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At least 91 records · Page 5Linked to original sources
PubMed2005

MRI morphology of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence.

OBJECTIVE: To evaluate pathomorphologic changes of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence (SUI) by MRI. STUDY DESIGN: Fifty-four women with SUI were examined by MRI (1.5T): body phased-array coil, axial and coronal proton-density-weighted sequences. RESULTS: The urethral sphincter muscle showed a reduced thickness of its posterior portion (37%), an omega shape (13%) or higher signal intensity (50%); its abnormal configuration was associated with an increased signal intensity in 70% (p=0.001). The levator ani muscle comprised an unilateral loss of substance in 30%, a higher signal intensity in 28%, and altered origin in 19%. Central defects of the endopelvic fascia were present in 39% (n=21), lateral defects in 46%. There was a significant association between loss of the symphyseal concavity of the anterior vaginal wall and lateral fascial defects (p=0.001) and levator ani changes (p=0.016). CONCLUSION: MRI yields findings supporting current theories on the pathogenesis of SUI.

Adult↗
PubMed2004

Histochemical and stereological analysis of the levator ani (pubocaudal) muscle in nulliparous and multiparous beagles.

Fiber-type composition and several stereological parameters of the levator ani (pubocaudal) muscle were evaluated in five nulliparous and five multiparous beagles using myosin ATPase-histochemistry and systematically selected muscle cross-sections. With respect to the narrow canine pelvic cavity, this study was also undertaken to determine whether vaginal birth of at least seven litters causes similar neuromuscular changes in the canine levator ani (pubocaudal) muscle analoguous to those seen in the pelvic floor muscles of women after vaginal delivery. The canine pubocaudal muscle is comprised of approximately equal amounts of slow twitch type I and fast twitch type II (IIA, IIS) fibers. The muscles of both the nulliparous and multiparous beagles did not display any signs indicative of denervation or myopathology. The multiparous dogs exhibited significantly increased mean absolute muscle (1720 mm(3)) and total fiber-type I volumes (850 mm(3)) as well as relevantly increased mean diameter of type I fibers (72.0 microm) when compared with the nulliparous group. The canine levator ani (pubocaudal) muscle is not pathologically affected by vaginal deliveries and seems to adapt to numerous successive pregnancies and births through fiber-type I hypertrophy.

Animals↗
PubMed2003

[Treatment of vesicovaginal fistulas using the musculofascial flap of the levator ani muscle: 26 case reports].

OBJECTIVE: The authors reported the preliminary results of levator ani muscle flap in the treatment of vesicovaginal fistula. MATERIALS AND METHODS: Twenty-six patients whose age varied between 13 and 18 years (mean: 30 years) are selected. All the patients are treated by the vaginal approach using the part of superficial rectal fibers of the levator ani muscle. RESULTS: Among the 26 patients, 14 are free after the first cure of vesicovaginal fistula (54%), and 4 patients (15%), after the treatment of some complications. CONCLUSION: The musculofascial levator ani flap with its vascular pedicle and its mobilisation can successfully close the vesicovaginal fistula. The preliminary results obtained (88%) tie up with that previously described in the literature.

Adolescent↗
PubMed1981

Cytosolic androgen receptor in regenerating rat levator ani muscle.

The development of the cytosolic androgen receptor was studied after degeneration and regeneration of the rat levator ani muscle after a crush lesion. Muscle regeneration appears to recapitulate myogenesis in many respects. It therefore provides a model tissue in sufficiently in large quantity for investigating the ontogenesis of the androgen receptor. The receptor in the cytosol of the normal levator ani muscle has binding characteristics similar to those of the cytosolic receptor in other androgen-sensitive tissues. By day 3 after a crush lesion of the levator ani muscle, androgen binding decreased to 25% of control values. This decrease was followed by a 4-5 fold increase in hormone binding, which attained control values by day 7 after crush. Androgen binding remained stable at the control value up to day 60 after crushing. These results were correlated with the morphological development of the regenerating muscle after crushing. It is concluded that there is little, if any, androgen receptor present in the early myoblastic stages of regeneration; rather, synthesis of the receptor may occur after the fusion of myoblasts and during the differentiation of myotubes into cross-striated muscle fibres.

