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Levator ani muscle avulsion: a risk factor for persistent postpartum voiding dysfunction

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Abstract

Introduction and hypothesis

Persistent postpartum voiding dysfunction (P-PPVD) is defined as the inability to empty the bladder properly 72 h after delivery despite the use of intermittent urinary catheterization. Our aim was to find predictive factors for P-PPVD and to compare its urogynecologic outcomes with transient dysfunctions.

Materials and methods

A case-control study was performed in a university hospital center between January 2018 and April 2019. The case group included women diagnosed with P-PPVD after vaginal delivery, and the control group included women with PPVD that resolved before 72 h. Patients were followed up at 12 weeks and 12 months postpartum, including an ultrasound assessment of the levator ani muscle (LAM).

Results

Of 2308 deliveries, 1894 (81%) were vaginal, 75 (3.85%) presented PPVD, and 1 lasted > 72 h (0.69% P-PPVD). LAM avulsion (OR 6.3, 95% CI 1.24–32.01) was the only independent risk factor for P-PPVD found. No significant differences in urogynecologic symptoms between transient and persistent PPVD were found in the short and the long term, except that women with P-PPVD had a lower prevalence of urinary incontinence at 12 weeks postpartum.

Conclusions

PPVD is a common, self-limited event, but in 17.3% of cases persists > 3 days. Levator ani muscle avulsion acts as an independent risk factor for P-PPVD. Early diagnosis and appropriate treatment of P-PPVD can help minimize any clinical implications for long-term urogynecologic disorders.

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Abbreviations

PPVD:

postpartum voiding dysfunction

PVR:

postvoid residual bladder volume

P-PPVD:

persistent postpartum voiding dysfunction

CIC:

clean intermittent catheterization

ICIQ-UI SF:

International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form

B-SAQ:

Bladder Control Self-assessment Questionnarie

UDI-6:

Urinary Distress Inventory-6

LAM:

levator ani muscle

POP:

pelvic organ prolapse

CI:

confidence interval

OR:

odds ratio

OASIS:

obstetric anal sphincter injury

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Author information

Authors and Affiliations

  1. Pelvic Floor Unit, Department of Obstetrics and Gynaecology, Complejo Asistencial Universitario de León (CAULE), León, Spain

    Enrique Gonzalez-Díaz

  2. Department of Obstetrics and Gynaecology, Complejo Asistencial Universitario de León (CAULE), León, Spain

    Enrique Gonzalez-Díaz & Gema Perú Biurrun

Authors
  1. Enrique Gonzalez-Díaz
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  2. Gema Perú Biurrun
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Contributions

• E Gonzalez Diaz: Conception and design, Data collection, Data analysis, Manuscript writing.

• G Perú Biurrun: Manuscript writing.

• C Fernandez Fernandez: Supervision.

• A Fernandez Corona: Supervision.

All authors assisted in critical revision of the manuscript and have read and approved the final version of the article.

Corresponding author

Correspondence to Enrique Gonzalez-Díaz.

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None.

Details of ethics approval

Approval for the study was given by the local Research Ethics Board (Comité Ético de Investigación Clínica de León).

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Gonzalez-Díaz, E., Biurrun, G.P. Levator ani muscle avulsion: a risk factor for persistent postpartum voiding dysfunction. Int Urogynecol J 31, 2327–2335 (2020). https://doi.org/10.1007/s00192-020-04412-3

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  • DOI: https://doi.org/10.1007/s00192-020-04412-3

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