What's a proper push? The Valsalva manoeuvre revisited

In daily practice, the Valsalva manoeuvre is used to assess pelvic organ prolapse, virtually always without standardisation of pressure. We undertook a study to determine maximum pressures reached and pressures required to obtain 80% of maximal pelvic organ descent, to investigate the need for such standardisation. Clinical data and ultrasound data sets of 75 women seen for urodynamic testing were reviewed retrospectively, with three Valsalva manoeuvres registered per patient. Maximum rectal pressures generated during Valsalva were 107 cm H ₂O on average (range, 45-190 cm H ₂O). Ninety-seven percent of all women managed to reach pressures ≥60 cm H ₂O. On average, 80% of maximal bladder neck descent was reached at 56 cm H ₂O, 80% of maximal pelvic organ descent at 38 cm H ₂O. Our results imply that virtually all patients were able to generate pressures resulting in ≥80% of maximal pelvic organ descent. This implies that standardisation of Valsalva pressures for prolapse assessment may be unnecessary.