ObjectiveFirst, to assess whether levator ani deficiency (LAD) is associated with pelvic floor dysfunction 1 year postpartum, including urinary, vaginal and bowel symptoms; and second, to explore at what cut‐off of LAD score such pelvic floor dysfunction arises.DesignNested case–control study.SettingÖrebro University Hospital, Örebro, Sweden.Population or SamplePrimiparous women 1 year after vaginal birth.MethodsThree‐dimensional endovaginal ultrasound assessment of the levator ani muscle; LAD score based on this ultrasound, and validated questions about pelvic floor dysfunction. Logistic regression models were used.Main Outcome MeasuresSymptoms of pelvic floor dysfunction associated with LAD.ResultsAltogether 190 women were included, 103 of whom were symptomatic cases and 87 asymptomatic controls. 53% in the case group, and 58% in the control group had a LAD score of 0. A greater LAD score was significantly associated with urinary incontinence (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.00–1.22) and vaginal laxity (aOR 1.14, 95% CI 1.03–1.25). The risk of urinary incontinence was increased when the LAD cut‐off score was set between ≥ 1 point and ≥ 4 points. The risk of vaginal laxity was increased when the cut‐off was set between ≥ 8 and ≥ 14 points.ConclusionsLAD was associated with both urinary incontinence and vaginal laxity. The risk of urinary incontinence increased already with minor LAD and defects of the most medial levator ani muscle portions normally supporting the midurethra may explain this increase.

中文翻译：

---

产后 1 年肛提肌缺乏症和盆底功能障碍：一项前瞻性嵌套病例对照研究


目的首先，评估肛提肌缺乏症 （LAD） 是否与产后 1 年盆底功能障碍相关，包括泌尿、阴道和肠道症状;其次，探索出现这种盆底功能障碍的 LAD 评分临界值。设计嵌套的个案对照研究。地点Örebro University Hospital， Örebro， Sweden.人口或样本阴道分娩后 1 年的初产妇。方法肛提肌的三维阴道内超声评估;基于该超声的 LAD 评分，以及有关盆腔底功能障碍的验证问题。使用 Logistic 回归模型。主要结局指标LAD 相关盆底功能障碍症状。结果共纳入 190 例女性，其中 103 例为有症状病例，87 例为无症状对照者。病例组 53% 的患者和对照组 58% 的 LAD 评分为 0。较高的 LAD 评分与尿失禁 （校正比值比 [aOR] 1.11,95% 置信区间 [CI] 1.00-1.22）和阴道松弛 （aOR 1.14,95% CI 1.03-1.25） 显著相关。当 LAD 临界评分设定在 ≥ 1 分到 ≥ 4 分之间时，尿失禁的风险增加。当临界值设置在 ≥ 8 到 ≥ 14 分之间时，阴道松弛的风险增加。结论 LAD 与尿失禁和阴道松弛均相关。轻微 LAD 导致尿失禁的风险已经增加，通常支撑尿道中段的最内侧提肌部分的缺陷可以解释这种增加。