Pelvic floor imaging

A greater awareness of the therapies now available for pelvic floor dysfunc tion has increased demand for specialized imaging of this region. Some of t he techniques required are available at relatively few centers, and the pur pose of this review is to introduce the emerging subspecialty of pelvic flo or imaging to a more general readership. Pelvic floor anatomy is complex an d is being unraveled by means of magnetic resonance (MR) imaging. This is d iscussed in detail by using a global, rather than a compartmentalized, anat omic approach. The physiology of normal urinary and anal function and the r outine clinical tests applied to them are outlined. The imaging techniques involved include MR imaging, endosonography, and fluoroscopy. The main inve stigations include video urodynamic imaging, evacuation proctography, dynam ic cystoproctography, dynamic MR imaging of the pelvic floor, and endolumin al imaging of the anal sphincters with MR imaging and ultrasonography. Thes e are described in detail, and their role with regard to the main pathologi c conditions of the pelvic floor-urinary and anal incontinence, constipatio n, and prolapse-are discussed.