Abstract
The patient with pelvic floor and anorectal dysfunction may present with a variety of symptoms such as urinary or defecatory dysfunction, urogenital or anorectal prolapse, pelvic or abdominal pain, and dyspareunia (1–5). Occasionally, rectal bleeding may eventually be found to be due to rectal prolapse. Physical examination of these patients will frequently identify the underlying anatomical abnormality that results in these clinical presentations (5–7). However, various radiological imaging techniques may be appropriately called upon to complement the workup of these patients to confirm the clinical suspicion as well as to identify unsuspected findings and defects that may impact upon the management decisions (5,7–10). This chapter will review the current range of imaging techniques available to assess the pelvic floor either anatomically or functionally and discuss aspects of radiologic interpretation, strengths, and weaknesses of each modality.
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References
Hiltunen KM, Kolehmainen H, Matikainen M. Does defecography help in diagnosis and clinical decision-making in defecation disorders? Abdom. Imaging, 19 (1994) 355–358.
Karasick S, Ehrlich S. Evacuation proctography (defecography): Roentgenographic findings in 274 consecutive patients. In Programs and Abstracts of the 94th Annual Meeting of the American Roentgen Ray Society. New Orleans, LA, 1994, p. 71.
Ott DJ, Donati DL, Kerr RM, Chen MYM. Defecography: results in 55 patients and impact on clinical management. Abdom. Imaging, 19 (1994) 349–354.
Shorvon PJ, Stevenson GW. Defecography: setting up a service. Br. J. Hosp. Med., 41 (1989) 460–466.
Harvey CJ, Halligan S, Bartram Cl, Hollings N, Sandev A, Kingston K. Evacuation proctography: A prospective study of diagnostic and therapeutic effects. Radiology, 211 (1999) 223–227.
Kelvin FM, Maglinte DDT, Hornback JA, Benson JT. Pelvic prolapse: Assessment with evacuation proctography (defecography). Radiology, 184 (1992) 547–551.
Kelvin FM, Hale DS, Maglinte DDT, Patten BJ, Benson JT. Female pelvic organ prolapse: Diagnostic contribution of dynamic cystoproctography and comparison with physical examination. Am. J. Roentgenol., 173 (1999) 31–37.
Brubaker L, Retzky S, Smith C, Saclarides T. Pelvic floor evaluation with dynamic fluoroscopy. Obstet. Gynecol., 82 (1993) 863–868.
Fenner DE. Diagnosis and assessment of sigmoidoceles. Am. J. Obstet. Gynecol., 175 (1996) 1438–1442.
Maglinte DDT, Kelvin FM, Hale DS, Benson JT. Dynamic cystoproctography: a unifying diagnostic approach to pelvic floor and anorectal dysfunction. Am. J. Roentgenol., 169 (1997) 759–767.
Kelvin FM, Maglinte DDT, Benson JT, Brubaker LP, Smith C. Dynamic cystoproctography: A technique for assessing disorders of the pelvic floor in women. Am. J. Roentgenol., 163 (1994) 368–370.
Weidner AC, Low VHS. Imaging studies of the pelvic floor. Obstet. Gynecol. Clin. N. Am., 25 (1998) 825–848.
Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW. Defecography in normal volunteers: results and implications. Gut, 30 (1989) 1737–1749.
Ikenberry S, Lappas JC, Hana MP, Rex DK. Defecography in healthy subjects: comparison of three contrast media. Radiology, 201 (1996) 233–238.
Archer BD, Somers S, Stevenson GW. Contrast medium gel for marking vaginal position during defecography. Radiology, 182 (1992) 278–279.
Ho LM, Low VHS, Freed KS. Vaginal opacification during defecography: utility of placing a folded gauze square at the introitus. Abdom. Imaging, 24 (1999) 562–564.
Low VHS, Ho LM, Freed KS. Vaginal opacification during defecography: direction of vaginal migration aids in diagnosis of pelvic floor pathology. Abdom. Imaging, 24 (1999) 565–568.
