Levator avulsion—hidden birth injury
The levator ani muscle is the main support of the pelvic floor. During natural childbirth, especially the first, with a large fetus or with the application of forceps, its bundles may be partially or completely torn off from the place of attachment to the pubic bone. This injury is not visible from the outside, is not accompanied by bleeding and therefore usually remains unrecognized, but in a significant proportion of cases it determines the development of prolapse years later.
Three-dimensional ultrasound examination of the pelvic floor allows you to directly see the levators: assess the symmetry, integrity of the attachment on both sides and measure the area of the genital hiatus at rest and during straining. Widening of the hiatus and unilateral or bilateral muscle avulsion are objective signs that cannot be obtained during a routine gynecological examination.
The practical implications are straightforward. With intact levators, the basis of treatment is training the pelvic floor muscles, and it is really effective. If the muscle is torn off, exercises will not restore the attachment, and you have to rely on a pessary or surgical correction. In addition, the presence of a levator defect increases the risk of relapse after surgery for prolapse, which is taken into account when choosing a technique.
Ultrasound capabilities
Ultrasound remains the first choice for imaging in almost every situation: it is accessible, safe, does not require radiation, and provides images in real time. It perfectly shows parenchymal organs, fluid formations, walls of hollow organs and soft tissues, and in Doppler mode, blood flow in the vessels.
A separate advantage is the possibility of dynamic tests: the doctor can ask you to strain, change your body position, fill or empty an organ and see how the picture changes. Neither computed tomography nor magnetic resonance imaging provide such an opportunity.
What influences the quality of research
The main enemy of ultrasound is gas: it completely reflects the wave. Therefore, distended intestines can make the pancreas, aorta, and retroperitoneal structures invisible. For the same reason, preparation for examining the abdominal cavity is not a formality, but a condition for a reliable result.
Severe obesity, postoperative scars, bandages and open wounds in the area of interest also have an effect. If the picture turns out to be uninformative, the doctor indicates this in the protocol and recommends an alternative method - computed tomography or magnetic resonance imaging.
Doppler mode
Dopplerography shows the movement of blood: color mapping reflects the direction of flow, spectral analysis measures velocities and resistance indices. This allows you to assess the patency of the vessel, identify stenosis, thrombus, aneurysm, pathological reflux and the nature of the blood supply to the formation.
Increased blood flow in Doppler mode is an important sign of active inflammation or tumor growth, which is why many organ studies are supplemented with Doppler as a mandatory part of the protocol.