Abstract
The obstructed defecation syndrome is the main functional disorder of the posterior or ano-rectal pelvic floor compartment. Different mechanical and functional rectal disorders may cause this syndrome, including rectocele, rectal invagination, rectal prolapse, and pubo-rectalis muscle dyskinesia. Since pelvic floor muscles and fasciae act as a unique functional entity, dysfunctions of the posterior compartment are usually associated to variable dysfunctions of the anterior and middle urogenital compartments as well. Over 50% of postmenopause women are affected by severe symptoms due to pelvic floor disorders, with frequent need of surgical invasive treatments. Both diagnosis of the specific ano-rectal dysfunction and identification of all possible associated disorders are mandatory for an effective surgical or conservative treatment. Currently, dynamic MRI provides an excellent morphological and functional display of the pelvic floor like no other imaging modality. Pros and cons of posterior pelvic floor MRI, different evaluation techniques, reference lines and grading systems together with the main imaging findings will be discussed and illustrated.
Similar content being viewed by others
References
Olsen AL, Smith VJ, bergstrom JO, et al. (1997) Epidemiology of surgically managed pelvic organ prolapsed and urinary incontinence. Obstet Gynecol 89:501–506
Subak LL, Waetjen LE, van den Eeden S, et al. (2001) Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol; 98
DeLancey JOL (1993) Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol 36:897–909
DeLancey JO (1994) The anatomy of pelvic floor. Curr Opin Obstet Gynecol 6:313–316
Elneil S (2009) Complex pelvic floor failure and associated problems Best Practice & Research Clinical Gastroenterology 23555–573
Mortele KJ, Fairhurst J (2007) Dynamic MR defecography of the posterior compartment: indications, technique and MRI features. Eur J Radiol 61(3):462–472
Bump RC, Mattiason A, Bo K, et al. (1996) The standardization of terminology of female pelvic floor prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17
Fielding JR (2002) Practical MR imaging of female pelvic floor weakness. RadioGraphics 22:295–304
Fitzgerald MP, Weber AM, Howden N, et al. (2007) Risk factors for anal sphincter tear during vaginal delivery. Obstet Gynecol 109:29–34
Karasik S, Spettel CM (1997) The role of parity and hysterectomy on the development of pelvic floor abnormalities revealed by defecography. AJR Am J Roentgenol 169:1555–1558
Kelvin FM, Maglinte DD (2003) Dynamic evaluation of female pelvic organ prolapse by extended proctography. Radiol Clin North Am 41(2):395–407
Maglinte DDT, Kelvin FM, Fitzgerald K, et al. (1999) Association of compartment defects in pelvic floor dysfunction. Am J Roentgenol 172:439–444
Ganeshan A, Anderson EM, Upponi S, et al. (2008) Imaging of obstructed defecation. Clin Radiol 63:18–26
Stoker J, Halligan S, Bartram C (2001) Pelvic floor imaging. Radiology 218(621–64):1
Preston DM, Lennard-Jones JE (1986) Severe chronic constipation of young women: idiopathic slow transit constipation. Gut 27:41–48
Elshazly WG, ElNekady Hassan H (2010) Role of dynamic magnetic resonance imaging in management of obstructed defecation case series Intern J Surg 274–282
Bharucha AE (2006) Update of tests of colon and rectal structure function. J Clin Gastroenterol 40:96–103
Kelvin FM, Maglinte DD, Hornback JA, et al. (1992) Pelvic prolapse: assessment with evacuation proctography (defecography). Radiology 184:547e51
Kelvin FM, Hale DS, Maglinte DDT, Patten BJ, Benson JT (1999) Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination. AJR Am J Roentgenol 173:31
Kelvin FM, Maglinte DDT, Hale DS, Benson JT (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocoloproctography. AJR Am J Roentgenol 174:81–88
Maglinte DDT, Bartram C (2007) Dynamic imaging of posterior compartment pelvic floor dysfunction by evacuation proctography: techniques, indications, results and limitations. Eur J Radiol 61:454–461
Maglinte DDT, Bartram CI, et al. (2011) Functional imaging of the pelvic floor. Radiology 258:23–29
Goei R, Kemerink G (1990) Radiation dose in defecography. Radiology 176:137
Seifert H, Blass G, Leetz HK, et al. (1994) The determination of the ovarian dosage in defecography on a digital C-arm unit. Rofo 161:70
Zonca G, De Thomatis A, Marchesini R, et al. (1997) The absorbed dose to the gonads in adult patients undergoing defecographic study by digital or traditional radiographic imaging. Radiol Med 94:520
Bertschinger KM, Hetzer FH, Roos JE, et al. (2001) Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 223(2):501–508
Roos JE, Weishaupt D, Wildermuth S, et al. (2002) Experience of 4 years with open MR defecography: pictorial review of anorectal anatomy and disease. RadioGraphics 22:817–832
Pannu HK, Kaufman HS, Cundiff GW, et al. (2000) Dynamic MR imaging of pelvic organ prolapse: spectrum of abnormalities. Radiographics 20(6):1567–1582
El Sayed RF, El Mashed S, Farag A (2008) Pelvic floor dysfunction: assessment with combined analysisof static and dynamic MR Imaging findings. Radiology 248:518–539
