Pelvic floor dysfunction after levator trauma one year postpartum: a prospective case-control study

Introduction and Hypothesis: Aim of this study was to evaluate pelvic floor dysfunction and anatomical signs of pelvic organ prolapse (POP) in patients with levator ani muscle (LAM) trauma in comparison with patients with intact LAM one year postpartum. Methods: This is a prospective case-control study. Primiparous women after vaginal delivery with 3D ultrasound diagnosis of LAM trauma were included in the case group. The controls were represented by patients with the same inclusion criteria but intact levator. All women were investigated one year postpartum on bladder, bowel, prolapse and sexual function using the Australian Pelvic Floor Questionnaire, on POP according to the pelvic organ prolapse quantification system and on pelvic floor muscle strength with Oxford Grading Scale. Results: Forty patients were included in the study: 20 with and 20 without levator trauma. Urinary symptoms were significantly increased in women with levator trauma compared with controls (p = 0.01). The two groups were comparable regarding bowel, sexual and prolapse symptoms (p = 0.24, p = 0.60, p = 0.99, respectively). In contrast to POP stage II and III, the occurrence of POP stage I was significantly higher in cases in comparison with controls (p = 0.003) with a positive association between POP stage I and LAM trauma [RR = 7.2]. The involvement of multiple compartments was significantly higher in cases than in controls (p = 0.003). Conclusions: Except for urinary symptoms, LAM trauma was asymptomatic in nearly all patients one year postpartum. However, POP stage I involving multiple compartments occurred more frequently in LAM trauma patients than in controls.