The association between levator plate integrity and pelvic floor defaecatory dysfunction.

Area of Science:

• Pelvic floor disorders
• Colorectal surgery
• Urogynecology

Background:

• Levator ani deficiency is implicated in anterior pelvic floor pathology.
• Its association with pelvic floor defaecatory dysfunction is less clear.

Purpose of the Study:

• To examine the relationship between levator ani deficiency and anatomical abnormalities (rectocele, intussusception, enterocele, perineal descent).
• To investigate the association between levator ani deficiency and patient symptoms (bowel, vagina) in those with pelvic floor defaecatory dysfunction.

Main Methods:

• Prospective observational case series of 223 women with defaecatory dysfunction.
• Assessment included symptom severity and quality of life (QoL) scores, integrated total pelvic floor ultrasound (PFUS), and defaecation proctography (DP).
• Levator ani deficiency was scored using endovaginal ultrasound (mild, moderate, severe).

Main Results:

• The proportion of patients with rectocele, enterocele, and intussusception increased with worsening levator ani deficiency.
• Weakly positive correlations were found between rectocele size, intussusception, enterocele, perineal descent, and levator ani deficiency.
• No association was found between bowel symptoms or QoL scores and levator ani deficiency; however, vaginal symptoms were associated.

Conclusions:

• Anatomical abnormalities associated with pelvic floor defaecatory dysfunction correlate with increased levator ani deficiency.
• While bowel symptoms are not linked, vaginal symptoms are associated with levator ani deficiency.