Valsalva test: a new method to evaluate postpartum anal sphincter function by perineal ultrasound

Abstract

A 37-year-old woman (gravida 1, para 1) visited our hospital for flatus from the vagina. She was 6 months postpartum and her mode of delivery was vacuum extraction at another hospital. Anal sphincter defects were found on neither inspection nor palpation of the vagina. Three-dimensional (3D) transperineal ultrasonography (US) was performed using GE Healthcare Voluson i with a transvaginal probe (5–9 MHz). 3D-US volume data of the anal canal were obtained, tomographically sliced at 1-mm intervals at the coronal section. Both internal and external anal sphincters were thin in the direction of one o’clock (Fig. 1). Next, she was told to strain and her anal canal was observed by 2D-US. A rectovaginal fistula with both anal sphincter defects was clearly visualized in the direction of one o’clock (Fig. 2).