If, on examination, tenderness that replicates the dyspareunia is elicited when palpating the
levator or obturator internus muscle, pelvic-floor muscle trigger-point injection can be offered (although physical therapy is first-line treatment).
Transsphincteric fistulas were defined as the ones that pierce and penetrate both the external and internal sphincters, whereas suprasphincteric fistulas as the ones crossing and violating the
levator plate.
The aim of our study was therefore to determine if altered
levator ani muscle morphology (in the form of distension and avulsion) is a contributing factor to successful pessary use.
Division of these recto-sacral fascial fibers will lead to the
levators.
To preserve the normal tissue, achieve local radical excision, and minimize the operative trauma of the perineal wound as well as minimize the damage to the nerves supplying the genital organs, we hypothesized that preserving part of the
levator ani muscle or sacrococcyx, according to preoperative pelvic magnetic resonance imaging (MRI), may lower the perineal morbidity.
Levator pits have ellipsoidal shape with the longer axis about 1.3 cm parallel to the posterior margin of the plate.
The cause for SUI in old ages is weak support at the midurethra and failed bladder neck closure from the collagen deficient pubourethral ligament, vaginal hammock, vaginal wall, and denervated or damaged
levator ani [1,13].
The main pathogenesis mechanism of blepharoptosis is involutional changes at the
levator aponeurosis [10].
We thought that the bilateral nerve fibers of the
levator palpebrae superioris muscle were damaged in the oculomotor fascicles and that of the other external and internal muscles controlled by the oculomotor nerve were damaged supranuclearly.
Stage 2 uterus prolapse was seen in middle compartment, the
levator animuscle was not broken, and hiatus of
levator animuscle was normal in posterior compartment (see Figure 2).
After the hernia content was reduced into the abdomen, the double-sided synthetic patch was placed over the defect and fixed to the
levator ani muscle laterally, the vagina anteriorly, and the coccyx posteriorly with the 2/0 polyprolene sutures.
To measure the function of the
levator muscle, the patient is asked to gaze from below upwards while keeping the eyebrows stable with compression.