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Updated: Sep 3, 2025

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse

Published on: April 17, 2019

All or nothing? A second look at partial levator avulsion.

H P Dietz¹, K L Shek², G K Low^3,4,5

¹Sydney Urodynamic Centres, Penrith, NSW, Australia.

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology

|July 25, 2022

Summary

This summary is machine-generated.

Partial levator avulsion, a form of pelvic floor trauma, is linked to pelvic organ prolapse (POP) symptoms and signs. This association is primarily explained by the impact on hiatal area.

Keywords:

avulsion birth trauma levator ani pelvic floor ultrasound pelvic organ prolapse tomographic ultrasound translabial ultrasound

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Area of Science:

Urogynecology
Pelvic Floor Imaging
Female Pelvic Medicine

Background:

Pelvic organ prolapse (POP) affects many women, with levator trauma being a significant contributing factor.
Understanding the specific impact of partial levator trauma is crucial for diagnosis and management.

Purpose of the Study:

To investigate the association between partial levator trauma and the symptoms and objective signs of pelvic organ prolapse (POP).

Main Methods:

Retrospective analysis of 2513 women with pelvic floor dysfunction symptoms.
Standardized interviews, Pelvic Organ Prolapse Quantification (POP-Q), and tomographic ultrasound imaging were used.
Partial levator avulsion was quantified using the tomographic trauma score (TTS).

Main Results:

Partial levator trauma (TTS > 0) was present in 26.5% of analyzed women.
All measures of POP, particularly cystocele, showed a significant association with partial levator trauma.
The association between partial avulsion and POP disappeared when accounting for hiatal area on Valsalva.

Conclusions:

Partial levator avulsion is significantly associated with POP symptoms and objective findings.
The strongest association was observed for cystocele.
The impact of partial avulsion on POP is mediated through its effect on hiatal area.