Skip to main content

Advertisement

SpringerLink
Log in

Pelvic floor dysfunction after levator trauma 1-year postpartum: a prospective case–control study

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

The aim of this study was to evaluate pelvic floor dysfunction and anatomical signs of pelvic organ prolapse (POP) in patients with levator ani muscle (LAM) trauma compared with patients with an intact LAM 1 year postpartum.

Methods

In a prospective case–control study, primiparous women after vaginal delivery, with LAM trauma diagnosed on 3D ultrasound, were included in the case group. Controls consisted of patients who fulfilled the same inclusion criteria but had an intact levator. All women were investigated 1 year postpartum in respect of bladder, bowel, prolapse, and sexual function using the Australian Pelvic Floor Questionnaire. POP was assessed according to the Pelvic Organ Prolapse Quantification (POP-Q) system and pelvic floor muscle strength using the Oxford Grading Scale.

Results

Forty patients were included: 20 with and 20 without levator trauma. Urinary symptoms were significantly more frequent in women with LAM trauma compared with controls (p = 0.01). The two groups were comparable in respect of bowel, sexual, and prolapse symptoms (p = 0.24, p = 0.60, p = 0.99 respectively). Unlike POP stages II and III, POP stage I was significantly more common in LAM trauma patients (n = 19, 95 %) than in controls (n = 10, 50 %) (p =0.003). A positive association was noted between POP stage I and LAM trauma (RR = 7.2). The involvement of multiple compartments was significantly more frequent in cases than in controls (p = 0.003).

Conclusions

Except for urinary symptoms, LAM trauma was asymptomatic in nearly all patients 1 year postpartum. However, POP stage I involving multiple compartments occurred more frequently in LAM trauma patients than in controls.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

LAM:

Levator ani muscle

POP:

Pelvic organ prolapse

POP-Q:

Pelvic organ prolapse quantification

TUI:

Tomographic ultrasound imaging

References

  1. Sultan AH et al (1993) Anal-sphincter disruption during vaginal delivery. N Engl J Med 329(26):1905–1911

    Article  CAS  PubMed  Google Scholar 

  2. Sultan AH, Monga AK (1997) Anal and urinary incontinence in women with obstetric anal sphincter rupture. Br J Obstet Gynaecol 104(6):754–755

    Article  CAS  PubMed  Google Scholar 

  3. Scheer I et al (2008) Urinary incontinence after obstetric anal sphincter injuries (OASIS)—is there a relationship? Int Urogynecol J Pelvic Floor Dysfunct 19(2):179–183

    Article  PubMed  Google Scholar 

  4. Dietz HP, Lanzarone V (2005) Levator trauma after vaginal delivery. Obstet Gynecol 106(4):707–712

    Article  PubMed  Google Scholar 

  5. Kearney R et al (2006) Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol 107(1):144–149

    Article  PubMed Central  PubMed  Google Scholar 

  6. Valsky DV et al (2009) Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol 201(1):91.e1–7

    Article  PubMed  Google Scholar 

  7. Delancey JO, Hurd WW (1998) Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse. Obstet Gynecol 91(3):364–368

    Article  CAS  PubMed  Google Scholar 

  8. Dietz HP, Simpson JM (2008) Levator trauma is associated with pelvic organ prolapse. BJOG 115(8):979–884

    Article  CAS  PubMed  Google Scholar 

  9. Chen L et al (2006) Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol 108(2):324–332

    Article  PubMed Central  PubMed  Google Scholar 

  10. Rostaminia G et al (2013) Levator ani deficiency and pelvic organ prolapse severity. Obstet Gynecol 121(5):1017–1024

    Article  PubMed  Google Scholar 

  11. Dietz HP (2010) Pelvic floor ultrasound: a review. Am J Obstet Gynecol 202(4):321–334

    Article  PubMed  Google Scholar 

  12. Dietz HP, Shek C, Clarke B (2005) Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 25(6):580–585

    Article  CAS  PubMed  Google Scholar 

  13. Dietz HP, Shek KL (2009) Tomographic ultrasound imaging of the pelvic floor: which levels matter most? Ultrasound Obstet Gynecol 33(6):698–703

