Association of index finger palpatory assessment of pubovisceral muscle body integrity with MRIâ documented tear

Abstract

AimsPubovisceral (PV) muscle tears are associated with pelvic floor disorders. The goal of this study was to determine whether index finger palpatory assessment of PV muscle body integrity through the lateral vaginal wall is a reliable indicator of PV muscle tear severity diagnosed by magnetic resonance imaging (MRI).MethodsWe studied 85 women, 7 weeks after vaginal birth. All had at least one risk factor for obstetricâ related PV muscle tear. The ordinal outcome measure of MRIâ documented PV muscle tear was defined as: none, less than 50% unilateral tear, 50% or greater unilateral tear or less than 50% bilateral tear, and 50% or greater bilateral tear. PV muscle body integrity by palpatory assessment was scored on a matrix, with each side scored independently and classified as PV muscle body â presentâ (assuredly felt), â equivocalâ (not sure if felt), or â absentâ (assuredly not felt). Proportional odds models were constructed to estimate the relationship between PV muscle body integrity palpatory assessment and MRIâ documented PV muscle tears.ResultsThirtyâ five percent of study participants exhibited varying degrees of MRIâ documented PV muscle tears. Using palpatory assessment, we identified â PV muscle body present bilaterallyâ in 20%, â equivocal unilaterally or present contralaterallyâ in 8%, â equivocal or absent unilaterallyâ or â equivocal bilaterallyâ in 62%, and â absent bilaterallyâ in 9%. The odds ratio for estimating MRI results from palpatory assessment was 3.62 (95% confidence intervalâ =â 1.70â 7.73, Pâ =â 0.001).ConclusionsA rapid and inexpensive palpatory assessment in the clinic was highly associated with the risk of MRIâ documented PV muscle tear and is a useful component of a clinical assessment.