Functional disorders of the pelvic floor are common healthcare problems owing to increased incidence of obesity, pelvic surgeries, childbirth, heavy physical exertion etc. In the past, fluoroscopic defecography was used in their diagnosis, but it had its limitations like radiation exposure. Endoanal sonography and Magnetic Resonance Imaging (MRI) were also used to assess the pelvic pathologies but they could not assess the pelvic floor function. Magnetic Resonance Defecography (MRD) is a new modality that has come up over the years which allows dynamic imaging of the pelvic floor during defecation and thus plays a role in diagnosing these disorders.
To study the technique, applications and limitations of MR Defecography in evaluating Pelvic Floor Dysfunctional Disorders.
Twenty one patients of age range 20-80 years with suspected pelvic floor dysfunction referred to undergo MR Defecography scanning were included. For scanning Wipro GE Healthcare 1.5 Tesla MRI machine was used. Ultrasound jelly was instilled into the rectum of patient and was asked to defecate when instructed. Scanning was done in four phases-resting, straining, squeezing and defecation as per the standard protocol. Studies were interpreted using the parameters mentioned in literature and results were analyzed.
Most common complaint encountered was that of sense of incomplete defecation. Out of 21 patients, 11 were found normal and 31 were found to have one of the pelvic floor dysfunction disorder. Out of these, 21% were diagnosed as Spastic Perinuem Syndrome, 19% as Pelvic Floor Dysynergia, 14% were found to have Rectal Prolapse, 9% had Rectocoele, in 4.5% each Uterine prolapse and Cystocoele was found. Obstructive defecation disorders are more common in middle age, while the relaxing type which include Pelvic organ prolapse are more common in either younger age or elderly age. Obstructive defecation disorders are more common in males while Organ prolapse is more common in females.
MR Defecography is a new modality that invariably helps in diagnosing Pelvic floor functional pathologies. Based on the pelvic floor function during defecation, the disorders can be classified into two i.e Relaxing and non-relaxing types. In the past, fluoroscopic defecography was used in their diagnosis, but it had its limitations like radiation exposure. MR Defecography is a novel tool that enables real-time imaging of the defecation function, providing a multiplanar information. Also, good temporal resolution, high soft-tissue contrast and lack of radiation exposure, make it the preferred imaging modality for evaluation.