (2022) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.24810 · Cited by 25 · see citing works
Anatomical Cystocele Recurrence: Development and Internal Validation of a Prediction Model
Vergeldt, T. F. M., van Kuijk, S. M. J., Notten, K. J. B., Kluivers, K. B., & Weemhoff, M. (2016) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000001272 · Cited by 25 · see citing works
Predictors of Success for Pelvic Floor Muscle Training in Pelvic Organ Prolapse
Wiegersma, M., Panman, C. M. C. R., Hesselink, L. C., Malmberg, A. G. A., Berger, M. Y., Kollen, B. J., & Dekker, J. H. (2019) · Physical Therapy · doi:10.1093/ptj/pzy114 · Cited by 17 · see citing works
Long-term outcomes and predictors of failure after surgery for stage IV apical pelvic organ prolapse
Linder, B. J., El-Nashar, S. A., Mukwege, A. A., Weaver, A. L., McGree, M. E., Rhodes, D. J., Gebhart, J. B., Klingele, C. J., Occhino, J. A., & Trabuco, E. C. (2018) · International Urogynecology Journal · doi:10.1007/s00192-017-3482-5 · Cited by 14 · see citing works
Impact of levator muscle avulsions on Manchester procedure outcomes in pelvic organ prolapse surgery
Oversand, S. H., Staff, A. C., Volløyhaug, I., & Svenningsen, R. (2019) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13604 · Cited by 13 · see citing works
Mastwyk, S., McClelland, J., Rosamilia, A., & Frawley, H. (2019) · Neurourology and Urodynamics · doi:10.1002/nau.24025 · Cited by 5 · see citing works
- Authors
- DeLancey, J. O. L., Morgan, D. M., Fenner, D. E., Kearney, R., Guire, K., Miller, J. M., Hussain, H., Umek, W., Hsu, Y., & Ashton-Miller, J. A.
- Affiliations
- University College Hospital (GB)
- ORCID
- Venue
- Obstetrics & Gynecology
- Published
- 2007-02
- Volume
- 109
- Issue
- 2, Part 1
- Pages
- 295-302
- ISSN
- 0029-7844 (ISSN-L)
- OpenAlex
- W2033220802
- Cited by
- 707
- References
- 31
- Citations by year
- 2026: 20 · 2025: 33 · 2024: 22 · 2023: 33 · 2022: 36 · 2021: 33 · 2020: 34 · 2019: 33 · 2018: 42 · 2017: 35 · 2016: 52 · 2015: 58 · 2014: 45 · 2013: 41 · 2012: 39
- FWCI
- 25.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD038665, R01 HD38665)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- pelvic organ prolapse, pelvic floor function, genital hiatus, forceps delivery, pelvic floor muscle contraction, pelvic floor support
- MeSH terms
- Adult, Aged, Female, Humans, Isometric Contraction, Magnetic Resonance Imaging, Middle Aged, Risk Factors, Severity of Illness Index, Uterine Prolapse, Case-Control Studies, Pelvic Floor, Muscle Strength
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