Skip to main content

Advertisement

SpringerLink
Log in

Association between 2D trans-perineal ultrasound and physical examination in evaluation of ani function

  • Published:
Journal of Ultrasound Aims and scope Submit manuscript

Abstract

Purpose

To compare the correlation between 2D transperineal ultrasonography and physical examination (intravaginal palpation) for assessing pelvic floor and levator ani function.

Methods

Due to symptoms of pelvic floor disorder, 40 women between the ages of 29 and 75 were enrolled in this study as candidates for urodynamic and structural evaluation of the pelvic floor. A pelvic floor gynaecologist and radiologist assessed the levator ani function via physical examination (graded based on the Oxford Grading System) and transperineal 2D ultrasound, respectively.

Results

The ultrasound parameters for calculating the Levator Ani Index (LAI) demonstrate a difference between the anteroposterior dimension of the levator hiatus (r = 0.691, p < 0.001) and the cranial shift of muscle (r = 0.499, p < 0.001) at rest and during a squeezing manoeuvre in the mid-sagittal plane. Reduced anteroposterior diameter of the hiatus and increased cranial shift were associated with a higher Oxford Physical Examination Score (OPES). The association between LAI and OPES was independent of baseline variables such as age, BMI, number of births, and the presence of incontinence symptoms.

Conclusion

Measures such as the LAI can be used to quantify the function of the levator ani muscle, which may be useful for evaluating the efficacy of pelvic floor physiotherapy and exercise.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

Related data is available from corresponding author upon reasonable demand.

Abbreviations

PFM:

Pelvic floor muscles

SD:

Standard deviation

LAI:

Levator Ani Index

BMI:

Body mass index

OPES:

Oxford Physical Examination Score

References

  1. Shafik A, El-Sibai O (2002) Study of the levator ani muscle in the multipara: role of levator dysfunction in defecation disorders. J Obstet Gynaecol 22:187–192

    Article  CAS  PubMed  Google Scholar 

  2. Arbuckle JL, Parden AM, Hoover K, et al. Prevalence and awareness of pelvic floor disorders in female adolescents seeking gynecologic care. J Pediatr Adolesc Gynecol. 2019;32:288–92.

  3. Bø K, Finckenhagen HB (2001) Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand 80:883–887

    PubMed  Google Scholar 

  4. Romero-Cullerés G, Peña-Pitarch E, Jané-Feixas C et al (2017) Intra-rater reliability and diagnostic accuracy of a new vaginal dynamometer to measure pelvic floor muscle strength in women with urinary incontinence. Neurourol Urodyn 36:333–337

    Article  PubMed  Google Scholar 

  5. Aw HC, Ranasinghe W, Tan PHM et al (2017) Overactive pelvic floor muscles (OPFM): improving diagnostic accuracy with clinical examination and functional studies. Transl Androl Urol 6:S64–S67

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tubaro A, Koelbl H, Laterza R et al (2011) Ultrasound imaging of the pelvic floor: where are we going? Neurourol Urodyn 30:729–734

    Article  PubMed  Google Scholar 

  7. Dietz HP (2010) Pelvic floor ultrasound: a review. Am J Obstet Gynecol 202:321–334

    Article  PubMed  Google Scholar 

  8. Thompson JA, O’Sullivan PB, Briffa K et al (2005) Assessment of pelvic floor movement using transabdominal and transperineal ultrasound. Int Urogynecol J 16:285–292

    Article  Google Scholar 

  9. Peng Q, Jones R, Shishido K et al (2007) Ultrasound evaluation of dynamic responses of female pelvic floor muscles. Ultrasound Med Biol 33:342–352

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jamard E, Blouet M, Thubert T, et al. Utility of 2D-ultrasound in pelvic floor muscle contraction and bladder neck mobility assessment in women with urinary incontinence. J Gynecol Obstet Hum Reprod. 2020;49(1):101629. https://doi.org/10.1016/j.jogoh.2019.101629. Epub 2019 Sep 6. PMID: 31499282.

  11. Albrich S, Steetskamp J, Knoechel S-L et al (2016) Assessment of pelvic floor muscle contractility: digital palpation versus 2D and 3D perineal ultrasound. Arch Gynecol Obstet 293:839–843

    Article  PubMed  Google Scholar 

  12. Lone F, Thakar R, Sultan A et al (2012) Accuracy of assessing pelvic organ prolapse quantification points using dynamic 2D transperineal ultrasound in women with pelvic organ prolapse. Int Urogynecol J 23:1555–1560

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Arvin Arian, Seyedehsahel Rasoulighasemlouei, Seyedeh Nooshin Miratashi Yazdi & Mehran Arab-Ahmadi

  2. Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Zinat Ghanbari

Authors
  1. Arvin Arian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zinat Ghanbari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seyedehsahel Rasoulighasemlouei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seyedeh Nooshin Miratashi Yazdi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehran Arab-Ahmadi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AA, ZG, SR, MA-A, SNMY. The first draft of the manuscript was written by SR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Seyedehsahel Rasoulighasemlouei.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical statements

The study was approved by institutional ethics committee and all the patients signed an informed written consent before their participation.

Consent to publish

The authors affirm that research participants provided informed consent for publication of the images in Figs. 2 and 3.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arian, A., Ghanbari, Z., Rasoulighasemlouei, S. et al. Association between 2D trans-perineal ultrasound and physical examination in evaluation of ani function. J Ultrasound 26, 423–428 (2023). https://doi.org/10.1007/s40477-023-00776-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40477-023-00776-6

Keywords

Search

Navigation