Injuries to the levator ani in unexplained, chronic pelvic pain

Patterns of injury to the levator ani in parous women with laparoscopy-negative, chronic pelvic pain (CPP) are described. A consecutive series of 26 parous women with laparoscopy-negative CPP, had magnetic resonance imaging (MRI) in axial, coronal and sagittal planes. Similar imaging studies were performed in 32 parous women having MRI scans for other clinical indications and 20 asymptomatic, nulliparous women. Three patterns of injury/defect to the levator ani (LAd) were observed in 20/26 patients with unexplained pelvic pain: avulsion of the pubococcygeus from its origin at the pubis (LAd I, 3/20), avulsion of the pubococcygeus from its origin at the arcus tendineus levator ani (LAd II, 14/20), and, loss of shape and form of the pubococcygeus (LAd III, 6/20). Three patterns of injury to the levator ani have been described with MR imaging in parous women with unexplained CPP.