Send to

Choose Destination
Int Urogynecol J. 2013 Nov;24(11):1933-7. doi: 10.1007/s00192-013-2119-6. Epub 2013 May 18.

How to determine "ballooning" of the levator hiatus on clinical examination: a retrospective observational study.

Author information

Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia.



Dimensions of the levator hiatus determined on imaging are strong predictors of symptoms and signs of female pelvic organ prolapse (FPOP) and of FPOP recurrence. A clinical equivalence can be recorded as genital hiatus (Gh) + perineal body (Pb) using the ICS prolapse quantification system. The objective of this study was to stratify the Gh+Pb measurement to provide clinicians with clinical diagnostic criteria similar to those available on imaging.


A retrospective study of the data sets of 477 patients seen in a tertiary urogynecological clinic.


On average, Gh was 4.2 (range, 1.5-8.5) cm, Pb 3.8 (range, 2.0-7.0) cm, Gh+Pb 7.9 cm (range, 4.2-13.0). The sum of Gh+Pb was strongly associated with symptoms (p < 0.001) and signs (p < 0.001) of FPOP. On receiver-operator characteristic statistics, the area under the curve was determined as 0.707 (0.658-0.755) in predicting symptoms of FPOP, and as 0.890 (0.854-0.925) for predicting FPOP ≥ stage 2, using 7 cm as the optimal cut-off for Gh+Pb. Using the data sets of 309 patients with abnormal (i.e. ≥7 cm) Gh+Pb measurements, we stratified abnormal hiatal distensibility, or "ballooning", into mild, moderate, marked and severe as Gh+Pb = 7.0-7.99 cm, 8.0-8.99 cm, 9.0-9.99 cm and 10 cm or more respectively, as the optimal compromise between easily remembered cut-off numbers and quartiles.


The sum of Gh+Pb measurement may allow clinicians to determine the degree of excessive hiatal distensibility or 'ballooning' without requiring imaging assessment.

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center