Articles
Vol. 34 (2022)
https://doi.org/10.4081/uij.2022.293

Levator hiatal ballooning prevalence in pelvic organ prolapse patients and its relation to levator ani muscle strength

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Received: 5 June 2022
Accepted: 24 November 2022
Published: 28 December 2022
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Levator ani muscle strength, levator hiatal ballooning, pelvic organ prolapse, perineometer

Authors

Fernandi Moegni
fernandi71@ui.ac.id
https://orcid.org/0000-0001-9537-4256
Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Andrew Yurius Christian
Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.

Ballooning of the levator hiatus is a unique phenomenon of hyperdistention seen during the Valsalva maneuver in Pelvic Organ Prolapse (POP) patients. Although it is related to the weakness of pelvic floor muscles, there is only limited evidence of its effect on Levator Ani Muscle (LAM) strength, especially in Indonesia. The aim of this study was to describe the prevalence of levator hiatal ballooning in POP patients and its effect on LAM strength. A cross-sectional study was done on POP patients at Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, from July 2019 to June 2021. Subjects who could not perform the Valsalva maneuver or perineometer and those having a history of perineal rupture were excluded. Subjects were grouped into hiatal ballooning and non-ballooning group based on the maximum hiatal genital length measured using ultrasound examination. Clinical characteristics, hiatal ballooning status, and LAM strength were compared between groups. A total of 99 subjects (47 ballooning and 52 non-ballooning) were recruited during the study. The prevalence of hiatal ballooning in POP patients was 47.5%. There was significantly lower LAM strength in the ballooning group measured by perineometer (p = 0.018). There was a significant relationship between the perineometer result and Modified Oxford Grading Scale result in both groups (p < 0.001). Lower LAM strength was observed in POP patients with hiatal ballooning.

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Crossref
Scopus
Google Scholar
Europe PMC
Dietz HP, Shek C, De Leon J, Steensma AB. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol 2008;31:676–80. DOI: https://doi.org/10.1002/uog.5355
Friedman S, Blomquist JL, Nugent JM, et al. Pelvic muscle strength after childbirth. Obstet Gynecol 2012;120:1021–8. DOI: https://doi.org/10.1097/AOG.0b013e318265de39
Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2013;24:1783–90. DOI: https://doi.org/10.1007/s00192-013-2169-9
Santoso BI. Budi Iman Santoso Assessment (BISA): A model for predicting levator ani injury after vaginal delivery. Med J Indonesia 2012;21:102-7 DOI: https://doi.org/10.13181/mji.v21i2.487
Dietz HP. Ultrasound in the assessment of pelvic organ prolapse. Vol. 54, Best Practice and Research: Clinical Obstetrics and Gynaecology. Bailliere Tindall Ltd; 2019. p. 12–30. DOI: https://doi.org/10.1016/j.bpobgyn.2018.06.006
Khunda A, Shek KL, Dietz HP. Can ballooning of the levator hiatus be determined clinically? Am J Obstet Gynecol 2012;206:246.e1-246.e4. DOI: https://doi.org/10.1016/j.ajog.2011.10.876
Moegni F, Wengkang O. Correlation of levator ani muscle strength measurement between Modified Oxford Grading Scale and perineometer on pelvic organ prolapse patient. Urogynaecol Int J 2021;33:38–44. DOI: https://doi.org/10.4081/uij.2021.268
Laycock J. Clinical evaluation of pelvic floor. In: Schussler B, Laycock J, Norton P, Stanton S, editors. Pelvic floor re-education: principles and practice. London: Springer-Verlag; 1994. p. 42–8. 9.
Barbosa PB, Franco MM, Souza Fde O, et al. Comparison between measurements obtained with three different perineometers. Clinics (Sao Paulo) 2009;64:527-33. DOI: https://doi.org/10.1590/S1807-59322009000600007
Tailor VK, Bhide AA, Fernando R, et al. Does size matter? Perineometer and digital examination of a model levator hiatus. Neurourol Urodyn 2020;39:1338–44. DOI: https://doi.org/10.1002/nau.24384
UNICEF. Improving maternal and newborn health services in eastern indonesia [Internet]. Jakarta; 2017. Available from: https://www.unicef.org/indonesia/media/1801/file/Improving maternal and newborn health services in Eastern Indonesia.pdf

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Levator hiatal ballooning prevalence in pelvic organ prolapse patients and its relation to levator ani muscle strength. (2022). Urogynaecologia, 34. https://doi.org/10.4081/uij.2022.293
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