Association between levator ani avulsion and urinary incontinence in women: A systematic review and meta‐analysis

Abstract

Background Urinary incontinence is a bothersome symptom. Although the relationship between stress urinary incontinence (SUI) and vaginal delivery is established, the pathology underlying SUI after vaginal birth remains to be elucidated. Objectives To determine whether levator ani muscle avulsion predisposes for SUI in women. Search strategy Pubmed and Embase were searched for terms and their variations “levator ani muscle avulsion” and “urinary incontinence”, from inception until 5 November 2019. Selection criteria Inclusion criterion: studies describing the relationship between urinary incontinence and levator ani muscle avulsion in women at least 1 year after delivery. Exclusion criterion: studies only analyzing the urethral sphincter or hiatus dimensions. Data collection and analysis Odds ratios were used and if not available, were calculated as means of data synthesis, adjusted odds ratios if presented by the study, random‐effects model to compute a pooled estimate. Results Seven studies were included, accounting for 2388 women. Comparing women with and without levator ani muscle avulsion, the overall odds ratio for SUI is 0.87 (95% confidence interval 0.56–1.34), and after adjustment for possible confounders was 0.72 (95% confidence interval 0.40–1.30). Conclusion There is no relationship between levator ani muscle avulsion and SUI in women.

Association of Levator Ani Avulsion and Anatomical and Functional Disorders

“…Smeets, by a systematic review and meta-analysis, has shown that there is no relationship between levator ani muscle avulsion and stress urinary incontinence in women. The diagnosis of levator ani muscle avulsion was made with translabial ultrasound or magnetic resonance imaging in all studies which have been recruited in meta-analysis [26].…”

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

“…Excessive expansion or prolonged traction will lead to postpartum levator ani injury [ 3 , 15 ]. 3D ultrasound has the advantages of real-time dynamic, high accuracy, repeatable, low price, etc, which can effectively detect the level of maternal LHS and fetal HC with good accuracy [ 16 , 17 ]. Transperineal ultrasound indexes are closely related to the duration of labor.…”

Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward

“… 44 One systematic review reported a prevalence of stress urinary incontinence in women with levator ani muscle avulsion of 29–69%, at least 1 year after childbirth. 51 Sexual and reproductive health conditions Secondary infertility An analysis of 277 household surveys estimated that the prevalence of secondary infertility was 10·5% (95% CI 9·5–11·7). 52 Postpartum sexual dysfunction (including dyspareunia) A systematic review reported that the overall prevalence of dyspareunia was 35% (95% CI 29–41).…”