Introduction and hypothesis: Major levator ani abnormalities (LAA) may lead to abnormal pelvic floor muscle contraction (pfmC) and secondarily to stress urinary incontinence (SUI), prolapse, or fecal incontinence (FI). Methods: A retrospective observational study included 352 symptomatic patients to determine prevalence of LAA in underactive pfmC and the relationship with symptoms. On 2D/3D transperineal ultrasound, PfmC was subjectively assessed as underactive (UpfmC) or normal (NpfmC) and quantified. LAA, defined as a complete avulsion of the pubic bone, was analyzed using tomographic ultrasound imaging. Results: LAA were found in 53.8% of women with UpfmC versus 16.1% in NpfmC (P<0.001). Patients with UpfmC were less likely to reduce hiatal area on pfmC (mean 7% reduction vs 25% in NpfmC (P<0.001)). An UpfmC was associated with FI (P=0.002), not with SUI or prolapse of the anterior and central compartment. Conclusion: An underactive pfmC is associated with increased prevalence of LAA and FI.

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Keywords Fecal incontinence, Levator ani abnormalities, Pelvic floor muscle contraction, Prolapse, Stress urinary incontinence, Transperineal ultrasound
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Steensma, A.B., Konstantinovic, M.L., Burger, C.W., de Ridder, D., Timmerman, D., & Deprest, J.A.. (2010). Prevalence of major levator abnormalities in symptomatic patients with an underactive pelvic floor contraction. International Urogynecology Journal: and pelvic floor dysfunction, 21(7), 861–867. doi:10.1007/s00192-010-1111-7