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

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.

Appendix 1: Questionnaire protocol

Stress urinary incontinence (SUI):

• 1. “In the past month, have you leaked urine when you coughed, laughed, or sneezed?”

Responses to SUI item 1: “never, occasionally (once or twice), on about half the occasions, on most, or all of the occasions.”

• 2. “Do you experience urine leakage related to lifting, reaching, twisting, or bending over?”

• 3. “Do you experience urine leakage when you go from sitting to standing?”

• 4. “Do you experience urine leakage related to physical exercise such as walking, running, aerobics, or tennis?”

Responses to SUI items 2–4: “never, on an occasional day, on most days, or on every day.”

Urge urinary incontinence (UUI)

• 1. “In the past month, have you leaked urine when you were on your way to the toilet?”

• 2. “In the past month, have you leaked urine when you had to wait to use the toilet?”

• 3. “In the past month, have you leaked urine when you did not go to the toilet immediately when you first felt the urge?”

Responses to UUI items 1–3: “never, occasionally (once or twice), on about half the occasions, on most, or all of the occasions.”

• 4. “Do you experience urine leakage associated with a feeling of urgency, that is, a strong sensation of needing to go to the bathroom?”

Responses to UUI item 4: “never, on an occasional day, on most days, or on every day.”

Obstructive voiding (OV):

• 1. “When you urinate, does your stream start and stop and start again before you are finally finished?”

• 2. “Do you experience a feeling of incomplete bladder emptying?”

• 3. “Do you have a weak urine stream or feel that you take too long to empty your bladder?”

• 4. “Do you assume an unusual toileting position or change positions in order to start or complete urination?”

• 5. “Do you have to push up on a bulge in the vaginal area with your fingers to start or complete urination?”

• 6. “Do you have to push on your lower abdomen to start or complete urination?”

Responses to OV items 1–6: “never, on an occasional day, on most days, or on every day.”