MR Defecography: Clinical Indications, Technical Aspects, Reference Lines and Findings

Abstract

The female pelvic floor is divided in three main functional and anatomic compartments: the anterior, supporting the bladder and urethra; the middle, supporting the vagina and uterus; and the posterior or anorectal compartment [1, 2]. When the pelvic floor is damaged in its fascial, muscular, or neural components at the level of any of its three compartments, several pelvic floor dysfunctions or disorders (PFD) may arise [3]. Although the etiology of pelvic floor failure is multifactorial, obstetric lesions are considered primary causes of pelvic floor damage due to vaginal birth traumas, such as prolonged second stage of labor; forceps delivery; and multiple deliveries. As pelvic floor muscles and fasciae act as a unique functional entity, dysfunctions of the posterior compartment are usually associated with various dysfunctions of the anterior and middle urogenital compartments, as well. PFD are therefore characterized by a variable association of pelvic organ prolapse and functional disturbances [4] involving bladder (urinary incontinence and voiding dysfunction), vagina and/or uterus (sexual dysfunctions), and rectum [obstructed defecation syndrome (ODS)].