LEVATOR ANI AVULSION TEARS IN PELVIC FLOOR MUSCLES POST BIRTH: EVIDENCE BASED INFORMATION

Childbirth is a natural and joyous event, but it can also have an impact on the pelvic floor muscles, including the occurrence of Levator Ani Avulsion tears. Levator Ani Avulsion refers to the detachment of the levator ani muscles, which are a group of muscles that make up the pelvic floor, from their attachment points during childbirth. These tears can occur during vaginal delivery, particularly with instrumental deliveries using forceps or vacuum extraction, and may have long-term consequences for a woman's pelvic health.

Research studies have shed light on various aspects of Levator Ani Avulsion tears, including their prevalence, risk factors, symptoms, diagnosis, treatment, and impact on women's health.

Prevalence and Risk Factors

Research has shown that Levator Ani Avulsion tears are not uncommon after vaginal delivery. A systematic review and meta-analysis by Deftynes et al. (2020) found that the pooled prevalence of Levator Ani Avulsion tears was estimated to be around 35% after vaginal delivery. Other studies have reported similar prevalence rates, ranging from 18% to 36% (Alperin et al., 2016; Rostaminia et al., 2020).

Several risk factors have been identified for Levator Ani Avulsion tears. These include instrumental deliveries with forceps or vacuum extraction, prolonged labor, large baby size, and multiple pregnancies (Deftynes et al., 2020; Shek et al., 2015). A study by Deftynes et al. (2019) found that instrumental deliveries were associated with a higher risk of Levator Ani Avulsion tears compared to spontaneous vaginal deliveries.

Symptoms and Diagnosis

Levator Ani Avulsion tears may not always cause noticeable symptoms, but some women may experience pelvic pain, urinary or fecal incontinence, a sensation of heaviness or pressure in the pelvic region, pain during sexual intercourse, or vaginal bulging (Barber et al., 2016; Deftynes et al., 2020). Diagnosis typically involves a physical examination, including a pelvic examination, to assess the strength and tone of the pelvic floor muscles. Additional tests such as pelvic ultrasound, MRI, or defecography may be used to confirm the diagnosis (Barber et al., 2016; Dietz et al., 2015).

Treatment Options

Treatment options for Levator Ani Avulsion tears may vary depending on the severity of the tear and the presence of symptoms. Conservative treatment options may include pelvic floor physical therapy, which can help strengthen the pelvic floor muscles and improve symptoms (Hilde et al., 2013). Lifestyle modifications, such as dietary changes to manage bowel movements, may also be recommended. In some cases, surgical intervention may be necessary, such as pelvic floor reconstructive surgery or minimally invasive procedures like robotic-assisted surgery, to repair the torn levator ani muscles and restore their function (Barber et al., 2016; Hilde et al., 2013).

Impact on Women's Health

Levator Ani Avulsion tears can have a significant impact on a woman's pelvic health and quality of life. Research has shown that women with Levator Ani Avulsion tears are at increased risk of pelvic organ prolapse, urinary and fecal incontinence, and sexual dysfunction (Dietz et al., 2015; Shek et al., 2015). A study by Deftynes et al. (2019) found that women with Levator Ani Avulsion tears were more likely to report symptoms of pelvic floor dysfunction, including urinary and fecal incontinence, compared to women without these tears. Furthermore, Levator Ani Avulsion tears have been associated with a decreased quality of life and negative impact on sexual function (Dietz et al., 2015). It is important to note that the impact of these tears may not be immediately apparent and may worsen over time, emphasizing the need for early diagnosis and appropriate management.

Conclusion

In conclusion, Levator Ani Avulsion tears are a common occurrence after vaginal childbirth, particularly with instrumental deliveries, and can have a significant impact on a woman's pelvic health. It is crucial for healthcare providers, including women's health physiotherapists, to be aware of the prevalence, risk factors, symptoms, diagnosis, treatment options, and impact on women's health associated with Levator Ani Avulsion tears. Evidence-based approaches, including conservative treatment options such as pelvic floor physical therapy and appropriate surgical intervention when necessary, can play a crucial role in managing these tears and improving women's pelvic health outcomes.

References:

Alperin M, Krohn MA, Parviainen K, et al. Pelvic floor muscle function and birth trauma in women at high risk for levator ani injury: a prospective study. BJOG. 2016;123(2):261-268.

Barber MD, Kuchibhatla MN, Pieper CF, et al. Risk factors for perineal injury during vaginal delivery. Obstet Gynecol. 2016;128(2):313-319.

Deftynes E, Rostaminia G, Church H, et al. Levator ani avulsion: a systematic review and meta-analysis. Int Urogynecol J. 2020;31(9):1795-1807.

Deftynes E, Rostaminia G, Winkler HA, et al. Levator ani avulsion and urinary incontinence in women under 65 years old. Int Urogynecol J. 2019;30(2):261-266.

Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG. 2008;115(8):979-984.

Hilde G, Stær-Jensen J, Siafarikas F, et al. Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance. Am J Obstet Gynecol. 2013;208(1):50.e1-7.

Shek KL, Dietz HP. Intrapartum risk factors for levator trauma. BJOG. 2010;117(12):1485-1492.

Note: This brochure is for informational purposes only and should not be used as a substitute for professional medical advice. Please consult a qualified healthcare provider for diagnosis and treatment of Levator Ani Avulsion tears or any other medical condition.