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Updated: Jul 5, 2026
07:41
Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Levator trauma is associated with pelvic organ prolapse
1Department of Obstetrics and Gynaecology, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia. hpdietz@bigpond.com
Summary
Women with levator avulsion defects are nearly twice as likely to develop pelvic organ prolapse (POP) stage II or higher. This increased risk is primarily linked to cystocele and uterine prolapse development.
Area of Science:
- Urogynecology
- Pelvic Floor Disorders
- Anatomical Injury
Background:
- Pelvic organ prolapse (POP) is a common condition affecting women's quality of life.
- Levator avulsion injury, a tear in the muscle supporting the pelvic organs, is a suspected risk factor for POP.
- Understanding the association between levator avulsion and POP is crucial for diagnosis and treatment.
Purpose of the Study:
- To quantify the risk of developing significant pelvic organ prolapse (stage II or higher) in women with levator avulsion defects.
- To identify specific types of prolapse most strongly associated with levator avulsion.
Main Methods:
- A retrospective observational study was conducted at a tertiary urogynecological unit.
- Data from 781 women were analyzed, including clinical examination (POP-Q staging) and 4D translabial ultrasound for levator ani muscle assessment.
- Women with prior prolapse or anti-incontinence surgery were excluded.
Main Results:
- Significant prolapse (stage II+) was diagnosed in 53% of women, while levator avulsion defects were present in 23%.
- Women with levator avulsion had a relative risk (RR) of 1.9 (95% CI 1.7-2.1) for POP stage II or higher compared to those without avulsion.
- The association was strongest for cystocele (RR 2.3) and uterine prolapse (RR 4.0).
Conclusions:
- Levator avulsion defects significantly increase the likelihood of developing stage II or higher pelvic organ prolapse.
- Cystocele and uterine prolapse are the types of prolapse most strongly associated with levator avulsion.
- These findings highlight the importance of assessing levator muscle integrity in women with or at risk for pelvic organ prolapse.
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