Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review

Transabdominal ultrasound was used to assess 104 women with incontinence and prolapse. The bladder was used as a marker of levator plate (LP) movement. The women were asked to draw in and lift the pelvic floor muscles (PFM) and a change in position of the LP in a cranial or caudal direction during contraction was documented. Three different patterns of movement of the LP were identified, with 38% of subjects elevating and 43% of subjects depressing the LP; 19% had no change in LP movement. In the stress incontinence group there was a higher than expected number that elevated the LP. In the urgency and prolapse groups there was a higher than expected number of subjects that depressed the LP (P=0.008).The results highlight three different subgroups based on the patients' attempt to initiate elevation of the LP. Subjects who depressed the LP when instructed to elevate it appeared to adopt straining strategies via the generation of intra-abdominal pressure. Depression of the LP may have long-term negative implications for prolapse and incontinence.