Cundiff GW, Weidner AC, Visco AG, Addison WA, Bump RC. An anatomical and functional assessment of the discrete defect posterior colporrhaphy. In Abstract of the 24th Scientific Meeting of the Society of Gynecologic Surgeons. Orlando, FL, 1997.
McGee SG, Bartram CI. Intra-anal intussusception: Diagnosis by posteroanterior stress proctography. Abdom. Imaging, 18 (1993) 136–140.
Halligan S, Bartram CI, Park HJ, Kamm HA. Proctographic features of anismus. Radiology, 197 (1995) 679–682.
Oettle GJ, Roe AM, Bartolo DCC, Mortensen NJ. What is the best way of measuring perineal descent? A comparison of radiographic and clinical methods. Br. J. Surg., 72 (1985) 999–1001.
Parks AG, Porter NH, Hardcastle J. The syndrome of the descending perineum. Proc. R. Soc. Med., 59 (1966) 477–450.
Henry MM, Parks AG, Swash M. The pelvic floor musculature in the descending perineum syndrome. Br. J. Surg., 69 (1982) 470–472.
Altringer WE, Saclarides TJ, Dominguez JM, Brubaker LP, Smith CS. Four-contrast defecography: pelvic “floor-oscopy.” Dis. Colon Rectum, 38 (1995) 695–699.
Versi E, Cardozo L, Studd J, et al. Distal urethral compensatory mechanisms in women with an incompetent bladder neck who remain continent, and the effect of the menopause. Neurourol. Urodyn., 9 (1990) 579–590.
Ahmed M. Anorectal manometry, EMG, defecography and colonic transit studies to evaluate constipation. Pract. Gastroenterol., 23 (1999) 52–62.
Mertz H, Naliboff B, Mayer E. Physiology of refractory chronic constipation. Am. J. Gastroenterol., 94 (1999) 609–615.
Karasick S. Does barium enema predict defecographic abnormalities? In Programs and Abstracts of the 96th Annual Meeting of the American Roentgen Ray Society. San Diego, CA, 1996, p. 83.
Gantke B, Schafer A, Enck P, Lubke H. Morphology and function: sonographic, manometric, and myographic evaluation of the anal sphincters. Dis. Colon Rectum, 36 (1993) 1037–1041.
Schafer A, Enck P, Furst G, Kahn TH, Frieling T, Lubke HJ. Anatomy of the anal sphincters: comparison of anal endosonography to magnetic resonance imaging. Dis. Colon Rectum, 37 (1994) 777–781.
Law PJ, Kamm MA, Bartram CI. A comparison between electromyography and anal endosongraphy in mapping external anal sphincter defects. Dis. Colon Rectum, 33 (1990) 370–373.
Meyenberger C, Bertschinger P, Zala GF, Buchmann P. Anal sphincter defects in fecal incontinence: correlation between endosonography and surgery. Endoscopy, 28 (1996) 217–224.
Nielsen MB, Rasmussen 00, Pedersen JF, Christiansen J. Anal endosonographic findings in patients with obstructed defecation. Acta Radiol, 34 (1993) 35–38.
Frudinger A, Bartram CI, Kamm MA. Transvaginal versus anal endosonography for detecting damage to the anal sphincter. Am. J. Roentgenol., 168 (1997) 1435–1438.
Kohorn EL, Scioscia AL, Jeanty P, Hobbins JC. Ultrasound cystourethrography by perineal scanning for the assessment of female stress urinary incontinence. Obstet. Gynecol., 68 (1986) 269–272.
Peschers U, Schaer G, Anthuber C, DeLancey JO, Schuessler B. Changes in vesical neck mobility following vaginal delivery. Obstet. Gynecol., 88 (1996) 1001–1006.
Stewart LK, Wilson SR. Transvaginal sonography of the anal sphincter: reliable, or not ? Am. J. Roentgenol., 173 (1999) 179–185.
