Pelvic floor support in women with a gystocele
Objectives It has been proposed that pelvic prolapse occurs because of failure of the levator ani muscles to function. To investigate this, we assessed the capability of the levator ani muscles to elevate the bladder base in women with a cystocele. Methods Women with a cystocele underwent videourodynamics. Subjects were administered 200 mL of radiographic contrast. They were asked to “bear down” to demonstrate the maximal size of the cystocele and then to “pull up” to demonstrate levator ani function. Results Median age of the women was 63 years. Cystoceles ranged from grade 2 to grade 4. When instructed to pull up, 95% of the women had some elevation of the pelvic floor, as seen by elevation of the bladder base or the most dependent part of the cystocele. Two patients were not able to reduce the cystoceles when pulling up, but there was a change in the shape of the cystocele, suggesting that the levator was able to contract. Conclusion Women with a cystocele have functioning pelvic floor musculature. Therefore, loss of baseline muscular tone probably is most critical for pelvic support. © 1998 Lippincott Williams & Wilkins, Inc.
