A review of levator ani avulsion after childbirth: Incidence, imaging and management

Key Content

• Levator ani muscle (LAM) avulsion injury occurs occultly during childbirth, most commonly during operative vaginal deliveries.

• Injuries of levator ani have long term sequelae for pelvic floor health. As life expectancy increases the burden of disease upon urogynaecology services will need to be considered.

• Diagnosis of this condition can be difficult as there is no agreed ‘gold standard’ imaging modality.

• There is no consensus regarding surgical management of LAM avulsion.

Learning objectives

• Review anatomy and function of levator ani muscle • Identify the risk factors for levator ani avulsion injury

• Role of imaging to appropriately identify LAM injury and current management options including appropriate follow up • Management of subsequent pregnancy following LAM avulsion

Ethical issues

• Is there value to the patient in diagnosing levator ani avulsion when there is no recommended treatment for these injuries?