    Article  CAS  PubMed  Google Scholar 

  14. Dietz HP, Abbu A, Shek KL (2008) The levator-urethra gap measurement: a more objective means of determining levator avulsion? Ultrasound Obstet Gynecol 32(7):941–945

    Article  CAS  PubMed  Google Scholar 

  15. Baessler K et al (2009) Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research. Int Urogynecol J Pelvic Floor Dysfunct 20(2):149–158

    Article  PubMed  Google Scholar 

  16. Baessler K (2009) Validierung eines umfassenden Beckenboden-Fragebogens für Klinik, Praxis und Forschung. Gynakol Geburtshilfliche Rundsch 49:299–307

    Article  PubMed  Google Scholar 

  17. Bump RC et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17

    Article  CAS  PubMed  Google Scholar 

  18. Haylen BT et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21(1):5–26

    Article  PubMed  Google Scholar 

  19. Orno AK, Dietz HP (2007) Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver. Ultrasound Obstet Gynecol 30(3):346–350

    Article  CAS  PubMed  Google Scholar 

  20. Laycock J (1994) Clinical evaluation of the pelvic floor. In: Schussler B, Laycock J, Norton P, Stanton SL (eds) Pelvic floor reeducation, principles, and practice. Springer, London, pp 39–51

    Google Scholar 

  21. Von Elm E et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457

  22. Albrich SB et al (2012) Impact of mode of delivery on levator morphology: a prospective observational study with three-dimensional ultrasound early in the postpartum period. BJOG 119(1):51–60

    Article  CAS  PubMed  Google Scholar 

  23. Guzman Rojas R et al (2014) Impact of levator trauma on pelvic floor muscle function. Int Urogynecol J 25(3):375–380

    Article  PubMed  Google Scholar 

  24. Shek KL, Dietz HP (2009) The effect of childbirth on hiatal dimensions. Obstet Gynecol 113(6):1272–1278

    Article  PubMed  Google Scholar 

  25. Morgan DM et al (2010) Levator ani defect status and lower urinary tract symptoms in women with pelvic organ prolapse. Int Urogynecol J 21(1):47–52

    Article  PubMed Central  PubMed  Google Scholar 

  26. Dietz HP et al (2009) Does avulsion of the puborectalis muscle affect bladder function? Int Urogynecol J Pelvic Floor Dysfunct 20(8):967–972

    Article  CAS  PubMed  Google Scholar 

  27. Heilbrun ME et al (2010) Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women. Am J Obstet Gynecol 202(5):488.e1–6

    Article  PubMed Central  PubMed  Google Scholar 

  28. Tumbarello JA et al (2010) Do repetitive Valsalva maneuvers change maximum prolapse on dynamic MRI? Int Urogynecol J 21(10):1247–1251

    Article  PubMed Central  PubMed  Google Scholar 

  29. Orejuela FJ, Shek KL, Dietz HP (2012) The time factor in the assessment of prolapse and levator ballooning. Int Urogynecol J 23(2):175–178

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None related to this article.

Author information

Authors and Affiliations

  1. Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria

    Rosa Maria Laterza, Lore Schrutka, Wolfgang Umek & Heinz Koelbl

  2. Department of Obstetrics and Gynecology, University of Mainz, Mainz, Germany

    Stefan Albrich

Authors
  1. Rosa Maria Laterza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lore Schrutka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wolfgang Umek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Albrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Heinz Koelbl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rosa Maria Laterza.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Laterza, R.M., Schrutka, L., Umek, W. et al. Pelvic floor dysfunction after levator trauma 1-year postpartum: a prospective case–control study. Int Urogynecol J 26, 41–47 (2015). https://doi.org/10.1007/s00192-014-2456-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-014-2456-0

Keywords

Search

Navigation