Rubens DJ, Strang JG, Bogineni-Misra S, Wexler IE. Transperineal sonography of the rectum: anatomy and pathology revealed by sonography compared with CT and MR imaging. Am. J. Roentgenol., 170 (1998) 637–640.
Roehrborn CG, Peters PC. Can transabdominal ultrasound estimation of postvoiding residual replace catheterization? Urology, 16 (1988) 445–449.
deSouza NM, Puni R, Zbar A, Gilderdale DJ, Coutts GA, T. MR imaging of the anal sphincter in multiparous women using an endoanal coil: Correlation with in vitro anatomy and appearances in fecal incontinence. Am. J. Roentgenol., 167 (1996) 1465–1471.
Hussain SM, Stoker J, Lameris JS. Anal sphincter complex: Endoanal MR imaging of normal anatomy. Radiology, 197 (1995) 671–677.
deSouza NM, Gilderdale DJ, Maclver DK, Ward HC. High-resolution MR imaging of the anal sphincter in children: a pilot study using endoanal receiver coils. Am. J. Roentgenol., 169 (1997) 201–206.
Stoker J, Hussain SM, van Kempen D, Elevelt Ai, Lameris JS. Endoanal coil in MR imaging of anal fistulas. Am. J. Roentgenol., 166 (1996) 360–362.
Hussain SM, Stoker J, Schouten WR, Hop WC, Lameris JS. Fistula in ano: Endoanal sonography versus endoanal MR imaging in classification. Radiology, 200 (1996) 475–481.
Schaer GN, Koechli OR, Schuessler B, Haller U. Improvement of perineal sonographic bladder neck imaging with ultrasound contrast medium. Obstet. Gynecol., 86 (1995) 950–954.
Fielding JR, Dumanli H, Schreyer AG, et al. MR-based three-dimensional modeling of the normal pelvic floor in women: Quantification of muscle mass. Am. J. Roentgenol., 174 (2000) 657–660.
Tan IL, Stoker J, Zwaborn AW, Entius KAC, Calame JJ, Lameris JS. Female pelvic floor: Endovaginal MR imaging of normal anatomy. Radiology, 206 (1998) 777–783.
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N. Engl. J. Med., 329 (1993) 1905–1911.
Delemarre JBVM, Kruyt RH, Doornbos J, et al. Anterior rectocele: assessment with radiographic defecography, dynamic magnetic resonance imaging, and physical examination. Dis. Colon Rectum, 37 (1994) 249–259.
Goodrich MA, Webb MJ, King BF, Bampton AEH, Campeau NG, Riedener SJ. Magnetic resonance imaging of pelvic floor relaxation: dynamic analysis and evaluation of patients before and after surgical repair. Obstet. Gynecol., 82 (1993) 883–891.
Healy JC, Halligan S, Reznek RH, et al. Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement. Am. J. Roentgenol., 169 (1997) 775–779.
Goh V, Halligan S, Kaplan G, Healy JC, Bartram CI. Dynamic MR imaging of the pelvic floor in asymptomatic subjects. Am. J. Roentgenol., 174 (2000) 661–666.
Schoenenberger AW, Debatin JF, Guldenschuh I, Hany TF, Steiner P, Krestin GP. Dynamic MR defecography with a superconducting, open-configuration MR system. Radiology, 206 (1998) 641–646.
Kelvin FM, Maglinte DDT, Hale DS, Benson JT. Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. Am. J. Roentgenol., 174 (2000) 81–88.
Yang A, Mostwin JL, Rosenshein NB, Zerhouni EA. Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology, 179 (1991) 25–33.
Freimanis MG, Wald A, Caruana B, Bauman DH. Evacuation proctography in normal volunteers. Invest. Radiol., 26 (1991) 581–585.
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Low, V.H.S. (2003). Defecography and Related Radiologic Imaging Techniques. In: Koch, T.R. (eds) Colonic Diseases. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-314-9_21
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DOI: https://doi.org/10.1007/978-1-59259-314-9_21
Publisher Name: Humana Press, Totowa, NJ
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