Anal Canal↗
PubMed2003

Indices for studying urinary incontinence and levator ani function in primiparous women.

Urinary incontinence (UI) is a complex phenomenon that is prevalent in pregnant and parous women and requires the use of sophisticated measures to adequately reflect functioning of the continence system. The purpose of this study was to develop reliable and valid measures of UI and levator ani function for use in research and clinical settings. A Leakage Index (LI) and a Levator Ani Function Index (LAFI) were developed using data from a longitudinal study of primiparous women. Reliability and validity tests were conducted to: (i) estimate the internal consistency reliability of each index, (ii) determine whether the indices captured change in continence status and pelvic floor function during pregnancy through 1 year postpartum, and (iii) estimate association between the indices as a test of predictive validity. Cronbach's alpha ranged from 0.72 to 0.84 for the LI and from 0.53 to 0.79 for the LAFI across the six data collection time points of the study. Average LI scores increased late in pregnancy and decreased postpartum, though not significantly. Average LAFI scores decreased significantly at 35 weeks gestation (t = 4.84, P = 0.000) and increased significantly at 12 months postpartum (t = -3.51, P = 0.002) relative to baseline. The LI and LAFI were significantly associated at 20 weeks gestation (Pearson r = -0.40, P = 0.007) and at 6 weeks postpartum (Pearson r = -0.33, P = 0.029). The findings suggest the LI and LAFI are reliable and valid measures of UI and levator ani function in primiparous women, which can be used with confidence in clinical and research settings.

Adolescent↗
PubMed2002

Intra-dermal methylene blue, hydrocortisone and lignocaine for chronic, intractable pruritus ani.

OBJECTIVE: To assess the use of intradermal methylene blue, lignocaine and hydrocortisone in cases of chronic pruritus ani refractory to standard primary, dermatological and colorectal care. METHODS: Five ml 1% methylene blue, 100 mg hydrocortisone and 15 ml 1% lignocaine were injected into the peri-anal skin of 25 patients with chronic pruritus ani which had proved refractory to standard care. Clinical and telephone follow-up was undertaken. RESULTS: After one injection of the above solution, 16 (64%) of patients were rendered symptom free. Repeat injection in those initial nonresponders ultimately rendered 22 (88%) symptom free overall. Morbidity was 4%. Treatment failure occurred in three patients (12%). CONCLUSIONS: Methylene blue used in solution with hydrocortisone and lignocaine can achieve effective control of pruritus ani in 88% of patients who have failed to respond to standard dermatological, hygiene and surgical treatments.

Journal Article↗
PubMed2003

Anatomic variations in the levator ani muscle, endopelvic fascia, and urethra in nulliparas evaluated by magnetic resonance imaging.

OBJECTIVE: The purpose of this study was to develop a system to quantify interindividual variation in the appearance of continence system structures in normal continent nulliparous women. STUDY DESIGN: Magnetic resonance imaging (1.5 T) was performed in 20 healthy continent nulliparous women (mean age, 30.1 +/- 5.1 years) with normal pelvic organ support and urodynamics. Morphometric measurements of the levator ani muscle, endopelvic fascia, and urethra were performed. RESULTS: The ratio of the maximum-to-minimum measured values shows that 2- to 3-fold differences occur in distance, area, or volume measures of continence system morphologic features. The mean urogenital hiatus area was 15.2 +/- 2.9 cm(2) in women without a visible connection of the levator ani muscle to the pubic bone (4/20 women) and 12.3 +/- 2.4 cm(2) in women with an levator ani muscle-pubic bone connection (16/20 women, P =.05). CONCLUSION: Considerable variation that was not attributable to limitations of the measuring technique that was used occurs in the size and configuration of the urethral support structures in nulliparous asymptomatic women.

