Menopause is associated with impaired responsiveness of involuntary pelvic floor muscle contractions to sudden intra-abdominal pressure rise in women with pelvic floor symptoms: A retrospective study

Aims: To explore the effect of menopause on the movements of the bladder neck and genital hiatus during involuntary and voluntary pelvic floor muscle (PFM) contractions among women with pelvic floor symptoms. Methods: The data of 162 premenopausal and 215 postmenopausal women were retrospectively analyzed. The investigation encompassed clinical interview, pelvic examination, and four-dimensional ultrasound. The ultrasound manifestations of the bladder neck and genital hiatus during involuntary and voluntary PFM contractions were assessed during coughing and maximal squeezing. The bladder neck location, genitohiatal size, and genitohiatal location were evaluated with bladder neck distance (BND) and bladder neck angle (BNA), genitohiatal dimension (GHD) and genitohiatal area (GHAR), as well as genitohiatal angle (GHA), respectively. Results: From resting to coughing, postmenopausal women exhibited a more caudodorsal bladder neck movement (changes in BND/BNA, premenopausal vs. postmenopausal women: −0.91 ± 1.22 cm/–12 ± 47° vs. −0.48 ± 0.83 cm/11 ± 38°, P < 0.001), less genitohiatal size reduction (changes in GHD/GHAR, premenopausal vs. postmenopausal women: −1.38 ± 2.15 cm/−5.5 ± 8.4 cm² vs. −0.46 ± 1.68 cm/−1.9 ± 7.6 cm², P < 0.001), and less cranioventral genitohiatal movement (changes in GHA, premenopausal vs. postmenopausal women: −33 ± 63° vs. −11 ± 43°, P < 0.001) than premenopausal women. Premenopausal and postmenopausal women demonstrated comparable ultrasound manifestations of the bladder neck and genital hiatus during maximal squeezing. Conclusions: For women with pelvic floor symptoms, menopause is associated with impaired responsiveness of involuntary PFM contractions to sudden intra-abdominal pressure rise but not with voluntary PFM contractions.