Skip to main content
SpringerLink
Log in

Aging effects on pelvic floor support: a pilot study comparing young versus older nulliparous women

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

We sought to determine age-related changes to the pelvic floor in the absence of childbirth effects.

Methods

A case–control study was conducted from June 2017 to August 2018 comparing two groups of nulliparous women: <40 years old and ≥ 70 years old. Clinical evaluation included POP-Q, instrumented speculum testing, and handgrip strength. Dynamic 3D-stress MRI was performed on all women to obtain genital and levator hiatus (LH) lengths, LH area, and levator bowl volume. LH shape was quantified using a novel measure called the “V-U index.” Pubovisceral muscle (PVM) cross-sectional area (CSA) was also measured. Bivariate comparisons between the two groups were made for all variables. Effect sizes were calculated for MRI measurements.

Results

Twelve young and 9 older nulliparous women were included. Levator bowl volume at rest was 83% larger in older women (108.0 ± 34.5 cm3 vs 59.2 ± 19.3 cm3, p = 0.001, d = 1.82). MRI genital hiatus at rest was larger among the older group (2.7 ± 0.6 cm vs 3.5 ± 0.6 cm, p = 0.007, d = 1.34). V-U index, a measure of LH shape where 0 = “V” and 1 = “U,” differed between groups indicating a more “U”-like shape among older women (0.71 ± 0.23 vs 0.35 ± 0.18, p = 0.001, d = 1.72). Handgrip strength was lower in the older vs young group (23.2 ± 5.2 N vs 33.4 ± 5.2 N, p < 0.0001); however, the Kegel augmentation force and PVM CSA were similar (3.2 ± 1.1 N vs 3.3 ± 2.2 N, p = 0.89, and 0.8 ± 0.3 cm2 vs 0.7 ± 0.2 cm2, p = 0.23 respectively).

Conclusions

Levator bowl volume at rest was over 80% larger among older women, reflecting a generalized posterior distension with age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Dieter AA, Wilkins MF, Wu JM. Epidemiological trends and future care needs for pelvic floor disorders. Curr Opin Obstet Gynecol. 2015;27(5):380–4. https://doi.org/10.1097/GCO.0000000000000200.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Swift SE. The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol. 2000;183(2):277–85. https://doi.org/10.1067/mob.2000.107583.

    Article  CAS  PubMed  Google Scholar 

  3. Faulkner JA, Larkin LM, Claflin DR, Brooks SV. Age-related changes in the structure and function of skeletal muscles. Clin Exp Pharmacol Physiol. 2007;34(11):1091–6. https://doi.org/10.1111/j.1440-1681.2007.04752.x.

    Article  CAS  PubMed  Google Scholar 

  4. Blomquist JL, Munoz A, Carroll M, Handa VL. Association of delivery mode with pelvic floor disorders after childbirth. JAMA. 2018;320(23):2438–47. https://doi.org/10.1001/jama.2018.18315.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol. 1997;104(5):579–85.

    Article  CAS  PubMed  Google Scholar 

  6. Trowbridge ER, Wei JT, Fenner DE, Ashton-Miller JA, Delancey JO. Effects of aging on lower urinary tract and pelvic floor function in nulliparous women. Obstet Gynecol. 2007;109(3):715–20. https://doi.org/10.1097/01.AOG.0000257074.98122.69.

    Article  PubMed  Google Scholar 

  7. Morris VC, Murray MP, Delancey JO, Ashton-Miller JA. A comparison of the effect of age on levator ani and obturator internus muscle cross-sectional areas and volumes in nulliparous women. Neurourol Urodyn. 2012;31(4):481–6. https://doi.org/10.1002/nau.21208.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Alperin M, Cook M, Tuttle LJ, Esparza MC, Lieber RL. Impact of vaginal parity and aging on the architectural design of pelvic floor muscles. Am J Obstet Gynecol. 2016;215(3):312 e311–9. https://doi.org/10.1016/j.ajog.2016.02.033.

    Article  Google Scholar 

  9. Xue QL, Walston JD, Fried LP, Beamer BA. Prediction of risk of falling, physical disability, and frailty by rate of decline in grip strength: the women’s health and aging study. Arch Intern Med. 2011;171(12):1119–21. https://doi.org/10.1001/archinternmed.2011.252.

    Article  PubMed  Google Scholar 

  10. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    Article  CAS  PubMed  Google Scholar 

  11. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  12. Ashton-Miller JA, Zielinski R, DeLancey JO, Miller JM. Validity and reliability of an instrumented speculum designed to minimize the effect of intra-abdominal pressure on the measurement of pelvic floor muscle strength. Clin Biomech (Bristol, Avon). 2014;29(10):1146–50. https://doi.org/10.1016/j.clinbiomech.2014.09.011.

    Article  Google Scholar 

  13. Bautmans I, Gorus E, Njemini R, Mets T. Handgrip performance in relation to self-perceived fatigue, physical functioning and circulating IL-6 in elderly persons without inflammation. BMC Geriatr. 2007; https://doi.org/10.1186/1471-2318-7-5.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tumbarello JA, Hsu Y, Lewicky-Gaupp C, Rohrer S, DeLancey JO. Do repetitive Valsalva maneuvers change maximum prolapse on dynamic MRI? Int Urogynecol J. 2010;21(10):1247–51. https://doi.org/10.1007/s00192-010-1178-1.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Betschart C, Chen L, Ashton-Miller JA, Delancey JO. On pelvic reference lines and the MR evaluation of genital prolapse: a proposal for standardization using the pelvic inclination correction system. Int Urogynecol J. 2013;24(9):1421–8. https://doi.org/10.1007/s00192-013-2100-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Chen L, Lisse S, Larson K, Berger MB, Ashton-Miller JA, DeLancey JO. Structural failure sites in anterior vaginal wall prolapse: identification of a collinear triad. Obstet Gynecol. 2016;128(4):853–62. https://doi.org/10.1097/AOG.0000000000001652.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sammarco AG, Nandikanti L, Kobernik EK, Xie B, Jankowski A, Swenson CW, et al. Interactions among pelvic organ protrusion, levator ani descent, and hiatal enlargement in women with and without prolapse. Am J Obstet Gynecol. 2017;217(5):614 e611–7. https://doi.org/10.1016/j.ajog.2017.07.007.

