Levator Avulsion

Levator avulsion refers to the ‘traumatic detachment of the puborectalis muscle from its insertion on the inferior pubic rami”. It is possible to have either a partial or complete avulsion, and is estimated to occur in 14-36% of women after birth.

HOW DO I KNOW IF I HAVE A LEVATOR AVULSION?

There are several methods used for assessing and diagnosing levator avulsion injury. Typically, a physical examination will be conducted to assess muscle strength, muscle integrity, and presence of prolapse. If a levator avulsion injury is suspected, a patient is commonly referred for ultrasound imaging for a more formal assessment and diagnosis.'

WHAT ARE THE RISK FACTORS FOR LEVATOR AVULSION?

• Increasing maternal age

• Low BMI

• Lower bladder neck descent in pregnancy

• Speed of vaginal delivery

• Prolonged second stage of labour

• Use of forceps

WHAT ARE THE SYMPTOMS OF LEVATOR AVULSION?

Symptoms of levator avulsion injury may include:

• Pelvic Organ Prolapse (heaviness, dragging, bulge felt in vagina)

• Urinary Incontinence

• Fecal Incontinence

• Pain during sexual activity (dyspareunia)

HOW DO I TREAT LEVATOR AVULSION

Historically it was thought that there was no spontaneous healing of the puborectalis muscle however, a 2014 study found that 62% of levator avulsion injuries were no longer present at 12 months postpartum.

Management can include:

• Pelvic Floor Muscle Strength Training under the guidance of your pelvic floor physiotherapist.

• Pessary use for pelvic organ support

• Management of bladder and bowels

• Management of lifestyle factors (e.g. weight management).

If you’ve experienced a levator avulsion injury, or are concerned about your risk factors, click here to book in your appointment or get in touch hello@scencephysiotherapy.com.au