The practical value of levator ani muscle injury repair

Excerpt

The levator ani muscles (LAM) and the endopelvic fascia are partners in providing pelvic support. A healthy levator ani muscle with normal tone absorbs some of the pressure transferred to the connective tissue. Once the muscles are damaged, the ligaments are burdened to carry an increasing share of the load which may result in connective tissue failure over time [1]. It is well known from the orthopedics literature that it is best to repair a muscle separated from the bony enthesis as soon as possible to prevent the muscle from undergoing significant atrophy. However, identifying levator ani separation immediately post-partum when delivery related pain and discomfort may mask levator ani muscle rupture can be very difficult (Fig. 1). The patient can be asymptomatic or in the cases of catastrophic injury have urinary retention, severe vaginal pain, or a cystocele. Most sign and symptoms of levator ani muscle injury during labour go unnoticed in modern labour and delivery units as the staff and physicians are not trained to recognize them or such injuries are viewed as a natural part of vaginal birth process. The patients who are seen at our “perineal” clinic for example, most often find us through internet search and investigation and are not referred by health care providers. …