To study the presence levator ani muscle avulsion would affect the outcome of pelvic floor training in women with urinary incontinence.

A prospective study was conducted in a tertiary urogynecology center which included women with urinary incontinence who referred for pelvic floor training program. All women presented with urinary incontinence with or without pelvic organ prolapse underwent a medical consultation by gynecologist using a standard consultation form. Levator ani muscle was assessed by 3D/4D transperineal USG. They completed a validated Urinary distress inventory short form (UDI-6) and Incontinence impact questionnaire questionnaires (IIQ-7) in Chinese1 by herself in the first and last session of pelvic floor training program. The program was led by specialized continent advisor which consisted of a teaching session on life style, drinking and voiding habit and pelvic floor exercise with bladder retraining, followed by 2-3 sessions of individual tutorial on pelvic floor training. Urodynamic study was arranged for them which were investigated using Laborie Urodynamics, Aquarius system, (Laborie, Canada) in a standard protocol. Treatment outcome was assessed by using the UDI-6 and IIQ-7 scores before and after the training program. 

An analysis was carried to assess the change of UDI-6 and IIQ-7 scores before and after the pelvic floor training program in women with and without levator ani muscle avulsion. Statistical analysis using student T test and Chi-square test were performed with SPSS 22.0 software (SPSS, Inc, Chicago, IL). Ethics approval was obtained ( CREC-2009.080).

Total of 100 women were recruited for analysis; 56 with levator ani muscle intact while 44 of them with either unilateral or bilateral levator ani muscle avulsion. The mean age of the women was 61.5 years old (SD 10.4) with median parity of 2 (1-3), and mean BMI of 25.3 kg/m2 (SD:3.6). The mean follow-up time was 9.5 (4.7) months. All of them reported with urinary symptoms and had urodynamic study, 21/100 (21%) women were diagnosed with urodynamic stress incontinence and 4/100 (4%) were with detrusor overactivity. 4/100 (4%) of them had both stress incontinence and detrusor overactivity and 41/100 (41%) had no abnormality detected. Both of the UDI-6 and IIQ-7 scores were reported to be improved after the training program with the mean UDI-6 scores from 40.1 (19.1) to 31.5 (18.5); the mean IIQ-7 score was from 29.4 (147.5) to 22.1 (21.9) with both p<0.001. The mean difference of the UDI-6 was -8.6 (16.2) and IIQ -7 was –7.3 (19.9). Comparing women with or without levator ani muscle avulsion, there were no difference in their basic demographics and the mean difference of UDI-6 and IIQ-7 were similar in women with levator ani muscle avulsion. (Table 1)

Women with levator ani muscle avulsion presented with urinary incontinence reported similar improvement after the pelvic floor training program with mean improvement of UDI-6 and IIQ-7 score.

Pelvic floor training is effective to improve symptoms of urinary incontinence in women. Women who sustained levator ani muscle injury during her previous deliveries showed similar improvement in their quality of life in this cohort. Further study with larger sample size is required to evaluate this association.

Chinese validation of Urogenital Distress Inventory and Incontinence Impact Questionnaire short form. Int Urogynecol J. 2010 Jul;21(7):807-812