Valsalva maneuver

Ultrasound

Surgery

Rectum

Levator ani

Rectal prolapse

Obstructed defecation

Avulsion

Radiology

Blood pressure

Pelvic floor

Pelvic floor dysfunction

Medicine

Best Practice & Research Clinical Obstetrics & Gynaecology

Imaging is increasingly being used in urogynaecology. Because of low cost and universal availability, ultrasound (US) is the most commonly used diagnostic modality, which allows the observation of manoeuvres such as Valsalva and pelvic floor muscle contraction in real time. The ability to see beyond surface anatomy is particularly important in the posterior compartment and in obstructed defecation where this method may replace defecation proctography. Imaging is especially useful in the form of 3D/4D multiplanar and tomographic translabial US, as these modalities give access to the axial plane and the levator ani. This allows assessment of both avulsion, i.e. major maternal birth trauma, and hiatal overdistension, i.e. ballooning. Both are major risk factors for both prolapse and prolapse recurrence. This review will outline current clinical utility, introduce recent research in the respective field and provide an overview of likely future utility of imaging in the investigation of pelvic organ prolapse.

Ultrasound in the assessment of pelvic organ prolapse