    Article  Google Scholar 

  18. Nandikanti L, Sammarco AG, Chen L, Ashton-Miller JA, DeLancey JO. Levator bowl volume during straining and its relationship to other levator measures. Int Urogynecol J. 2019; https://doi.org/10.1007/s00192-019-04006-8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Masteling M, Ashton-Miller JA, DeLancey JOL. Technique development and measurement of cross-sectional area of the pubovisceral muscle on MRI scans of living women. Int Urogynecol J. 2018; https://doi.org/10.1007/s00192-018-3704-5.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zhong X, Nickel MD, Kannengiesser SA, Dale BM, Kiefer B, Bashir MR. Liver fat quantification using a multi-step adaptive fitting approach with multi-echo GRE imaging. Magn Reson Med. 2014;72(5):1353–65. https://doi.org/10.1002/mrm.25054.

    Article  PubMed  Google Scholar 

  21. Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13. https://doi.org/10.1016/j.ajog.2004.12.025.

    Article  CAS  PubMed  Google Scholar 

  22. O’Donnell LJ, Virjee J, Heaton KW. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. BMJ. 1990;300(6722):439–40.

    Article  PubMed  PubMed Central  Google Scholar 

  23. The World Health Organization Quality of Life Assessment (WHOQOL). Development and general psychometric properties. Soc Sci Med. 1998;46(12):1569–85.

    Article  Google Scholar 

  24. Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9.

    Article  CAS  PubMed  Google Scholar 

  25. Minnesota State University Moorhead. Introduction to effect size (d). http://web.mnstate.edu/malonech/Psy633/Articles/Effect%20size%20Patten.pdf. Accessed 12 June 2019.

  26. Rodrigues Junior AA, Herrera-Hernadez MC, Bassalydo R, McCullough M, Terwilliger HL, Downes K, et al. Estimates of the levator ani subtended volume based on magnetic resonance linear measurements. Neurourol Urodyn. 2016;35(2):199–205. https://doi.org/10.1002/nau.22691.

    Article  PubMed  Google Scholar 

  27. Dietz HP, Shek C, De Leon J, Steensma AB. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol. 2008;31(6):676–80. https://doi.org/10.1002/uog.5355.

    Article  CAS  PubMed  Google Scholar 

  28. Pannu HK, Genadry R, Gearhart S, Kaufman HS, Cundiff GW, Fishman EK. Focal levator ani eventrations: detection and characterization by magnetic resonance in patients with pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(2):89–93. https://doi.org/10.1007/s00192-003-1037-4.

    Article  CAS  PubMed  Google Scholar 

  29. Kamisan Atan I, Gerges B, Shek KL, Dietz HP. The association between vaginal parity and hiatal dimensions: a retrospective observational study in a tertiary urogynaecological centre. BJOG. 2015;122(6):867–72. https://doi.org/10.1111/1471-0528.12920.

    Article  CAS  PubMed  Google Scholar 

  30. Handa VL, Blomquist JL, Roem J, Munoz A. Longitudinal study of quantitative changes in pelvic organ support among parous women. Am J Obstet Gynecol. 2018;218(3):320.e1–7. https://doi.org/10.1016/j.ajog.2017.12.214.

    Article  Google Scholar 

  31. DeLancey JO, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109(2 Pt 1):295–302. https://doi.org/10.1097/01.AOG.0000250901.57095.ba.

    Article  PubMed  Google Scholar 

  32. Weemhoff M, Vergeldt TF, Notten K, Serroyen J, Kampschoer PH, Roumen FJ. Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study. Int Urogynecol J. 2012;23(1):65–71. https://doi.org/10.1007/s00192-011-1524-y.

    Article  PubMed  Google Scholar 

  33. Volloyhaug I, Wong V, Shek KL, Dietz HP. Does levator avulsion cause distension of the genital hiatus and perineal body? Int Urogynecol J. 2013;24(7):1161–5. https://doi.org/10.1007/s00192-012-1993-7.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This research was supported by the Claude D. Pepper Older Americans Independence Center (OAIC), NIH National Institute on Aging grant #P30 AG024824; the Michigan Institute for Clinical and Health Research (MICHR) grant # UL1TR002240; and the University of Michigan Geriatrics Center. Investigator support for CWS was provided by the National Institute of Child Health and Human Development WRHR Career Development Award K12 HD065257. The NIH did not play a role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA

    Carolyn W. Swenson, John O. DeLancey & Payton Schmidt

  2. Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA

    Mariana Masteling

  3. School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Lahari Nandikanti

  4. Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA

    Luyun Chen

Authors
  1. Carolyn W. Swenson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mariana Masteling
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John O. DeLancey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lahari Nandikanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Payton Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luyun Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carolyn W. Swenson.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Swenson, C.W., Masteling, M., DeLancey, J.O. et al. Aging effects on pelvic floor support: a pilot study comparing young versus older nulliparous women. Int Urogynecol J 31, 535–543 (2020). https://doi.org/10.1007/s00192-019-04063-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-019-04063-z

Keywords

Search

Navigation