Physiotherapeutic treatment for levator ani avulsion after delivery: A transperineal three-dimensional ultrasound assessment

Abstract

Background: Levator ani avulsion is defined as the interruption of the insertion of this muscle on the pubic bone. It is currently recognized as an important triggering factor for genital prolapse. Although surgical interventions are available, there are no conservative strategies for this muscular injury. Description: A 40-year-old female presented with urinary incontinence and levator ani avulsion, which was confirmed on transperineal three-dimensional ultrasound (3DUS). Upon referral for physiotherapy, she presented with incorrect and weak contractions of the pelvic floor. Her treatment comprised 13 sessions of intravaginal electrotherapy followed by pelvic floor muscle (PFM) exercises in different positions. At the end of the sessions, another transperineal 3DUS was performed, and it revealed rapprochement of the levator ani muscle. The avulsed levator ani muscle can be reinserted using physiotherapeutic interventions, especially a combination of electrotherapy and PFM exercises. Conclusion: Transperineal 3DUS is an important approach for the follow-up of conservative treatment until full recovery.

The predicting value of the ratio of levator hiatus diameter to fetal head circumference in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum

“…If the second stage of labor is delayed or even stagnated, forceps midwifery or emergency cesarean section is required, which increases the risk of complex cesarean section, pelvic floor injury and neonatal asphyxia [ 22 ]. The study found that 13.00 %–14.00 % of primipara have postpartum levator ani muscle injury during delivery [ 23 ]. It is reported that the probability of levator ani injury after vaginal delivery of primipara in China is as high as 21.70 % [ 24 ].…”