Association between levator ani avulsion and urinary incontinence in women: A systematic review and meta-analysis

BackgroundUrinary incontinence is a bothersome symptom. Although the relationship between stress urinary incontinence (SUI) and vaginal delivery is established, the pathology underlying SUI after vaginal birth remains to be elucidated. ObjectivesTo determine whether levator ani muscle avulsion predisposes for SUI in women. Search strategyPubmed and Embase were searched for terms and their variations "levator ani muscle avulsion" and "urinary incontinence", from inception until 5 November 2019. Selection criteriaInclusion criterion: studies describing the relationship between urinary incontinence and levator ani muscle avulsion in women at least 1 year after delivery. Exclusion criterion: studies only analyzing the urethral sphincter or hiatus dimensions. Data collection and analysisOdds ratios were used and if not available, were calculated as means of data synthesis, adjusted odds ratios if presented by the study, random-effects model to compute a pooled estimate. ResultsSeven studies were included, accounting for 2388 women. Comparing women with and without levator ani muscle avulsion, the overall odds ratio for SUI is 0.87 (95% confidence interval 0.56-1.34), and after adjustment for possible confounders was 0.72 (95% confidence interval 0.40-1.30). ConclusionThere is no relationship between levator ani muscle avulsion and SUI in women. A systematic review and meta-analysis was conducted to evaluate the relationship between levator ani muscle avulsion and stress urinary incontinence, which could not be supported.