Prolapse symptoms are associated with abnormal functional anatomy of the pelvic floor

Introduction and hypothesis The etiology of pelvic organ prolapse (POP) likely includes over-distension or tears (avulsion) of the levator ani muscle. However, there is a lack of studies evaluating the association between symptoms of POP and these factors. This study was designed to determine the association between POP symptoms and clinical prolapse stage on the one hand, and pelvic floor functional anatomy on the other hand. Methods This prospective observational study included 258 patients seen at a tertiary urogynecological unit with symptoms of POP as defined by pertinent ICIQ questions. After informed consent and a detailed history including ICIQ responses, 3D transperineal ultrasonography was performed using a GE Voluson i ultrasound system. Offline analysis was performed on de-identified datasets. Results The mean age of the patients was 60.6 years (25-91 years) and their mean BMI was 29.8 kg/m(2) (18-53 kg/m(2)). Levator defects were found in 78 (32.4%) of the patients and the defect was bilateral in almost half of these patients (n = 36). There were significant associations between awareness and visualization of a vaginal lump on the one hand and hiatal area measurements as well as diagnosis of avulsion on the other. Interference with everyday life was significantly associated with hiatal area and prolapse stage, but not with avulsion. Conclusions There is a significant association between awareness, visualization and/or feeling of a vaginal lump and abnormal pelvic floor functional anatomy, that is, hiatal ballooning and levator avulsion.