"Ultrasound" view of the pelvic floor: Pelvic floor ultrasound reveals women's unspeakable secrets

There is an often neglected but vital part of the female body - the pelvic floor, which is composed of multiple layers of muscles and fascia that close the pelvic outlet. Under normal circumstances, the pelvic floor muscles and fascia have sufficient tension and elasticity to maintain the stability of the pelvic organs during various physiological activities. However, due to the influence of factors such as pregnancy, childbirth, aging, obesity, long-term coughing, and constipation, this "hammock" may become loose, damaged, and cause many unspeakable problems for women. At present, pelvic floor ultrasound, as a non-invasive and accurate examination method, is gradually becoming a powerful tool to reveal the unspeakable secrets of the female pelvic floor. So today, let us use the magical pelvic floor ultrasound to unveil the mystery of female pelvic floor diseases.

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1. Principles and advantages of pelvic floor ultrasound

1. Principle

Pelvic floor ultrasound is a method of examining the pelvic floor structure using ultrasound technology. Ultrasound is a high-frequency sound wave that can penetrate human tissue and produce reflected waves when encountering different tissue interfaces. By receiving and processing these reflected waves, an image of the pelvic floor structure can be generated. During a pelvic floor ultrasound examination, the doctor will ask the patient to take different positions, such as supine position, lithotomy position, etc., and then use an ultrasound probe to scan the perineum or vagina. By observing the shape, position and movement of structures such as the pelvic floor muscles, fascia, bladder, uterus, and rectum, the doctor can evaluate whether the pelvic floor function is normal.

2. Advantages

First, it is non-invasive. Pelvic floor ultrasound does not require any invasive operation and does not harm the patient's body. Compared with other examination methods, such as pelvic floor angiography and magnetic resonance imaging, pelvic floor ultrasound is safer, more comfortable, and more acceptable to patients. Secondly, it is highly accurate. Through two-dimensional and three-dimensional ultrasound imaging technology, doctors can observe the shape, position, and movement of pelvic floor muscles, fascia, and pelvic organs from multiple angles and levels, thereby discovering some early and mild manifestations of pelvic floor dysfunction. For example, pelvic floor ultrasound can accurately measure the position and activity of the bladder neck and the opening of the internal urethra of patients with stress urinary incontinence, providing a strong basis for diagnosis. Thirdly, it has good repeatability. The treatment of pelvic floor dysfunction usually requires a process. During the treatment process, doctors need to perform pelvic floor examinations regularly. The non-invasive nature of pelvic floor ultrasound allows it to be performed multiple times, helping doctors understand the recovery of the patient's pelvic floor structure and adjust the treatment plan. In addition, pelvic floor ultrasound examination is simple to operate. During the examination, the patient only needs to adopt different body positions according to the doctor's requirements and cooperate with the doctor to perform some simple movements such as coughing, holding the breath, and contracting the pelvic floor muscles. The whole process usually only takes about ten minutes and will not cause too much inconvenience to the patient.

Three-dimensional ultrasound of the pelvic floor shows the anal levator muscle layer

Observation of anal sphincter integrity during pelvic floor contraction using TUI mode

Ultrasonography of cystocele

2. Indications for pelvic floor ultrasound examination

1. Postpartum women

The pelvic floor tissue of postpartum women will be damaged to varying degrees during pregnancy and delivery. During pregnancy, the uterus gradually enlarges, causing continuous pressure on the pelvic floor muscles, fascia and ligaments, causing the pelvic floor support structure to become loose; during delivery, especially vaginal delivery, the squeezing of the fetal head and the force during delivery may further aggravate the damage to the pelvic floor tissue. Pelvic floor ultrasound can clearly show the changes in the pelvic floor structure of postpartum women, such as whether the position of pelvic organs such as the bladder, uterus, and rectum is normal, and whether there is cystocele, uterine prolapse, rectocele, etc. For women who experience symptoms such as urinary incontinence, pelvic distension, and sexual discomfort after delivery, pelvic floor ultrasound examination can help doctors accurately determine the type and degree of pelvic floor dysfunction and provide a basis for formulating personalized rehabilitation treatment plans. For example, if ultrasound examination finds cystocele, patients can be guided to conduct targeted pelvic floor muscle training, such as Kegel exercises, according to the degree of cystocele, and combined with physical therapy and other methods to promote the recovery of pelvic floor tissue.

