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Year : 2020  |  Volume : 28  |  Issue : 4  |  Page : 245-248

Physiotherapeutic treatment for levator ani avulsion after delivery: A transperineal three-dimensional ultrasound assessment

1 Department of Obstetrics, Paulista School of Medicine, Federal University of Sao Paulo (EPM-UNIFESP), Sao Paulo, Brazil
2 Moara Health Clinic, São Paulo, Brazil
3 Department of Human Movement Science, Federal University of São Paulo, Baixada Santista Campi (UNIFESP), Santos, São Paulo, Brazil

Correspondence Address:
Prof. Edward Araujo Júnior
Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, Sao Paulo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JMU.JMU_43_20

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Background: Levator ani avulsion is defined as the interruption of the insertion of this muscle on the pubic bone. It is currently recognized as an important triggering factor for genital prolapse. Although surgical interventions are available, there are no conservative strategies for this muscular injury. Description: A 40-year-old female presented with urinary incontinence and levator ani avulsion, which was confirmed on transperineal three-dimensional ultrasound (3DUS). Upon referral for physiotherapy, she presented with incorrect and weak contractions of the pelvic floor. Her treatment comprised 13 sessions of intravaginal electrotherapy followed by pelvic floor muscle (PFM) exercises in different positions. At the end of the sessions, another transperineal 3DUS was performed, and it revealed rapprochement of the levator ani muscle. The avulsed levator ani muscle can be reinserted using physiotherapeutic interventions, especially a combination of electrotherapy and PFM exercises. Conclusion: Transperineal 3DUS is an important approach for the follow-up of conservative treatment until full recovery.

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