PATTERNS OF PROLAPSE IN WOMEN WITH SYMPTOMS OF PELVIC FLOOR WEAKNESS - ASSESSMENT WITH MR IMAGING

PURPOSE: To show the magnetic resonance (MR) imaging patterns of prola pse and to correlate them with symptoms in patients with constipation or fecal incontinence. MATERIALS AND METHODS: Thirty women underwent M R imaging with fast spoiled gradient-recalled acquisition in the stead y state. The women were divided into three groups: 10 were asymptomati c volunteers, 10 had constipation, and 10 had fecal incontinence. Visc eral prolapse and the configuration of the pelvic floor muscles were i dentified at rest and during straining. Visceral descent was compared between the three groups. RESULTS: Visceral prolapse was seen at multi ple sites, most frequently in constipated patients. There was signific antly greater bladder base descent (P < .01), uterocervical descent (P < .001), and puborectalis muscle ballooning (P < .05) in the group of constipated patients when compared with the group with fecal incontin ence or the asymptomatic group. The degree of anorectal junction desce nt was significantly greater (P < .05) in the group of incontinent pat ients when compared with the asymptomatic group. CONCLUSION: MR imagin g clearly shows pelvic visceral prolapse and pelvic floor configuratio n on straining. Prolapse frequently involves multiple sites in constip ated patients, which is suggestive of global pelvic floor weakness. In contrast, the weakness is frequently posterior in fecally incontinent patients.