International Urogynecology Journal

, Volume 20, Issue 8, pp 967–972

Does avulsion of the puborectalis muscle affect bladder function?

  • H. P. Dietz
  • A. Kirby
  • K. L. Shek
  • P. J. Bedwell
Original Article


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.


3D ultrasound Avulsion Birth trauma Female pelvic organ prolapse Levator ani Translabial ultrasound 


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Copyright information

© The International Urogynecological Association 2009

Authors and Affiliations

  • H. P. Dietz
    • 1
  • A. Kirby
    • 1
  • K. L. Shek
    • 1
  • P. J. Bedwell
    • 1
  1. 1.Nepean Clinical School, Nepean HospitalUniversity of SydneyPenrithAustralia

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