Adult↗
PubMed1975

New concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. II. Anatomy of the levator ani muscle with special reference to puborectalis.

A study of the surgical anatomy of the levator ani muscles, with special stress on the puborectalis, was performed on 22 cadaveric specimens. The study comprised dissection and microscopic examination. The levator ani was found to consist of two portions only: pubococcygeus and iliococcygeus, the puborectalis being a part of the external anal sphincter. Both levatores decussate at the anococcygeal raphe, which represents a "decussation line" and not a site of insertion for the muscle fibers. A "digastric" pattern of the levator is demonstrated, which is responsible for the harmonic nature of the function of the muscle bundles on each side of the pelvis. The levator hiatus was found to be formed of the medial borders of the pubococcygeus, , and not the puborectalis. A "hiatal ligament" was identified, stretched between the edges of the levator hiatus and the intrahiatal viscera. The role of the pubococcygeus in anal fixation is discussed, and a new concept that the puborectalis does not belong to the levator ani but constitutes na integral portion of the external and sphincter. The puborectalis and the deep external anal sphincter were found to be fused together and identical from the morphologic, histologic, and functional points of view as well as with respect to innervation. Both form a single U-shaped loop which is given the name "top loop."

Adolescent↗
PubMed2003

[Quantitative analysis of motoneurons innervating the muscle levator ani in rats with anorectal malformation].

OBJECTIVE: To quantify the motorneurons innervating the muscle levator ani (rat equivalent of puborectalis in human) by retrograde tract-tracing in a rat model of anorectal malformation. METHODS: Anorectal malformation is induced in fetuses by gavage feeding of ethylenethiourea (ETU; 125 mg/kg body weigh) to pregnant outbreed Wistar rats at day 11 of gestation. At E20, fetal surgery was performed to expose the muscle levator ani and fluorogold (FG) was injected. Fetuses were collected 24 hours later, fixed by paraformaldehyde infusion cardially. The lumbosacral spinal cord was removed for cryosection. Serial longitudinal sections (60 micro m) encompassing the whole width of lumbosacral spinal cord were studied with fluorescent microscopy. The number of FG-labelled motoneurons were scored and compared between fetuses with or without malformation in the ETU-injection group, and normal controls. RESULTS: In the ETU-injection group, 55.6% (95/171) of fetuses displayed anorectal malformation, 56.7% of fetuses displayed anomalies of neural tube. FG was injected to the muscle levator ani of 8 fetuses without defects of anorectum or neural tube, 5 fetuses with imperforate anus only, 10 fetuses with anomalies of neural tube, and 15 fetuses with combined imperforate anus and anomalies of neural tube. Fetuses (n = 9) from non-injected with ETU group were injected with FG as normal controls. The total number of FG-labelled motoneurons in the fetuses without defects of anorectum and neural tube, with imperforate anus, with anomalies of neural tube, with combined imperforate anus and anomalies of neural tube, and normal controls were 109 +/- 38, 55 +/- 26, 48 +/- 30, 54 +/- 29 and 135 +/- 29 respectively. FG-labelled motoneurons in the fetuses with imperforate anus, anomalies of neural tube, and combined imperforate anus and anomalies of neural tube are significantly fewer than that in fetuses without defects of anorectum or neural tube (P < 0.05), and in normal controls (P < 0.005). The number of FG-labelled motoneurons did not differ between the fetuses without defects of anorectum or neural tube and normal controls (P > 0.05). CONCLUSION: Fewer motoneurons that innervates the puborectalis may contribute to the poor postoperative anorectal function in patients with anorectal malformation.

Abnormalities, Multiple↗
PubMed2003

Electrical stimulation in the treatment of pelvic pain due to levator ani spasm.

