Anti-sagging test on a sagittal section. A: sagging of the levator plate – descending perineum syndrome (levator plate or ano-coccygeal raphe in red) during Valsalva's maneuver. B: anti-sagging test: support of the posterior perineum restores normal position. Dotted lines represent structures which are not in the section plane: thin lines = limits of the levator hiatus (increase of its size if perineal descent during Valsalva's maneuver), thick lines = right pudendal nerve (stretching induced by perineal descent). Small red ring = anal sphincter.
Beco BMC Surgery 2008 8:13 doi:10.1186/1471-2482-8-13