Urethral Hypermobility and Levator Ani Ballooning in Primigravida: A Preliminary Report

Abstract

Pelvic organ prolapse (POP) affects 3.4% to 56.4% of women, urinary incontinence (UI) affects 5.2% to 70.8%, and faecal incontinence rates range from 5.3% to 41.0%. These clinical pelvic floor dysfunctions develop in correlation with urethral hypermobility and levator ani ballooning, with pregnancy and childbirth recognized as the primary precipitating factors. Earlier studies have reported that pelvic floor dysfunction may already develop during late pregnancy, even before delivery. A cross-sectional study was conducted at Dr. Cipto Mangunkusumo Hospital and YPK Mandiri Hospital from January 2023 to June 2024, involving 18–35 years old primigravida in ≥36 weeks of gestational age. Any compartment descent reaching grade 2 or more was considered positive POP, while positive urinary incontinence was determined according to QUID and cough test. Urethral hypermobility was defined as bladder neck descent (BND) >20.8 mm, retrovesical angle (RVA) >141°, or urethral rotational angle (URA) >19.43°, and levator ballooning as a levator hiatal area >25 cm² during maximum Valsalva. Pelvic floor ultrasound scans were performed by competent urogynecologists. Among thirty-two women included, urethral hypermobility was found in 46.9%, levator ballooning in 6.3%, and only 40.91% had clinical pelvic floor dysfunction, indicating that pathological anatomical findings did not strictly correlate with symptoms.