OBJECTIVE: To evaluate experience with intravaginal electrical stimulation for the relief of pain when used as adjunctive therapy in women with chronic pelvic pain and levator ani spasm. STUDY DESIGN: A retrospective cohort of consecutively treated patients from 1999 and 2000 was identified using billing records. Systematic chart review was completed using standardized data collection forms for all patients receiving electrical stimulation for pain from levator ani spasm. Data collected were objective for major variables and subjective for outcomes. Demographic data were reported as means and standard deviations. Stimulation characteristics were compared using ANOVA. Survival analysis was performed using life table methods. RESULTS: Medical records from 66 consecutive patients treated during an 18-month interval were reviewed. Demographic characteristics included mean age of 38.7 years, 13 years of education and parity of 2. Married women composed 75% of the study group, with 81% white, 10% Hispanic and 9% black. Of the 66 patients studied, 50 had follow-up documentation with an average duration of 14.5 weeks. Overall, 34 patients (52%) demonstrated improvement in pelvic pain following vaginal electrical stimulation. Using survival analysis, 51% of patients had persistent improvement 30 weeks after treatment. There were no differences in age, race, education or parity between patients reporting a sustained benefit of stimulation and those not reporting a benefit. CONCLUSION: Vaginal electrical stimulation may help a selected population of women with pelvic pain due to levator ani spasm.

Adolescent↗
PubMed1989

[Levator muscles pf the anus (levator ani). Normal or pathological cytoarchitecture of endorectal biopsies in man].

The structure and ultrastructure of normal or pathological needle biopsies of the human levator ani are studied. Disturbances of the muscular cyto-architecture: cellular degeneration with infiltration of glycogen and disorganization of the myofibrillar A, I and Z stripes are shown. The comparison between the histological data and the clinical results demonstrates that the quality of the levator ani is not always clearly defined by the clinic. The muscular biopsy reaches its main interest when in physical reeducation or in surgical correction of the incontinence, some doubt remains on the clinical value of the levator ani.

Anal Canal↗
PubMed1988

Coccygeus and levator ani muscles in the rabbit: morphology and proprioceptive innervation.

The Authors have studied the morphological features and the proprioceptive nervous component in the coccygeus and levator ani muscles of the rabbit, using Ruffini's and Barker-Ip's impregnations. The coccygeus muscle originates from ischiatic spine and inserts on the last three sacral vertebrae and on the first four or five caudal vertebrae. The levator ani muscle originates from the ischiatic spine and the coccygeus muscle aponeurosis and inserts directly on the caudal vertebrae 3-5 or 4-6. The proprioceptive innervation in both muscles is constituted by muscle spindles and Golgi tendon organs with a typical structure. Muscle spindles are more numerous than Golgi tendon organs and the spindle density is higher in the levator ani muscle.

Animals↗
PubMed1982

[Anatomic and tomodensitometric study of the levator ani muscle in infants].

A double anatomic and computed tomographic study of the muscle levator ani has been performed in pediatric patients. In or study, we have used frozen anatomical specimens. The anatomic and computed tomographic sections have been made strictly comparable, every 3 millimeters. These actions provide the normal computed tomographic aspect of the muscle levator ani. This anatomic study may have a direct application in the evaluation of imperforate anus, which is often difficult to diagnose : it allows a more precise determination of the level of the terminal rectal pouch compared to the level of the levator ani.

Anal Canal↗
PubMed1994

Pruritus ani. Causes and concerns.

