title: Does avulsion of the puborectalis muscle affect bladder function?
abstract: OBJECTIVE
  The levator ani muscle is generally thought to play a role in urinary continence, with incontinence assumed to be due to abnormal muscle function or morphology. This study examined whether avulsion of the puborectalis muscle is associated with symptoms or signs of bladder dysfunction.
  
  
  METHODS
  In a retrospective observational study, we reviewed the records of 425 women who had attended a urogynecological unit for independent flowmetry, multichannel urodynamic testing, and 4D pelvic floor ultrasound.
  
  
  RESULTS
  Mean age was 55 years (range, 17-87 years). Of 420 women with complete datasets, 104 (25%) were diagnosed with a puborectalis muscle avulsion. These women were less likely to suffer from stress urinary incontinence (SUI; P < 0.001) and urodynamic stress incontinence (USI; P = 0.065) and more likely to present with symptoms of prolapse (P < 0.001) and show signs of voiding dysfunction (P = 0.005). The negative association between avulsion and SUI persisted in multivariate models.
  
  
  CONCLUSIONS
  Puborectalis muscle trauma is not associated with an increased risk of SUI or USI in a urogynecological population, even when controlling for symptoms or signs of prolapse and previous surgery.
authors.affiliation: Nepean Clinical School, Nepean Hospital, University of Sydney, Penrith, NSW 2750, Australia. hpdietz@bigpond.com
authors.forename: H P
authors.initials: HP
authors.lastname: Dietz
authors.forename: A
authors.initials: A
authors.lastname: Kirby
authors.forename: K L
authors.initials: KL
authors.lastname: Shek
authors.forename: P J
authors.initials: PJ
authors.lastname: Bedwell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000293:injuries; D012189:Retrospective Studies; D014463:Ultrasonography; D016055:Urinary Retention / Q000000981:diagnostic imaging / Q000209:etiology*; D014596:Uterine Prolapse / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology*; D055815:Young Adult