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2. Middle-aged and elderly women

As women age, hormone levels in their bodies change, especially when estrogen levels drop, which can cause the pelvic floor muscles and fascia and other tissues to atrophy, become thinner, and become less elastic. At the same time, long-term chronic cough, constipation, obesity and other factors can also increase the pressure on the pelvic floor, causing the pelvic floor function to gradually decline. Therefore, middle-aged and elderly women often suffer from stress urinary incontinence and pelvic organ prolapse. Pelvic floor ultrasound can accurately assess the integrity and functional status of the pelvic floor structure of middle-aged and elderly women by measuring the position and mobility of pelvic organs, and determine whether there is prolapse and the degree of prolapse. For patients with stress urinary incontinence, pelvic floor ultrasound can observe the changes in the shape and position of the internal urethral opening, as well as the movement of the bladder neck when abdominal pressure increases, which helps to clarify the cause of urinary incontinence. Doctors can provide appropriate treatment recommendations for middle-aged and elderly women based on the results of ultrasound examinations, such as conservative treatment including pelvic floor muscle training, biofeedback therapy, etc., or consider surgical treatment in severe cases.

3. Women with symptoms of pelvic floor dysfunction

For women with obvious symptoms of pelvic floor dysfunction, such as urinary incontinence (including stress incontinence, urge incontinence, etc.), dysuria, abnormal defecation (such as constipation, fecal incontinence), pelvic pain, sexual dysfunction, etc., pelvic floor ultrasound is an important examination method. In terms of urinary incontinence, pelvic floor ultrasound can distinguish different types of urinary incontinence and provide accurate direction for treatment. For example, for stress incontinence, ultrasound can observe the opening of the internal urethra and the downward movement of the bladder neck when abdominal pressure increases; for urge incontinence, the bladder capacity and detrusor activity can be evaluated. For patients with dysuria, pelvic floor ultrasound can check the morphology of the bladder, residual urine volume, and urethral patency, helping to determine whether there are problems such as bladder outlet obstruction. In terms of abnormal defecation, ultrasound can observe the morphology and position of the rectum, as well as its relationship with surrounding tissues, and determine whether there is rectocele, perineal descent syndrome, etc. For women with pelvic pain, pelvic floor ultrasound can check the tension of the pelvic floor muscles and whether there is fascial inflammation. In terms of sexual dysfunction, ultrasound can observe the integrity of structures such as the vagina and perineum, as well as the contraction function of the pelvic floor muscles, providing a basis for diagnosis and treatment.

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4. Evaluation before and after gynecological surgery

Before gynecological surgery, pelvic floor ultrasound can provide doctors with detailed pelvic floor anatomy information to help assess surgical risks and develop surgical plans. For example, if a patient with uterine prolapse is planning to undergo a hysterectomy, pelvic floor ultrasound can be used to understand the degree of prolapse, the relationship of surrounding tissues, and whether there are other pelvic floor structural abnormalities before surgery, so as to better deal with pelvic floor problems during surgery. After gynecological surgery, pelvic floor ultrasound can be used to evaluate the effect of the surgery. For example, after uterine prolapse surgery, ultrasound examination can be used to observe whether the position of the uterus has returned to normal, whether the pelvic floor structure is stable, and whether there are signs of recurrence. For pelvic floor reconstruction surgery, ultrasound can evaluate the position, morphology, and function of the implant to ensure the success of the operation. In addition, for patients with gynecological malignancies who receive radiotherapy or chemotherapy, pelvic floor ultrasound can also monitor changes in pelvic floor tissues and promptly detect complications caused by radiotherapy or chemotherapy, such as radiation cystitis and proctitis.

3. Pelvic floor ultrasound examination process and diagnostic criteria

1. Inspection process

Before undergoing a pelvic floor ultrasound examination, the patient needs to empty the bladder and rectum to prevent urine and feces in the bladder and rectum from affecting the quality of the ultrasound image and interfering with the doctor's observation of the pelvic floor structure. At the same time, the patient should wear loose and comfortable clothes so that the perineum can be easily exposed during the examination. During the examination, the patient should lie on the examination bed first. The doctor will first perform a routine gynecological ultrasound examination to understand the condition of the uterus, ovaries and other pelvic organs to rule out other diseases that may affect the pelvic floor structure; then, the doctor will ask the patient to take the lithotomy position, that is, to spread and bend the legs, similar to the position during childbirth, and then apply coupling agent and sterile isolation sound-transmitting membrane on the ultrasound probe, and gently insert it into the vagina or place it on the perineum for scanning. After the examination, the doctor will analyze and diagnose the examination results and explain the examination results to the patient.

