INTRODUCTION AND HYPOTHESIS: Pregnancy and delivery are commonly associated with ano-rectal dysfunction. In addition, vaginal delivery may impact both the structure and functionality of the pelvic floor. Herein, we systematically reviewed the literature for the potential association between levator ani muscle (LAM) avulsion and ano-rectal function after childbirth. METHODS: We systematically searched the PubMed, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL (Cochrane), Clinicaltrials.gov, and ICTRP databases from inception. We selected studies reporting on the anatomy of the LAM and ano-rectal function within 24 months after childbirth, the former determined by imaging and the latter measured through validated questionnaires or ano-rectal manometry. Meta-analyses were used to pool data from studies reporting on the association between LAM avulsion and ano-rectal function, with subgroup analysis according to the presence or absence of anal sphincter trauma. Summary odds ratio (OR) and mean difference (MD) are reported with 95% confidence intervals. RESULTS: From the 7,621 studies identified, 11 were included, reporting on 2,146 women. Ten studies used transperineal ultrasound (TPUS) and one study used magnetic resonance imaging (MRI) for LAM assessment. Ano-rectal function was assessed through validated questionnaires in all but one study, in which ano-rectal manometry was used. There was no evidence for an association between LAM avulsion and symptoms of incontinence (OR 1.75 [0.74, 4.12]; MD 0.13 [-0.58, 0.85]), including in the subgroup of patients with concomitant anal sphincter injury (OR 1.83 [0.71, 4.71]). CONCLUSIONS: We did not identify an association between LAM avulsion and ano-rectal dysfunction following vaginal childbirth.

• Keywords
• Anal dysfunction, Childbirth, Levator ani muscle, Pelvic floor ultrasound, Postpartum, Puborectalis muscle,
• MeSH
• Anal Canal * physiopathology   injuries   diagnostic imaging   MeSH
• Fecal Incontinence etiology   physiopathology   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Manometry MeSH
• Rectal Diseases * etiology   physiopathology   MeSH
• Pelvic Floor * physiopathology   diagnostic imaging   injuries   MeSH
• Postpartum Period MeSH
• Pregnancy MeSH
• Delivery, Obstetric * adverse effects   MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Systematic Review MeSH

INTRODUCTION AND HYPOTHESIS: Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS. METHODS: This is a planned secondary analysis of a prospective cohort study. Pregnant women were asked to fill out standardised questionnaires on PFD and undergo TPUS at 12-14 weeks and 28-32 weeks of gestation. We compared bladder neck descent, urethral rotation, retrovesical angle, pelvic organ descent, genital hiatus dimensions and the presence of anal sphincter defects between women with and those without PFD using t test and Fisher's exact test. Linear mixed-effects models were used to assess the correlation between TPUS findings and PFD severity. As this is a secondary subgroup analysis of participants who underwent TPUS, no sample size was determined upfront. RESULTS: At Valsalva, women with urinary incontinence had more pronounced bladder neck descent (p = 0.02) and urethral rotation (p < 0.01), as well as wider retrovesical angles (p = 0.04) and larger genital hiatus areas (p < 0.01). After controlling for age, BMI and parity, the retrovesical angle was the only persistent predictor of urinary incontinence. No correlation was observed between any TPUS marker and symptoms of either prolapse or anorectal dysfunction. CONCLUSIONS: In pregnant women, symptoms of urinary incontinence, but not of prolapse and anorectal dysfunction, are associated with differences in pelvic floor anatomy at TPUS.

• Keywords
• Anal incontinence, Constipation, Gestation, Pelvic organ prolapse, Transperineal ultrasound, Urinary incontinence,
• MeSH
• Anal Canal diagnostic imaging   MeSH
• Adult MeSH
• Urinary Incontinence diagnostic imaging   MeSH
• Pregnancy Complications * diagnostic imaging   MeSH
• Humans MeSH
• Pelvic Floor Disorders * diagnostic imaging   MeSH
• Pelvic Floor * diagnostic imaging   physiopathology   MeSH
• Prospective Studies MeSH
• Surveys and Questionnaires MeSH
• Pregnancy MeSH
• Ultrasonography MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH