Interventional manometry: transvaginal support of pelvic floor ligaments raises endoanal pressure

Abstract: Background: The interaction between pelvic floor ligaments and muscles and anorectal pressure is not well characterized. Pelvic
floor muscle vectors act against pelvic floor suspensory ligaments, including pubourethral (PUL) uterosacral (USL) and, inferiorly, perineal
body (PB). Laxity of the pelvic floor leads to reduced endoanal pressures at rest and during a voluntary anal squeeze. Aim: We tested pelvic
floor function using a new technique; interventional anal manometry. Methods: In a heterogeneous group of 14 women, with pelvic floor dysfunction of various causes, anorectal pressure measurements were obtained at rest and during maximal voluntary anal squeeze, before and
during the following per-vaginal interventions, a] digital support at midurethra to support the pubourethral ligament (PUL); b] after a 3x6 cm
tampon was inserted into the posterior fornix to support the uterosacral ligaments (USL); c] with combined PUL and USL support; d] with
PUL, USL and perineal body (PB) support. Results: Resting and squeeze anorectal pressures increased during the support manoeuvres described, especially during experiment [d]. Conclusions: Creation of firm insertion points at PUL, USL, PB enabled muscle vectors to act more
efficiently, leading to increased endoanal pressure. These interventions do not increase pressure generation by internal (IAS) and external
sphincters (EAS) themselves, but result from changes in anorectal cross-sectional area. “Interventional manometry” offers a method for better understanding functional abnormality in the pelvic floor in women with clinical problems due to pelvic floor weakness.
Key words: Anal manometry; Pubourethral ligament; Uterosacral ligament; Perineal body; Pelvic floor laxity.