Related Experiment Video
Updated: May 29, 2026

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
The time factor in the assessment of prolapse and levator ballooning
Francisco J Orejuela1, Ka Lai Shek, Hans Peter Dietz
1Department of Obstetrics and Gynecology, University of Texas Health Science Center, Houston, TX, USA. Francisco.J.Orejuela@uth.tmc.edu
Introduction And Hypothesis:
The goal of the study was to define the time needed to obtain maximal organ descent and hiatal distension during Valsalva measured by transperineal ultrasound. Secondarily, we aimed to describe the timing of these events in relationship to each other.
Methods:
We undertook a retrospective review of the stored ultrasound volume datasets of 50 patients with pelvic organ prolapse. Data on organ descent and hiatal distension were obtained in 10 volumes from rest to maximal Valsalva.
Results:
On average, a Valsalva maneuver lasted 9.4 s (range 5 to 18). It took patients on average about six volumes (approximately 5-6 s) to reach 80% of maximum organ descent. The time to maximum organ descent was 8.9 s and the time to maximum distension of the levator hiatus was 8.2 s, p = 0.031.
Conclusions:
In order to obtain adequate assessment of pelvic organ prolapse, a Valsalva maneuver should last at least 6 s. Hiatal distension seems to precede pelvic organ descent.
Related Concept Videos
Mitral Valve Prolapse II: Assessment and Management
Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
Assessment of the Abdomen III: Palpation
Nursing Assessment of the Genitourinary System II: Inspection and Palpation
Mitral Valve Prolapse I: Introduction
Muscles of the Pelvic Floor and Perineum
Perineal Layer
The perineum is a diamond-shaped area below the pelvic diaphragm, divided into an anterior urogenital triangle that contains the external genitals and a posterior anal triangle housing the anus. The urogenital...

