Sonographic detection of puborectalis muscle avulsion is not associated with anal incontinence

Abstract

Surprisingly, we found no association between avulsion of the puborectalis muscle and hiatal biometry on the one hand and anal continence on the other hand. These findings argue against a major role of the puborectalis muscle in anal continence.

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

“…Although two studies among older women showed an association between faecal incontinence and LAM avulsion, 17,19 another study in a tertiary referral centre showed the opposite. 20 The incidence of urinary incontinence prior to childbirth can be explained by the physiological changes that occur during pregnancy and the load of the gravid uterus predisposing women to urinary incontinence. However, we could not explain why women that were later to sustain LAM avulsion had more antenatal urinary incontinence.…”

“…Although the relationship between LAM avulsion and faecal [17][18][19][20] and urinary incontinence [21][22][23][24][25] has been evaluated, sexual function has not been studied in relation to LAM avulsion. We are not aware of a study in the literature that has utilised validated methods for objective and subjective assessment of PFD in relation to LAM avulsion before and after childbirth.…”

Alteration of anal sphincter function in patients with levator avulsion: observational study

“…Complete LAM avulsion is currently associated with an increased risk of prolapse and recurrence [15], but no statistically significant association with UI [16] or FI has been found [17]. Because the role of the PRM in the physiology of fecal continence is well known, this lack of association may be due to studies where the role of the sphincter complex was not objectively quantified [18].…”

“…The correlation of LAM injury with POP and risk of POP recurrence after surgery has been proven, but no association with FI or UI has been found [16,17,26]. Although for years it was thought that the LAM was fundamental to the anal continence mechanism, this is currently a controversial topic [2,17,27].…”

“…To our knowledge, this is the first time that this information has been published in the scientific literature. This leads us to believe that perhaps, although a statistical correlation between LAM avulsion and FI has not yet been documented [17], LAM injury plays an important role in its pathophysiology. Further studies are needed, with more patients and longer follow-up periods, in order to determine manometric cutoff points and predict which patients are most likely to develop FI.…”