Correlação entre as disfunções do assoalho pélvico e o defeito do músculo levantador do ânus em mulheres após parto vaginal utilizando a ultrassonografia tridmensional dinâmica anorretal e endovaginal

Abstract

Pelvic floor dysfunction (PFD) is a common condition that affects approximately one third of adult women, presenting with symptoms of the genitourinary and intestinal tracts. The relationships between abnormalities found in imaging exams, dysfunction and symptoms remain unclear in women with defects of the levator ani muscle (LAM). The aim of this study was to investigate correlations between defects in the LAM, symptoms related to anorectal and/or urinary disorders, dynamic dysfunctions, anatomical abnormalities of the sphincter muscles and dimensions of the levator hiatus in women previously submitted to vaginal delivery, using three-dimensional dynamic ultrasonography with anorectal (USAR) and endovaginal (EVUS) access. A cross-sectional study was carried out, including 92 women with a history of vaginal delivery, with a mean age of 59.8 years, all of whom underwent USAR and EVUS; they were divided into two groups: GI: with defective LAM (34%); and GII: with MLA without defect (66%); they were compared regarding symptoms, anatomical abnormalities and dynamic dysfunctions. Fecal incontinence (FI) was observed in 55.4% of patients, symptoms of obstructed defecation (OD) constipation in 83.7% and urinary incontinence (UI) in 23.9%. The prevalence and severity of FI were higher in GI patients. In contrast, the prevalence of constipation/OD was higher in GII, while UI symptoms were similar between groups. Ultrasound findings demonstrate that sphincter defects and the levator hiatus area, at rest and during the Valsalva maneuver, were significantly higher in GI patients. However, the prevalence of cystocele, rectocele, intussusception, anismus, perineal descent and enterosigmoidocele were similar between the two groups. It is concluded that the presence of MLA defects was associated with a higher rate and severity of FI, a higher rate of sphincter defects and an increase in the levator hiatus area at rest and during the Valsalva maneuver, compared to women with intact MLA. MLA defects were not related to constipation/OD, UI and the presence of cystocele, rectocele, enterosigmoidocele, anismus, perineal descent or intussusception.