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Effect of levator ani muscle injury on primiparous women during the first year after childbirth

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Abstract

Introduction and hypothesis

To evaluate the effect of levator ani muscle (LAM) injury on pelvic floor disorders and health-related quality of life in Chinese primiparous women during the first year after delivery.

Methods

At 8 weeks and 12 months after delivery, 328 women were assessed for symptoms of pelvic floor disorders and quality of life using the standardised questionnaire, POP-Q; and translabial ultrasound to detect LAM injury. Descriptive analysis, independent sample t test, non-parametric testing, Chi-squared test and two-sided Fisher’s exact test were used.

Results

At 8 weeks after delivery, 48 (19.0 % [95 % CI, 14.2–23.8 %]) women with vaginal delivery had LAM injury; 38 women (79.2 %) had persistent LAM injury at 12 months. At 8 weeks, LAM injury was associated with prolapse symptoms, descent at Pelvic Organ Prolapse Quantification (POP-Q) Aa and Ba points and a higher Pelvic Organ Prolapse Distress Inventory (POPDI) general and Urinary Distress Inventory (UDI) Obstructive subscale score. At 12 months, it was not associated with prolapse symptoms, Pelvic Floor Distress Inventory (PFDI) or Pelvic Floor Impact Questionnaire (PFIQ). There was also no association between stress urinary incontinence (SUI), urge urinary incontinence (UUI), mixed urinary incontinence (UI), faecal incontinence (FI) with LAM injury at both time points.

Conclusions

Seventy-nine per cent of women who had LAM injury at 8 weeks after vaginal delivery had persistent LAM injury at 12 months. LAM injury was associated with prolapse symptoms, lower POP-Q Aa and Ba points at 8 weeks after delivery and a higher POPDI general and UDI Obstructive subscale scoring. However, we are not able to confirm the association between LAM injury and SUI, UUI, mixed UI, FI at 8 weeks or 12 months after delivery; or prolapse symptoms, PFDI or PFIQ scores at 12 months after delivery.

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Abbreviations

FI:

Faecal incontinence to solid/liquid stool

LAM:

Levator ani muscle

LUG:

Levator–urethral gap

PFDI:

Pelvic Floor Distress Inventory

PFIQ:

Pelvic Floor Impact Questionnaire

POPDI:

Pelvic Organ Prolapse Distress Inventory

POP-Q:

Pelvic Organ Prolapse Quantification

SUI:

Stress urinary incontinence

UDI:

Urinary Distress Inventory

USG:

Ultrasound

UI:

Urinary incontinence

UUI:

Urge urinary incontinence

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Acknowledgement

This study obtained a grant from the Health and Health Services Research Fund from the Food and Health Bureau of Hong Kong SAR.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong

    Symphorosa S. C. Chan, Rachel Y. K. Cheung, K. W. Yiu, L. L. Lee & Tony K. H. Chung

  2. Department of Obstetrics and Gynaecology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong

    Symphorosa S. C. Chan

Authors
  1. Symphorosa S. C. Chan
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  2. Rachel Y. K. Cheung
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  3. K. W. Yiu
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  4. L. L. Lee
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  5. Tony K. H. Chung
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Corresponding author

Correspondence to Symphorosa S. C. Chan.

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Chan, S.S.C., Cheung, R.Y.K., Yiu, K.W. et al. Effect of levator ani muscle injury on primiparous women during the first year after childbirth. Int Urogynecol J 25, 1381–1388 (2014). https://doi.org/10.1007/s00192-014-2340-y

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  • DOI: https://doi.org/10.1007/s00192-014-2340-y

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