Childbirth puts an immense pressure and stress on the entire body system, some areas more than others. The pelvic floor provides crucial support to pelvic organs such as the uterus, bladder and rectum. This pelvic structure, in particular the muscular support can undergo significant injury as the baby is delivered through the birth canal.
Injury to the pelvic floor or pelvic floor muscle trauma occurs only during vaginal delivery especially with instrumental assistance, such as forceps. The pelvic floor muscle or otherwise known as the “levator muscles” can detach from the pubic bone during such delivery and is often referred to as a “levator avulsion”. The incidence of levator avulsion ranges between 10 to 30%.
What causes maternal pelvic floor trauma?
Studies have shown that the use of forceps increases the risk of levator avulsion. This may be because of the undue amount of force and speed required to stretch the pelvic muscles to enable delivery of the baby. Majority of the time, this injury is a permanent injury.
Aside from the use of forceps, other factors associated with an increase risk of levator avulsion injury include:
- Baby birth weight over 4kg
- Larger size of the fetal head
- Prolonged second stage (ie. prolonged pushing)
- An advanced maternal age
- Major tears of the vaginal walls or anal sphincter (muscle that controls the anus)
What are the symptoms of pelvic floor trauma?
Most patients may not have any symptoms of levator avulsion. However, women with levator avulsion are at increased risk of developing pelvic organ prolapse. Patients with levator avulsion may also feel weaker pelvic floor muscle strength.
There may be other associated issues such as poorer bowel control if the anal sphincter was also injured.
How is pelvic floor trauma diagnosed?
Aside from a thorough physical examination, a transperineal pelvic floor ultrasound is the best method for assessing the pelvic floor structures and the degree of injury sustained.
Treatment options
At this stage, there are no known successful treatments for levator avulsion. The only way, if possible, is to avoid the need to use forceps and to be informed of the possible factors that may lead to a major pelvic floor muscle trauma
To schedule an appointment with Dr Vivien Wong call 1300 848 966.
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