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International Urogynecology Journal

Published in:

01-03-2014 | Original Article

Impact of levator trauma on pelvic floor muscle function

Authors: Rodrigo Guzmán Rojas, Vivien Wong, Ka Lai Shek, Hans Peter Dietz

Published in: International Urogynecology Journal | Issue 3/2014

Abstract

Introduction and hypothesis

Levator trauma is common after vaginal delivery, either as macrotrauma, i.e., levator avulsion, or microtrauma, i.e., irreversible overdistension of the levator hiatus. The effect of microtrauma on muscle function is unknown. We tested the hypothesis that levator trauma is associated with reduced contractile function of the levator ani.

Methods

Pregnant nulliparous women were recruited and seen before and after childbirth. All underwent an interview, a clinical examination including pelvic floor muscle (PFM) assessment using the Modified Oxford scale (MOS) [as an optional component] and translabial ultrasound. Sonographic and clinical parameters of PFM function were assessed before and after childbirth.

Results

Out of 560 women, 446 returned at a median of 5 months after childbirth and 433 were suitable for analysis. There was a significant reduction in all measures of PFM function except for MOS. Change in MOS was associated with delivery mode [analysis of variance (ANOVA) P = 0.006). Forty-seven (15 %) vaginally parous women were diagnosed with levator avulsion, which was associated with a reduction in PFM contractility on sonographic parameters and MOS. However, only clinical assessment reached statistical significance. Sixty-five of 312 (21 %) women were diagnosed with microtrauma. We found no evidence of impairment in PFM contractility on ultrasound, but there was a statistically significant reduction in MOS.

Conclusions

Both levator avulsion (macrotrauma) and irreversible overdistension (microtrauma) are associated with reduced contractile function. This effect is more easily detected by palpation than by sonographic indices of levator function.

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Title: Impact of levator trauma on pelvic floor muscle function
Authors: Rodrigo Guzmán Rojas
Vivien Wong
Ka Lai Shek
Hans Peter Dietz
Publication date: 01-03-2014
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 3/2014
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-013-2226-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of levator trauma on pelvic floor muscle function

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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