Related Experiment Video
Updated: Feb 11, 2026
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Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
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Levator Avulsion Is Associated With Pelvic Organ Prolapse 23 Years After the First Childbirth
Ixora Kamisan Atan1,2, Sylvia Lin3,4, Hans P Dietz1
1Sydney Medical School Nepean, University of Sydney, Australia.
Summary
Levator avulsion, a childbirth injury, is linked to pelvic organ prolapse (POP) in women. This association appears to strengthen over time, particularly affecting anterior and central compartments.
Area of Science:
- Obstetrics and Gynecology
- Pelvic Floor Disorders
- Female Reproductive Health
Background:
- Pelvic organ prolapse (POP) is a common condition affecting women's quality of life.
- Levator avulsion, a tear in the muscle supporting the pelvic organs, is a potential risk factor for POP.
- Understanding this association is crucial for prevention and treatment strategies.
Purpose of the Study:
- To investigate the association between levator avulsion and the occurrence of pelvic organ prolapse (POP).
- To determine if levator avulsion is a significant predictor of POP, considering clinical and sonographic measures.
- To explore how this association may change over time and with aging.
Main Methods:
- Cross-sectional study of 195 women 20 years after childbirth.
- Utilized standardized questionnaires, International Continence Society Pelvic Organ Prolapse Quantification (POPQ) assessment, and 4D translabial ultrasound.
- Levator avulsion and pelvic organ descent were assessed via ultrasound, blinded to other data.
Main Results:
- Of 194 women assessed, 16% had levator avulsion and 36% had significant clinical POP.
- Levator avulsion and defect score were significantly associated with both clinical and sonographic POP (OR 2.6-3.3, P < .01).
- Significant associations were found with anterior (bladder, uterus) and central (rectal) compartment prolapse, but not symptoms.
Conclusions:
- Levator avulsion is demonstrably associated with pelvic organ prolapse, particularly affecting the anterior and central pelvic compartments.
- The link between levator avulsion and POP may intensify with advancing age.
- This finding highlights the importance of assessing levator muscle integrity in women with or at risk for POP.
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