Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION AND HYPOTHESIS: The perineal membrane (PM), perineal body, and levator ani muscles form the perineal complex, which is responsible for hiatal closure. Yet failures in its connective tissues that may lead to hiatal closure impairment are poorly understood. We tested the hypothesis that pelvic organ prolapse involves PM abnormalities by comparing PM morphology between young women with prolapse and parous controls using a validated MRI-based reconstruction and analysis technique. METHODS: . Six PM parameters were measured: swinging door angle, visible bony origin length, hiatal anteroposterior diameter and area, PM surface area, and midline separation. Group comparisons used t tests, with Cohen's d, correlations, and stepwise regression analysis. RESULTS: Resting MRIs from 17 young parous women (aged < 40 years) with prolapse and 20 parous controls were compared. Women with prolapse showed 23% greater midline separation of the PM, 30% larger hiatal area, 26% larger hiatal anteroposterior diameter, 17% longer bony origin, and 26% larger PM surface area (all p ≤ 0.002, d = 1.1-1.6); swinging door angle was similar between groups (p = 0.60). Levator ani status, midline separation, and PM surface area independently predicted prolapse, explaining 76% of variance. CONCLUSIONS: The PM structure was altered in those with prolapse through loss of central PM connection, hiatal elongation, and hiatal widening. Larger studies are needed to confirm and guide targeted repair techniques that could potentially prevent prolapse development and/or progression.
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,790
Funders: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, National Institutes of Health, National Institute on Aging, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Child Health and Human Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1940128809, G2290386743, G2791660229, G3031150197, Using a mechanistic classification scheme to identify the causes of anterior vaginal wall prolapse and develop a validated surgical planning system, Birth, Muscle Injury and Pelvic Floor Dysfunction, Development of 21st Century Concepts and Tools for Quantifying Urethral Failure Mechanisms that Cause Urinary Incontinence, G8495917057, Claude D. Pepper Older Americans Independence Center at the University of Michigan (UM Pepper Center)
OpenAlex ID: W7159954840
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