Ultrasongraphic age-related changes of the pelvic floor muscles in nulliparous women and their association with pelvic floor symptoms: A pilot study

Objective: To assess age-related changes in the pelvic floor muscular hiatus and their association with symptoms of pelvic organ prolapse, urinary and fecal incontinence, and sexual function. Methods: In this pilot study we performed 3D endovaginal ultrasonography in two age groups of nulliparous women: 18 to 40 years and 52 to 85 years. Anterior-posterior (AP) diameter, left-right (LR) diameter, and the Minimal Levator Hiatus area were measured. The AP/LR ratio was calculated to compare the shape of the pelvic floor muscles between participants (oval vs circular). Other measurements included length of the urethra, and levator plate lift. Participants were assessed for (1) distress symptoms of pelvic floor prolapse, urinary, and fecal symptoms by the Pelvic Floor Distress Inventory-20, (2) quality of life via the pelvic floor impact inventory-7, and (3) sexual function by the female sexual function inventory (FSFI-19). Results: A total of 12 women into the younger group and 10 to the older group were recruited. Older women had higher AP/LR ratio and longer distance levator plate lift while performing the squeeze maneuver (P = 0.017 and 0.038, respectively). Older women had worse urinary and pelvic organ prolapse symptoms (P = 0.002 and 0.004, respectively). Fewer women in the older group were sexually active (60% vs 92%) and their quality of sexual life was lower based on their FSFI-19 results. Conclusion: Levator ani muscle hiatus changes to a more oval form in older nulliparous postmenopausal women and this change in shape is associated with increased pelvic floor symptoms.