Related Experiment Video
Updated: Nov 28, 2025

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Association between levator ani avulsion and urinary incontinence in women: A systematic review and meta-analysis
Carlijn F A Smeets1, Tineke F M Vergeldt1, Kim J B Notten1
1Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
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.
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