Fecal incontinence in older women: are levator ani defects a factor?

Objective: We sought to compare pelvic floor structure and function between older women with and without fecal incontinence (FI) and young continent (YC) women. Study Design: YC (n = 9) and older continent (OC) (n = 9) women were compared to older women with FI (older incontinent [OI]) (n = 8). Patients underwent a pelvic organ prolapse quantification, measurement of levator ani (LA) force at rest and with maximum contraction, and magnetic resonance imaging. Displacement of structures and LA defects were determined on dynamic magnetic resonance imaging. Results: LA defects were more common in the OI vs the YC (75% vs 11%, P = .01) and OC (22%, P = .14) groups; women with FI were more likely to have LA defects than women without (odds ratio, 14.0, 95% confidence interval, 1.8-106.5). OI women generated 27.0% and 30.1% less force during maximum contraction vs the OC (P = .13) and YC (P = .04) groups. During Kegel, OI absolute structural displacements were smaller than in the OC group (P = .01). Conclusion: OI women commonly have LA defects, and cannot augment pelvic floor strength.