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

  • Francesca Maccioni


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)].


Pelvic Floor Pelvic Organ Prolapse Pelvic Floor Muscle Rectal Prolapse Puborectal Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    DeLancey JOL (1993) Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol 36:897–909.PubMedCrossRefGoogle Scholar
  2. 2.
    DeLancey JOL (1994) The anatomy of pelvic floor. Curr Opin Obstet Gynecol 6:313–316.PubMedCrossRefGoogle Scholar
  3. 3.
    Olsen AL, Smith VJ, Bergstrom JO et al (1997) Epidemiology of surgically managed pelvic organ prolapsed and urinary incontinence. Obstet Gynecol 89:501–506.PubMedCrossRefGoogle Scholar
  4. 4.
    Elneil S (2009) Complex pelvic floor failure and associated problems. Best Practice & Research Clinical Gastroenterology 23555–23573.Google Scholar
  5. 5.
    Subak LL, Waetjen LE, van den Eeden S et al (2001) Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 98.Google Scholar
  6. 6.
    Mortele KJ, Fairhurst J (2007) Dynamic MR defecography of the posterior compartment: indications, technique and MRI features. Eur J Radiol 61:462–472.PubMedCrossRefGoogle Scholar
  7. 7.
    Maccioni F (2013) Functional disorders of the anorectal compartment of the pelvic floor: clinical and diagnostic value of dynamic MRI. Abdom Imaging 38:930–951.PubMedCrossRefGoogle Scholar
  8. 8.
    Fielding JR (2002) Practical MR imaging of female pelvic floor weakness. Radiographics 22:295–304.PubMedCrossRefGoogle Scholar
  9. 9.
    Ganeshan A, Anderson EM, Upponi S et al (2008) Imaging of obstructed defecation. Clin Radiol 63:18–26.PubMedCrossRefGoogle Scholar
  10. 10.
    Stoker J, Halligan S, Bartram C (2001) Pelvic floor imaging. Radiology 218:1.CrossRefGoogle Scholar
  11. 11.
    Bharucha AE (2006) Update of tests of colon and rectal structure function. J Clin Gastroenterol 40:96–103.PubMedCrossRefGoogle Scholar
  12. 12.
    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.CrossRefGoogle Scholar
  13. 13.
    Elshazly WG, ElNekady Hassan H (2010) Role of dynamic magnetic resonance imaging in management of obstructed defecation 2627 case series. Intern J Surg 274–282.Google Scholar
  14. 14.
    Kelvin FM, Maglinte DD, Hornback JA et al (1992) Pelvic prolapse: assessment with evacuation proctography (defecography). Radiology 184:547e51.Google Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    Maglinte DDT, Bartram CI, Hale DA et al (2011) Functional imaging of the pelvic floor. Radiology 258:23–29.PubMedCrossRefGoogle Scholar
  18. 18.
    Goei R, Kemerink G (1990) Radiation dose in defecography. Radiology 176:137.PubMedCrossRefGoogle Scholar
  19. 19.
    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 closedmagnet unit. Radiology 223:501–508.CrossRefGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    Pannu HK, Kaufman HS, Cundiff GW et al (2000) Dynamic MR imaging of pelvic organ prolapse: spectrum of abnormalities. Radiographics 20:1567–1582.PubMedCrossRefGoogle Scholar
  22. 22.
    Solopova AE, Hetzer FH, Marincek B et al (2008) MR defecography: prospective comparison of two rectal enema compositions. AJR Am J Roentgenol 190:118–124.CrossRefGoogle Scholar
  23. 23.
    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:W394–W399.PubMedCrossRefGoogle Scholar
  24. 24.
    Law JM, Fielding JR (2008) MRI of pelvic floor dysfunctions. Review. AJR Am J Roentgenol 191:S45–S53.PubMedCrossRefGoogle Scholar
  25. 25.
    El Sayed RF, El Mashed S, Farag A (2008) Pelvic floor dysfunction: assessment with combined analysis of static and dynamic MR Imaging findings. Radiology 248:518–539.PubMedCrossRefGoogle Scholar
  26. 26.
    Reiner CS, Weishaupt D (2013) Dynamic pelvic floor imaging: MRI techniques and imaging parameters. Abdom Imaging 38:903–911.PubMedCrossRefGoogle Scholar
  27. 27.
    Betschart C, Chen L, Ashton-Miller JA et al (2013) On pelvic reference lines and the MR evaluation of genital prolapse: a proposal for standardization using the Pelvic Inclination Correction System. Int Urogynecol J 24:1421–1428.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Woodfield CA, Krishnamoorthy S, Hampton BS (2010) Imaging pelvic floor disorders: trend toward comprehensive MRI. AJR Am J Roentgenol 194:1640–1649.PubMedCrossRefGoogle Scholar
  29. 29.
    Felt-Bersma RJ, Cuesta MA (2001) Rectal prolapse, rectal intus-susception, rectocele, and solitary rectal ulcer syndrome. Gastroenterol Clin North Am 30:199–222.PubMedCrossRefGoogle Scholar
  30. 30.
    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.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Francesca Maccioni
    • 1
  1. 1.Department of Radiological Sciences, Oncology and PathologySapienza University of RomeRomeItaly

Personalised recommendations