Colaiacomo MC, Masselli G, Polettini E, et al. (2009) Dynamic MR imaging of the pelvic floor: a pictorial review. Radiographics 29(3):e35 ((Review))
Woodfield CA, Krishnamoorthy S, Hampton BS (2010) Imaging pelvic floor disorders: trend toward comprehensive MRI. AJR 194:1640–1649
Bolon N, Weishaupt D (2005) Dynamic MR imaging of outlet obstruction. Rom J Gastroenterol 14:293–302
Flusberg M, Sahni VA, Erturk SM, et al. (2011) Dynamic MR defecography: assessment of the usefulness of the defecation phase. AJR Am J Roentgenol 196(4):W394–W399
Boyadzhyan L, Raman SS, Raz S (2008) Role of static and dynamic mr imagingin surgical pelvic floor dysfunction. RadioGraphics 28:949–967
Law JM, Fielding JR (2008) MRI of pelvic floor dysfunctions. Review. AJR 191:S45–S53
Lamb GM, de Jode MG, Gould SW, et al. (2000) Gedroyc WM upright dynamic MR defaecating proctography in an open configuration MR system. Br J Radiol 73(866):152–155
Rentsch M, Paetzel C, Lenhart M, et al. (2001) Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology. Dis Colon Rectum 44(7):999–1007
Vanbeckevoort D, Van Hoe L, Oyen R, et al. (1999) (1999) Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging 9:373–377
Morakkabati-Spitz N, Gieseke J, Willinek WA, et al. (2008) Dynamic pelvic floor MR imaging at 3 T in patients with clinical signs of urinary incontinence-preliminary results. Eur Radiol 18:2620–2627
Otto SD, Oesterheld A, Ritz JP, et al. (2011) Rectal anatomy after rectopexy: cinedefecography versus MR-defecography. J Surg Res 165:52–58
Lienemann A, Fischer T (2003) Functional Imaging of the pelvic floor. Eur J Radiol 47:117–122
Solopova AE, Hetzer FH, Marincek B, et al. (2008) MR defecography: prospective comparison of two rectal enema compositions. AJR 190:118–124
Flechter JG, Busse RF, Riedered SJ, et al. (2003) Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders. Am J Gastroenterol 98:399–411
Lienemann A, Anthuber C, Baron A, et al. (1997) Dynamic MR colpocystorectography assessing pelvic floor descent. Eur Radiol 7:1309–1317
Etlik Ö, Arslan H, Odabaşi H, et al. (2005) The role of the MR-fluoroscopy in the diagnosis and staging of the pelvic organ prolapse. Eur J Radiol 53:136–141
Singh K, Reid WMN, Berger LA (2001) Assessment and grading of pelvic organ prolapse by use of dynamic magnetic resonance imaging. Am J Obstet Gynecol 185:71–77
Comiter CV, Vasavada SP, Barbaric ZL (1999) Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology 54(454):457
Goh V, Halligan S, Kaplan G, et al. (2000) Dynamic MRI of the pelvic floor in asymptomatic subjects. AJR Am J Roentgenol 174:661–666
Healy JC, Halligan S, Reznek RH, et al. (1999) Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement. AJR 1997(169):775–779
Stoker J, Halligan S, Bartram CI (2001) Pelvic floor imaging. Radiology 218(3):621–641
Shorvon PJ, Marshall MM (2005) Evacuation proctography. In: Wexner SD, Zbar AP, Pescatori M (eds) Complex anorectal disorder: investigation and management. Berlin Heideberberg, New York: Springer
Kenton K, Shott S, Brubaker L (1999) The anatomic and functional variability of rectoceles in women. Int Urogynecol J Pelvic Floor Dysfunct 10(2):96–99
Felt-Bersma RJ, Cuesta MA (2001) Rectal prolapse, rectal intussusception, rectocele, and solitary rectal ulcer syndrome. Gastroenterol Clin North Am 30:199–222
Dvorkin LS, Gladman MA, Scott MS, et al. (2005) Rectal intussusception: a study of rectal biomechanicsand visceroperception. Am J Gastroenterol 2005(100):1578–1585
Dvorkin LS, Hetzer F, Scott SM, et al. (2004) Open-magnet MR defaecography compared with evacuation proctography in the diagnosis and management of patients with rectal intussusception. Colorectal Dis 6(1):45–53
Fengler SA, Pearl RK, Prasad ML, et al. (2000) Management of recurrent rectal prolapse. Dis Colon Rectum 40:832–834 Lienemann A, Anthuber C, Baron A, Reuser M. Diagnosing enteroceles using dynamic magnetic resonance imaging. Dis Colon Rectum 43:205–212
Gousse AE, Barbaric ZL, Safir MH, et al. (2000) Dynamic half Fourier acquisition single shot turbo spin-echo magneticresonance imaging for evaluating the female pelvis. J Urol 164:1606–1613
Cappabianca S, Reginelli A, Iacobellis F, et al. (2011) Dynamic MRI defecography vs. entero-colpo-cysto-defecography in the evaluation of midline pelvic floor hernias in female pelvic floor disorders. Int J Colorectal Dis 26:1191–1196
Parks AG, Porter NH, Hardcastle J (1966) The syndrome of the descending perineum. Proc R Soc Med 59:477–482
Broekhuis SR, Hendrik JCM, Jurgen JF (2010) Perineal descent and patients’ symptoms of anorectal dysfunction, pelvic organ prolapse, and urinary incontinence. Int Urogynecol J 21:721–729
Halligan S, Bartram CI, Park HJ, et al. (1995) Proctographic features of anismus. Radiology 197:679–682
Acknowledgments
This paper has been written in memory of Professor Irene Fortunee Habib, my friend and teacher.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Maccioni, F. Functional disorders of the ano-rectal compartment of the pelvic floor: clinical and diagnostic value of dynamic MRI. Abdom Imaging 38, 930–951 (2013). https://doi.org/10.1007/s00261-012-9955-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-012-9955-6