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Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review

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Abstract

Transabdominal ultrasound was used to assess 104 women with incontinence and prolapse. The bladder was used as a marker of levator plate (LP) movement. The women were asked to draw in and lift the pelvic floor muscles (PFM) and a change in position of the LP in a cranial or caudal direction during contraction was documented. Three different patterns of movement of the LP were identified, with 38% of subjects elevating and 43% of subjects depressing the LP; 19% had no change in LP movement. In the stress incontinence group there was a higher than expected number that elevated the LP. In the urgency and prolapse groups there was a higher than expected number of subjects that depressed the LP (P=0.008).The results highlight three different subgroups based on the patients' attempt to initiate elevation of the LP. Subjects who depressed the LP when instructed to elevate it appeared to adopt straining strategies via the generation of intra-abdominal pressure. Depression of the LP may have long-term negative implications for prolapse and incontinence.

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Abbreviations

LP:

levator plate

PFM:

pelvic floor muscles

MRI:

magnetic resonance imaging

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Authors and Affiliations

  1. School of Physiotherapy, Curtin University of Technology, Shenton Park, 6008, Perth, Western Australia, Australia

    Judith A. Thompson & Peter B. O'Sullivan

Authors
  1. Judith A. Thompson
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  2. Peter B. O'Sullivan
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Correspondence to Judith A. Thompson.

Additional information

Editorial Comment: These authors present a descriptive analysis of patients with pelvic floor dysfunction who were observed with an abdominal ultrasound while attempting voluntarily to contract their pelvic floor muscles. There seems to have been significant bias when the initial classification of patients was made. It is important to recognize the limitations of this study design. This is a descriptive study, which is only capable of showing statistical associations between groups. No cause and effect relationships among these groups should be assumed. It seems reasonable that transabdominal ultrasound may have an important role when assessing pelvic muscle contractility. Using this technique to teach patients to contract their pelvic floor effectively would be an interesting application. Further research in this area will be welcomed.

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Thompson, J.A., O'Sullivan, P.B. Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review. Int Urogynecol J 14, 84–88 (2003). https://doi.org/10.1007/s00192-003-1036-5

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  • DOI: https://doi.org/10.1007/s00192-003-1036-5

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