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International Urogynecology Journal

, Volume 19, Issue 5, pp 633–636 | Cite as

Levator avulsion and grading of pelvic floor muscle strength

  • H. P. DietzEmail author
  • C. Shek
Original Article

Abstract

In a retrospective study investigating the relationship between levator avulsion and clinical grading of levator ani muscle strength, we analyzed the 3D/4D translabial ultrasound and digital assessment data of 1,112 women seen in a tertiary Urogynecological clinic. Levator avulsion was diagnosed whenever the examiner was unable to palpate the insertion of the pubovisceral muscle on the inferior pubic ramus and/or whenever a discontinuity between bone and muscle was detected on ultrasound. For clinical grading of levator muscle strength, we used the modified Oxford grading. Avulsion defects were found in 252 women (23%), and this was associated with a highly significant reduction in the overall Oxford grading (2.07 vs 2.81, P < 0.001). The prevalence of avulsion increased depending on the side differences in the modified Oxford grading: from 16% when there was no difference to 76% when the side difference was 1.5 or higher (P < 0.001). Avulsion of the puborectalis muscle seems to have a marked effect on pelvic floor muscle strength, which may help in diagnosing trauma.

Keywords

3-D ultrasound Avulsion Birth trauma Levator ani Oxford grading Pelvic floor muscle Translabial ultrasound 

Notes

Acknowledgements

This study was supported in part by the Betty Byrne Henderson Foundation, University of Queensland, Brisbane, Queensland, Australia.

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Copyright information

© International Urogynecology Journal 2007

Authors and Affiliations

  1. 1.Nepean Clinical SchoolUniversity of Sydney, Nepean HospitalPenrithAustralia

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