Original Article

International Urogynecology Journal

, 21:47

First online:

Levator ani defect status and lower urinary tract symptoms in women with pelvic organ prolapse

  • Daniel M. MorganAffiliated withPelvic Floor Research Group, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School Email author 
  • , Pamela CardozaAffiliated withPelvic Floor Research Group, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School
  • , Kenneth GuireAffiliated withDepartment of Biostatistics, University of Michigan Medical School
  • , Dee E. FennerAffiliated withPelvic Floor Research Group, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School
  • , John O. L. DeLanceyAffiliated withPelvic Floor Research Group, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School

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Abstract

Introduction and hypothesis

Among women with pelvic organ prolapse, compare rates of lower urinary tract symptoms by levator ani defect (LAD) status.

Methods

Urinary incontinence and obstructive voiding are analyzed among 151 women with prolapse whose LAD status was determined with magnetic resonance imaging.

Results

Women with major LAD are less likely to experience stress incontinence when “coughing, laughing, or sneezing” (odds ratio (OR) 0.27) and when “twisting, reaching, lifting, or bending over” (OR 0.26) than women with normal muscles. They are less likely to have obstructive symptoms characterized by assuming an “unusual toileting position” or “changing positions…to start or complete urination” (OR 0.27). Women with minor LAD are more likely to experience stress incontinence with exercise (OR 3.1) and urge incontinence (OR 4.0) than those with normal muscles.

Conclusions

Lower urinary tract symptoms are less common among women with prolapse and major levator ani defects and more common among those with minor defects.

Keywords

Levator ani Obstructive voiding Pelvic organ prolapse Urinary incontinence