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Correlation between pelvic floor ultrasound parameters and vaginal pressures in nulliparous women: a subanalysis of the SUM-AN study

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Abstract

Introduction and hypothesis

Pelvic floor ultrasound is used as a validated technique for measuring levator ani dimensions. Vaginal manometry has been used in the past as a method to assess levator ani muscle (LAM) strength. Whether the combination of both methods can contribute to our understanding of pelvic floor pathophysiology has not yet been described. We hypothesized that as female pelvic floor muscular hiatus increases, the vaginal pressure and strength decrease.

Methods

We recruited 20 asymptomatic nulliparous women ages 18–85 years. Minimal levator hiatus (MLH) area, anteroposterior/left-right (AP/LR) diameter ratio, the distance between levator plate and the pubic symphysis (LP-PS) while at rest and squeeze were measured using endovaginal ultrasound (US). Vaginal pressure at rest, squeeze (Kegel) and Valsalva were measured using 3D manometry. Logistic and linear regression analysis was performed to assess correlations.

Results

MLH area was negatively correlated with the sum of all the squeeze pressures produced on the four walls of the vagina (p = 0.049, R2 = 0.197). There was also a borderline negative correlation between MLH and the sum of rest pressures (p = 0.09, R2 = 0.15). AP/LR ratio was negatively correlated with the sum of squeeze pressures (p = 0.056, R2 = 0.197). LP-PS distances, both while at rest and during squeeze, were negatively correlated with the vaginal squeeze pressure (p = 0.046, R2 = 0.21; p = 0.011, R2 = 0.31, respectively). LP-V distance, both at rest and during squeeze, was negatively correlated with the sum of squeeze pressures on four vaginal walls (p = 0.02, R2 = 0.25; p = 0.005, R2 = 0.36, respectively).

Conclusions

Stronger levator ani muscles, smaller MLH area and a more oval shape of pelvic floor hiatus as assessed by pelvic floor ultrasound are associated with higher squeeze vaginal pressures as assessed by 3D manometry.

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Acknowledgments

This study was funded by an INOVA seed grant.

Dr. Alshiek was funded by a research scholar grant from the International Continence Society and The American Healthcare Professionals and Friends of Medicine in Israel (APF).

The authors received no assistance—directly or indirectly—from any individuals or companies for the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Obstetrics & Gynecology, INOVA Women’s Hospital, 3300 Gallows Road, Second floor South tower, Falls Church, VA, 22042-3307, USA

    Jonia Alshiek & S. Abbas Shobeiri

  2. Bioengineering, George Mason University, Fairfax, VA, USA

    Jonia Alshiek, Qi Wei & S. Abbas Shobeiri

Authors
  1. Jonia Alshiek
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  2. Qi Wei
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  3. S. Abbas Shobeiri
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Contributions

Jonia Alshiek, MD, MSc: Protocol development, data collection, manuscript writing.

Qi Wei, PhD: Protocol development, data collection, manuscript writing.

S. Abbas Shobeiri, MD, MBA: Protocol development, data collection, manuscript writing.

Corresponding author

Correspondence to S. Abbas Shobeiri.

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Alshiek, J., Wei, Q. & Shobeiri, S.A. Correlation between pelvic floor ultrasound parameters and vaginal pressures in nulliparous women: a subanalysis of the SUM-AN study. Int Urogynecol J 33, 1481–1487 (2022). https://doi.org/10.1007/s00192-022-05117-5

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