Does avulsion of the puborectalis muscle affect bladder function?
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Introduction and hypothesis
The levator ani muscle is generally thought to play a role in urinary continence, with incontinence assumed to be due to abnormal muscle function or morphology. This study examined whether avulsion of the puborectalis muscle is associated with symptoms or signs of bladder dysfunction.
In a retrospective observational study, we reviewed the records of 425 women who had attended a urogynecological unit for independent flowmetry, multichannel urodynamic testing, and 4D pelvic floor ultrasound.
Mean age was 55 years (range, 17–87 years). Of 420 women with complete datasets, 104 (25%) were diagnosed with a puborectalis muscle avulsion. These women were less likely to suffer from stress urinary incontinence (SUI; P < 0.001) and urodynamic stress incontinence (USI; P = 0.065) and more likely to present with symptoms of prolapse (P < 0.001) and show signs of voiding dysfunction (P = 0.005). The negative association between avulsion and SUI persisted in multivariate models.
Puborectalis muscle trauma is not associated with an increased risk of SUI or USI in a urogynecological population, even when controlling for symptoms or signs of prolapse and previous surgery.
Keywords3D ultrasound Avulsion Birth trauma Female pelvic organ prolapse Levator ani Translabial ultrasound
- 6.Gainey HL (1943) Post-partum observation of pelvic tissue damage. Am J Obstet Gynecol 46:457–466Google Scholar
- 12.Dietz HP, Simpson J (2008) Levator trauma is associated with pelvic organ prolapse. Br J Obstet Gynaecol 115:979–984Google Scholar
- 14.Dietz HP, Steensma AB (2006) The prevalence of major abnormalities of the levator ani in urogynaecological patients. Br J Obstet Gynaecol 113(2):225–230Google Scholar
- 17.Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21(2):167–178PubMedCrossRefGoogle Scholar
- 19.Dietz HP (2009) Tomographic ultrasound of the pelvic floor: which levels matter most? Ultrasound Obstet Gynecol (in press)Google Scholar
- 21.Laycock J (1994) Clinical evaluation of the pelvic floor. In: Schuessler B (ed) Pelvic floor re-education: principles and practice. Springer, London, pp 42–48Google Scholar
- 24.Otcenasek M, Krofta L, Baca V, Grill R, Kucera E, Herman H et al (2007) Bilateral avulsion of the puborectal muscle: magnetic resonance imaging-based three-dimensional reconstruction and comparison with a model of a healthy nulliparous woman. Ultrasound Obstet Gynecol 29:692–696PubMedCrossRefGoogle Scholar
- 26.Abdool Z, Shek KL, Dietz HP (2009) The effect of levator avulsion on hiatal dimension and function. Am J Obstet Gynecol (in press)Google Scholar
- 28.Wilson PD, Hay Smith EJ, Nygaard IE, Wyman JF, Yamanishi T, Berghmans B et al (2005) Adult conservative management. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence: third international consultation on incontinence. Health Publications Ltd, Paris, pp p855–p964Google Scholar
- 31.DeLancey JO (2001) Anatomy. In: Cardozo L, Staskin D (eds) Textbook of female urology and urogynaecology. Isis Medical Media, London, UK, pp 112–124Google Scholar