Does avulsion of the puborectalis muscle affect bladder function?

Introduction and hypothesis: 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 420women 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. Conclusion: 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.