PURPOSE: The aim of this study was to determine how frequently pruritus ani (PA) is a symptom secondary to benign or malignant colon and anorectal pathology. METHODS: One hundred nine patients with PA as the only presenting symptom were prospectively evaluated over a two-year period. All patients underwent anoscopy, rigid proctoscopy, and colonoscopy and were treated for PA. Patient data were entered into a computer data base and analyzed. RESULTS: The mean age was 52.1 years; males outnumbered females 2:1. The mean duration of symptoms was 6.1 weeks. Mean coffee intake was four cups per day. Forty-five percent of patients smoked and 45 percent drank alcohol daily. Thirty-five percent had an abnormal proctosigmoidoscopy or colonoscopy. Twenty-seven (25 percent) patients had primary pruritus and 82 (75 percent) patients had coexisting colon or anorectal pathology. The PA-associated neoplasia included rectal cancer (11 percent), anal cancer (6 percent), adenomatous polyps (4 percent), and colon cancer (2 percent). Hemorrhoids (20 percent) and anal fissures (12 percent) were the most common pruritus-related anorectal diseases. Among the 23 percent of patients with PA and neoplasia, pruritic symptoms were present longer compared with those with PA and anorectal disease < 0.001 and primary pruritus (P < 0.0001). All patients with primary PA were initially treated with dietary fibers, steroid cream, and drying agents. The recurrence rate for primary pruritus was twice that for anorectal disease (P < 0.0001). CONCLUSIONS: PA responds to treatment in 89 percent of patients, while 11 percent are refractory to treatment. Symptoms suggestive of pruritus ani, especially those of long duration, should alert the surgeon to the potential for proximal colon and anorectal neoplasia.

Adenomatous Polyps↗
PubMedDate not supplied

Prospective studies on the etiology and treatment of pruritus ani.

Seventy-five patients presented with the complaint of pruritus ani. The following prospective studies were employed to evaluate groups of these patients; (1) laboratory, including blood count, stool examination for ova and parasites, urinalysis, Sequential Multiple Analysis-12 serum studies, stool pH, and skin scrapings for fungi; (2) Minnesota Multiphasic Personality Inventory; (3) anal manometry; (4) elimination of dietary factors, and (5) topical ointment application. Many patients were concerned that a cancer caused the symptom. Once reassured, they tolerated the pruritus. Forty-eight to 50 per cent of these patients had poorly formed stools or incomplete stool evacuation; thus, soiling was frequent. An underlying skin problem was found in six patients with psoriasis and in one with erythrasma. Patients tended to worsen the problem by application of many medications and overzealous cleaning. Minor surgical problems of the anus should be corrected before other managements are instituted. Idiopathic pruritus ani responds to anal cleanliness, dietary discretion with avoidance of specific items by some patients, bowel habit regulation, and a mild topical hydrocortisone cream.

Administration, Topical↗
PubMedDate not supplied

The cause and treatment of idiopathic pruritus ani.

Six common foods can cause the clinical entity called "idiopathic" pruritus ani. They are coffee, tea, cola, beer, chocolate, and tomatoes. Pruritus ani occurs in 24 to 48 hours when a patient consumers more than a threshold amount of one or more of these foods and disappears spontaneously in a few days provided the threshold is not exceeded again.

Beverages↗
PubMed1999

Anorectal pain and irritation: anal fissure, levator syndrome, proctalgia fugax, and pruritus ani.

Anal fissures, proctalgia fugax, levator ani syndrome, and pruritus ani are common causes of anorectal pain and irritation. The clinician who obtains a thorough history and performs a complete examination can accurately diagnose these disorders. Ancillary tests seldom are helpful and rarely are necessary. Most patients suffering from these conditions readily respond to conservative therapy provided in the primary care practitioner's office.

Anus Diseases↗
PubMed1979

Pruritus ani: is anal sphincter dysfunction important in aetiology?

Forty-three patients whose principal symptom was pruritus ani were studied. Twenty-eight had anal disease, while in 15 no such disease could be shown. Maximum resting pressures and transient and sustained pressures of the anal canal in response to rectal distension were measured by manometry. Although the maximum resting pressure in the patients with no disease was about the same as that in the group with disease, the pressures recorded in response to rectal distension were significantly lower. These results show that the anal sphincter relaxes in response to rectal distension more readily in patients with no anal disease. Hence soiling may occur, which may be a factor in the genesis of pruritus ani.

Adult↗