P26.02: Correlation of ultrasound evidence of levator ani trauma with clinical functional testing of pelvic floor muscles

Childbirth-related injuries are one of the main causes of pelvic floor dysfunction. To attempt to avoid serious tears during delivery, an episiotomy can be performed. In this study, we intended to investigate the biomechanical performance of the pelvic floor muscles after performing different episiotomies using a physics-based computational model which includes the pelvic floor muscles and the fetus. Previous biomechanical studies have analysed the mechanical effects of single incisions of different lengths; in this study, we intend to analyse the implications of multiple small incisions, evaluating the reaction forces, the stress on the muscles and the loss of tissue integrity sustained by the pelvic floor. The obtained results predict that an episiotomy delivery reduces the likelihood of macroscopic levator trauma by decreasing the stress on the region of insertion of the rectal area of the levator ani in the symphysis pubis . From the mechanical point of view, multiple incisions do not bring benefits compared to larger incisions. However, nothing can be ascertained about the clinical benefit of such an approach.

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Management of Dyspareunia and Associated Levator Ani Muscle Overactivity

Physical Therapy ◽

10.2522/ptj.20060168 ◽

2007 ◽

Vol 87 (7) ◽

pp. 935-941 ◽

Cited By ~ 28

Author(s):

Kimberly A Fisher

Keyword(s):

Pelvic Floor ◽

Rating Scale ◽

Physical Therapist ◽

Management Strategies ◽

Levator Ani ◽

Pelvic Floor Muscles ◽

Future Research ◽

Levator Ani Muscle ◽

Home Based ◽

And Function

Background and PurposeMusculoskeletal dysfunction is a known cause of dyspareunia and a reason for referral for physical therapist management. The purpose of this case report is to describe the physical therapist management of a patient with dyspareunia and overactivity of the pelvic-floor muscles with a limited number of visits and a focus on self-management strategies.Case DescriptionThis case involved a 30-year-old married woman with levator ani muscle overactivity and dyspareunia that was 1 year in duration.InterventionThe therapist explained the anatomy and function of the pelvic-floor muscles during intercourse, instructed the patient on how to control the levator ani muscles, and instructed her on vaginal self-dilation techniques.OutcomesThe patient attended 3 physical therapy sessions over a period of 9 weeks. She performed vaginal self-dilation at home. She rated pain during intercourse as 0/10 on a verbal rating scale and had no remaining tenderness in the levator ani muscles at discharge.DiscussionSome women with dyspareunia may improve with an intervention that emphasizes education and vaginal self-dilation techniques. Future research should compare home-based and clinic-based treatments.

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S1839 Levator Ani or Pelvic Floor Muscles: What Is in the Name?

Gastroenterology ◽

10.1016/s0016-5085(08)61306-2 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-281

Author(s):

Varuna Raizada ◽

Sung-Ae Jung ◽

Robert F. Mattrey ◽

Milena M. Weinstein ◽

Dolores H. Pretorius ◽

...

Keyword(s):

Pelvic Floor ◽

Levator Ani ◽

Pelvic Floor Muscles

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Ultrasonic Diagnosis and Analysis of the Effect of Labor Analgesia on Early Pelvic Floor Function and Pelvic Floor Dysfunction

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3585 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1903-1910

Author(s):

Xiaolan Wang ◽

Fan Yang ◽

Wenjuan Chen ◽

Xiaohong Yuan

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Muscle ◽

Pelvic Floor Dysfunction ◽

Levator Ani ◽

Pelvic Floor Muscles ◽

Labor Analgesia ◽

Natural State ◽

Levator Ani Muscle ◽

Pelvic Floor Function ◽

Floor Function

Pelvic floor dysfunction disease (PFD) is a common pelvic organ dysfunction disease in the clinic of obstetrics and gynecology. Its cause is mainly the damage, defects and dysfunction of the pelvic floor support structure. Not only is the pathogenesis complicated, but also various symptoms coexist, which seriously affects the physical and mental health of female patients. Mechanical injury of the pelvic floor fascia tissue and levator ani muscles is the anatomical basis of PFD after birth; early postpartum pelvic floor examination and treatment can prevent and control the occurrence or development of PFD. Spinal canal anesthesia has good analgesic effect during labor and delivery, has little effect on mothers and infants, and is widely used. However, there are few domestic and foreign reports on the effect of labor analgesia on the pelvic floor. Labor analgesia relaxes the pelvic floor muscles, unblocks the birth canal, and the influence on the pelvic floor muscles is worth exploring. Based on the pelvic floor muscle strength screening to understand the changes in the function of the pelvic floor muscles, combined with the three-dimensional pelvic floor ultrasound examination, the pelvic floor structure and the levator ani muscle are clearly imaged, and the pelvic floor muscle structure is evaluated in the natural state and the analgesic muscle relaxation state. This study used a combination of the two to evaluate the effect of labor analgesia on pelvic floor function of primiparous women; provide individualized intervention treatment for high-risk groups screened; provide clinical basis for the prevention and treatment of PFD.

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P-23 A FINITE ELEMENT MODEL OF THE M. LEVATOR ANI BASED ON MRI FOR THE PELVIC FLOOR MUSCLES

The Proceedings of the Asian Pacific Conference on Biomechanics emerging science and technology in biomechanics ◽

10.1299/jsmeapbio.2007.3.s111 ◽

2007 ◽

Vol 2007.3 (0) ◽

pp. S111

Author(s):

Hongfang Song ◽

Le Ma ◽

Linlin Lei ◽

Zhicheng Liu

Keyword(s):

Finite Element ◽

Finite Element Model ◽

Pelvic Floor ◽

Levator Ani ◽

Element Model ◽

Pelvic Floor Muscles

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Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00111.2010 ◽

2010 ◽

Vol 299 (2) ◽

pp. R416-R438 ◽

Cited By ~ 63

Author(s):

Karl B. Thor ◽

William C. de Groat

Keyword(s):

Pelvic Floor ◽

Motor Neurons ◽

Basic Science ◽

Neural Control ◽

Levator Ani ◽

Pelvic Floor Muscles ◽

Urinary Continence ◽

Onuf's Nucleus ◽

Onuf’S Nucleus ◽

Pelvic Muscles

The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided.

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