Dynamic magnetic resonance defecography in the diagnosis of combined pelvic floor disorders in proctology.

Purpose: Evaluation of magnetic resonance defecography in the diagnosis of pelvic floor disorders were examined prospectively. MRI was performed on a 1.5 T scanner. The rectum was opacified with 200 ml of ultrasound transmiss ion gel. A sagittal single section T2-weighted gradient echo sequence with a temporal resolution of 1.1 second was performed. Changes of the anorectal angle and the position of the pelvic organs in relation to the pubococcyge al line were registered at rest, during straining, and during evacuation of the rectum. Results: Patients with obstructed defecation (n=15) showed pro lapse of the rectal mucosa (n=5), anterior rectocele (n=8), pelvic floor de scent (n=5), enterocele (n=2), and anorectal dyscoordination (n=3). Individ uals with stool incontinence (n=15) had an anterior rectocele (n=10), pelvi c floor descent (n=71), enterocele (n=2), prolapse of rectal mucosa (n=1), and a puborectal insufficiency (n=1). Urine incontinence was associated wit h cystocele (n=10) or normal findings (n=4). In patients with unspecific sy mptoms (n=6), anorectal dyscoordination (n=4) and prolapse of the rectal mu cosa (n=2) were found. MRI was superior for the detection of enteroceles, c ystoceles and pelvic floor descent compared with clinical investigation. Co nclusion: Dynamic MR imaging supplies complex information in anorectal dise ase and thus improves proctoscopy.