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2. Diagnostic criteria

Under normal circumstances, the pelvic floor muscles and fascia should be continuous and uniform, and the pelvic organs such as the bladder, uterus, and rectum should be in normal positions without prolapse or bulging. For abnormal pelvic floor structures, such as stress urinary incontinence, when the patient's abdominal pressure increases, pelvic floor ultrasound can observe that the bladder neck drops beyond the normal range and the internal urethral opening is funnel-shaped. At the same time, parameters such as the urethral rotation angle can be measured to determine whether the supporting structure of the bladder and urethra is relaxed; for pelvic organ prolapse, pelvic floor ultrasound can measure the degree of prolapse of pelvic organs and determine the type and severity of prolapse. For uterine prolapse, the distance from the cervix to the lower edge of the pubic symphysis can be measured, and for bladder prolapse, the distance from the bladder neck to the lower edge of the pubic symphysis can be measured. If there is pelvic floor muscle damage, pelvic floor ultrasound will observe thinning, interruption, or weak contraction of the pelvic floor muscles.

Treatment of pelvic floor dysfunction

1. Non-surgical treatment

Pelvic floor muscle training, also known as Kegel exercise, is a method of strengthening the pelvic floor muscles by contracting and relaxing them. It is simple and easy to do, not limited by time and place, and can effectively improve the symptoms of pelvic floor dysfunction. Patients can do it several times a day under the guidance of a doctor, each time lasting from a few seconds to a few minutes. Biofeedback therapy uses instruments to convert the activity of the pelvic floor muscles into visual or auditory signals, allowing patients to intuitively understand the functional status of their pelvic floor muscles, and adjust the contraction and relaxation of the pelvic floor muscles through training. This treatment method can help patients better master the training methods of the pelvic floor muscles and improve the training effect. Electrical stimulation therapy inserts electrodes into the vagina or rectum to give the pelvic floor muscles electrical stimulation of different intensities to enhance the contraction and endurance of the pelvic floor muscles. In addition, patients can also reduce the symptoms of pelvic floor dysfunction by adjusting their lifestyle, such as avoiding heavy physical labor, controlling weight, and treating chronic cough and constipation.

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2. Surgical treatment

For patients with severe pelvic floor dysfunction, when non-surgical treatment is ineffective, surgical treatment can be considered. The main surgical methods include pelvic floor reconstruction surgery, uterine suspension surgery, anterior and posterior vaginal wall repair, etc. The purpose of surgery is to restore the normal position and function of the pelvic floor structure and relieve symptoms.

5. How to prevent pelvic floor dysfunction

1. Pregnancy care

It is very important to properly control your weight during pregnancy. Excessive weight gain will put a huge burden on the pelvic floor muscles and increase the risk of pelvic floor dysfunction. Therefore, pregnant women should develop a scientific diet plan according to the doctor's advice, avoid excessive tonic, and ensure that their weight gain is within a reasonable range. Secondly, maintaining the same posture for a long time will cause continuous pressure on the pelvic floor muscles. Therefore, pregnant women should avoid standing or sitting for a long time, and should move their bodies at appropriate times, such as taking regular walks, doing simple stretching exercises, etc. Finally, pregnant women should perform appropriate pelvic floor muscle training under the guidance of a doctor to strengthen the pelvic floor muscles and prepare for childbirth.

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2. Choice of delivery method

Both natural childbirth and cesarean section may cause some damage to the pelvic floor structure, but natural childbirth is more damaging to the pelvic floor muscles, so if there is no medical indication, pregnant women can choose cesarean section. It should be noted that cesarean section cannot completely avoid the occurrence of pelvic floor dysfunction, so when choosing a delivery method, pregnant women should fully listen to the doctor's advice and make reasonable decisions based on their own situation.

3. Postpartum recovery

First of all, the pelvic floor function should be evaluated in time. 42 days after delivery is the best time to evaluate. Pregnant women can understand the recovery of the pelvic floor structure after delivery through professional pelvic floor ultrasound and other examination methods, find problems in time and take corresponding treatment measures. Secondly, if pelvic floor dysfunction is found, the mother should actively carry out rehabilitation training, such as pelvic floor muscle training, biofeedback therapy, electrical stimulation therapy, etc. At the same time, the mother should avoid heavy physical labor after delivery to avoid aggravating the damage to the pelvic floor muscles.

In summary, women's pelvic floor health is extremely important. In life, we should improve our understanding of pelvic floor dysfunction, and timely detect pelvic floor dysfunction through non-invasive and accurate examination methods such as pelvic floor ultrasound examination, and take corresponding treatment measures. At the same time, in order to prevent the occurrence of pelvic floor dysfunction, women should pay attention to pelvic floor health care during pregnancy, delivery and postpartum. I believe that with our joint efforts, every woman can have a healthy and beautiful life.