Related Experiment Video
Updated: Nov 15, 2025

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Physiotherapeutic Treatment for Levator Ani Avulsion after Delivery: A Transperineal Three-dimensional Ultrasound
Juliana Sayuri Kubotani1, Edward Araujo Júnior1, Andrea Silveira de Queiroz Campos2
1Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.
Background:
Levator ani avulsion is defined as the interruption of the insertion of this muscle on the pubic bone. It is currently recognized as an important triggering factor for genital prolapse. Although surgical interventions are available, there are no conservative strategies for this muscular injury.
Description:
A 40-year-old female presented with urinary incontinence and levator ani avulsion, which was confirmed on transperineal three-dimensional ultrasound (3DUS). Upon referral for physiotherapy, she presented with incorrect and weak contractions of the pelvic floor. Her treatment comprised 13 sessions of intravaginal electrotherapy followed by pelvic floor muscle (PFM) exercises in different positions. At the end of the sessions, another transperineal 3DUS was performed, and it revealed rapprochement of the levator ani muscle. The avulsed levator ani muscle can be reinserted using physiotherapeutic interventions, especially a combination of electrotherapy and PFM exercises.
Conclusion:
Transperineal 3DUS is an important approach for the follow-up of conservative treatment until full recovery.
Related Concept Videos
Muscles of the Pelvic Floor and Perineum
Perineal Layer
The perineum is a diamond-shaped area below the pelvic diaphragm, divided into an anterior urogenital triangle that contains the external genitals and a posterior anal triangle housing the anus. The urogenital...
Imaging Studies II: Ultrasonography
Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
Imaging Studies VI: Voiding Cystourethrography and Cystography
Urinary Tract Calculi VI: Surgical Management

