To study the effect of age and parity in pelvic floor anatomy in women with pelvic floor dysfunction and the changes in pelvic floor anatomy after a course of pelvic floor exercises.

A prospective study at Government Kilpauk Medical College (KMC), Chennai.

Patients with pelvic floor dysfunction are subjected to clinical examination and magnetic resonance imaging (MRI). The changes in anatomy are analyzed in terms of levator hiatus dimension and descent of the pelvic organs. Substratified analysis is done and mean diameters in each degree of prolapse are identified (Chi-square tests using cross tables). Patients with cystocele, rectocele, or enterocele are also compared in both clinical examination and MRI and the degree of correlation is measured (inter-rater kappa). The changes in pelvic floor anatomy in terms of H line, M line, and levator plate angle with respect to age and parity are studied. In patients with lower degrees of prolapse, the changes in anatomy in terms of H line, M line, and levator plate angle are studied after a course of pelvic floor exercises (post hoc tests and paired t-tests). The area under curve of receiver-operating curve in each degree of prolapse is seen and the critical cut-off value of the various anatomical parameters above which a patient develops a prolapse is calculated.

Ninety patients with symptoms of pelvic floor dysfunction were studied with clinical examination and MRI. Levator hiatus width cut off at rest above 5 cm and at straining above 5.8 cm develops clinical first-degree prolapse. Levator plate angle of more than 44.4° develops a clinical first-degree prolapse. With increasing age there is an increase in mean values of levator hiatus width at straining, levator plate angle, and descent of various organs. With increasing parity, there is an increase in mean values of levator hiatus width at rest and straining and increase in descent at straining.

Magnetic resonance imaging should be considered as a pretreatment planning tool when the physical findings are equivocal.

Shankar P, Gunasingh S. Role of Magnetic Resonance Imaging in the Diagnosis and Management of Pelvic Floor Dysfunction. J South Asian Feder Obst Gynae 2017;9(3):250-254.