Women's experiences of life and healthcare after levator ani avulsion: a qualitative interview study.

Background: Levator ani muscle (LAM) avulsion affects approximately 10-20% of women following vaginal delivery and results in permanent damage to the pelvic floor. This condition is a significant risk factor for pelvic floor dysfunction, including pelvic organ prolapse (POP). Despite its high prevalence, we lack knowledge and clinical guidelines regarding the prevention, diagnosis, management, and treatment of LAM. Women's views of living with this injury need to be acknowledged and explored.

Aim: To explore women's experiences of living with a LAM avulsion and their experiences of associated contact with healthcare.

Methods: A qualitative interview study in which the data were analysed using qualitative content analysis according to Graneheim and Lundman. Fifteen women aged 33-55 years with diagnosed LAM avulsion participated. Videoconference interviews were conducted using a semi-structured interview guide with open-ended questions.

Results: Three themes emerged: "Struggling to navigate healthcare", "Restricting everyday life", and "Seeing the future as uncertain, yet hopeful". These themes highlight women's frustration and challenges in navigating the healthcare system, their perception of a limited everyday life that must be adapted to what the body can handle, uncertainty about the future, and hope of good health and better care.

Conclusions: LAM avulsion can substantially impact women's quality of life. It is a hidden birth injury that needs attention. The results indicate many areas for improvement in healthcare, such as the value of confirmatory diagnosis and care that addresses the woman's overall situation.