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Prolaps organ panggul adalah penurunan dari organ visera pelvik (panggul) akibat dari turunnya fungsi sistem penyokong panggul. Hal ini jarang mengakibatkan hal yang serius, tetapi menjadi faktor penting pada kualitas hidup pasien. Walaupun etiologi dan faktor risiko dari prolaps organ panggul bersifat multifaktorial, kebanyakan menerima bahwa otot dasar panggul, yaitu levator ani, berperan sangat penting dalam menyokong dasar panggul.
Penelitian-penelitian sebelumnya menyebutkan adanya hubungan antara derajat prolaps organ panggul dengan fungsi dan integritas otot levator ani yang dinilai dengan pemeriksaan USG dan perineometer. Namun saat ini di indonesia tidak ada penelitian yang secara lengkap menggambarkan hal diatas tujuan dari penelitian ini adalah untuk melihat perbandingan antara kekuatan otot, area hiatus, dan avulsi otot levator ani pada penderita derajat prolaps organ panggul derajat ringan dan derajat berat.
Metode:
Penelitian analitik observasional, dengan disain kasus-kontrol. subjek penelitian 60 wanita, 30 wanita dengan derajat prolaps ringan, 30 wanita prolaps derajat berat. Untuk melihat perbandingan antara kekuatan otot levator ani pada saat kontraksi dan istirahat, area hiatus dan avulsi otot levator ani pada pasien normal dan prolaps organ panggul derajat ringan dibandingkan dengan prolaps organ panggul derajat berat.
Hasil:
Pada penelitian ini didapatkan perbedaaan bermakna (p<0,001) antara kekuatan otot levator ani baik saat istirahat maupun kontraksi pada kelompok kasus (derajat berat) dan kelompok kontrol (derajat ringan). Nilai median dari kekuatan otot pada kelompok kasus saat istirahat dan kontraksi berturut-turut adalah 2,0 dan 5,33 mmHg sementara pada kelompok kontrol sebesar 6,0 dan 11,30 mmHg. Didapatkan perbedaaan bermakna antara area hiatal otot levator ani pada kedua kelompok (p<0,001). Nilai median kelompok derajat berat sebesar 35,07 cm2 (20,7-61,8 cm2) sementara kelompok derajat ringan sebesar 20,75 cm2 (9,04 - 41,52 cm2). Tidak didapatkan perbedaaan bermakna antara kejadian avulsi pada kedua kelompok (p = 0,162). Pada kelompok derajat berat angka kejadian avulsi sebanyak 10%.
Kesimpulan:
Terdapat perbedaan bermakna antara kekuatan otot dan area hiatus otot levator ani pada penderita prolaps organ panggul derajat berat dan ringan. tidak terdapat perbedaan bermakna pada avulsi otot levator ani pada kedua kelompok.
Pelvic organ prolapse is a herniation of visceral pelvic organ as a result of weakening of pelvic supporting system function. This rarely leads to serious health problem, however it is an important factor when it comes to patient’s quality of life. Even though the aetiology and risk factors of pelvic organ prolapse are multifactorial, levator ani muscle is believed playing substantial role in supporting pelvic system.Previous studies have shown that there was correlation between the degree of pelvic organ prolapse and levator ani muscle function and integrity assessed with USG and perineometer examination. Unfortunately, research focusing on this study is still limited in Indonesia. The aim of this study is to see comparison between muscle strength, hiatal area, anal levator muscle avulsion in mild and severe degree of pelvic organ prolapse.
Method:
This is observational comparative analytic study with case-control design. There were 60 participants involved. We devided them into two groups. Thirty participants with mild prolapse were assigned to control group and the rest with severe prolapse were assigned to second group. We compared the levator ani muscle stregth between mild prolapse with severe prolapse during contraction and relaxation, also hiatal area and avulsion.
Result:
In this study we found that there was a significant difference (p<0.001) in levator ani strentgh during contraction and relaxation between case (severe prolapse) and control group (mild prolapse). The median score of muscle strength during relaxation and contraction were 2.0 and 5.33 mmHg, respectively. Meanwhile, the score of 6.0 and 11.30 mmHg were revealed in control group. A significant difference was found between levator ani hiatal area in case and control group (p<0.001). The median score was 20.75 cm2 (9,04 – 41,52) for control group and 35,07 cm2 (20,7 – 61,8) for case group. There was no significant difference between avulsion incidence in case and control group (p=0.162). In case group, the incidence of avulsion was 10 %.
Conclusion:
There is a significant difference in muscle strength and hiatal area levator ani in pelvic organ prolapse. There is no difference in levator ani avulsion between 2 groups."
