CCP demonstrates good agreement with surgical findings for detection of full-thickness rectal prolapse, posterior colopocele, rectocele, and peritoneocele, and excellent correlation for detection of internal rectal prolapse (intrarectal and intra-anal). Relative to surgical findings, sensitivities of CCP for detection of internal rectal prolapse and peritoneocele are 88% and 83%, respectively [23], whereas comparisons to physical examination demonstrate sensitivity of CCP for detection of rectoceles and enteroceles to be 94% and 35%, respectively. Nonetheless, physical examination only detected 7% of rectoceles and 51% of enteroceles seen in CCP in that study [11]. Thus, CCP may detect rectoceles or enteroceles that are clinically occult. In patients with fecal incontinence, anorectal angle measured on CCP has been shown to correlate with severity of fecal incontinence [85]. Fluoroscopy Voiding Cystourethrography To our knowledge, there is no relevant literature to support the use of VCUG in assessment of patients with defecatory dysfunction. MR Defecography MR defecography with rectal contrast is one of the initial imaging tests of choice for evaluation of patients with defecatory dysfunction. The inherent high soft-tissue contrast resolution of MRI allows for direct visualization of pelvic organs, pelvic floor muscles and fascia, and associated anatomic abnormalities or masses that may cause rectal obstruction or incontinence. MR defecography can confirm suspected structural and functional abnormalities in patients with defecatory dysfunction such as rectal intussusception or prolapse, rectocele, and pelvic floor dyssynergia. Findings of pelvic floor dyssynergia on MR defecography include impaired evacuation, abnormal anorectal angle change, and paradoxical sphincter contraction [86].
Pelvic Floor Dysfunction in Females. CCP demonstrates good agreement with surgical findings for detection of full-thickness rectal prolapse, posterior colopocele, rectocele, and peritoneocele, and excellent correlation for detection of internal rectal prolapse (intrarectal and intra-anal). Relative to surgical findings, sensitivities of CCP for detection of internal rectal prolapse and peritoneocele are 88% and 83%, respectively [23], whereas comparisons to physical examination demonstrate sensitivity of CCP for detection of rectoceles and enteroceles to be 94% and 35%, respectively. Nonetheless, physical examination only detected 7% of rectoceles and 51% of enteroceles seen in CCP in that study [11]. Thus, CCP may detect rectoceles or enteroceles that are clinically occult. In patients with fecal incontinence, anorectal angle measured on CCP has been shown to correlate with severity of fecal incontinence [85]. Fluoroscopy Voiding Cystourethrography To our knowledge, there is no relevant literature to support the use of VCUG in assessment of patients with defecatory dysfunction. MR Defecography MR defecography with rectal contrast is one of the initial imaging tests of choice for evaluation of patients with defecatory dysfunction. The inherent high soft-tissue contrast resolution of MRI allows for direct visualization of pelvic organs, pelvic floor muscles and fascia, and associated anatomic abnormalities or masses that may cause rectal obstruction or incontinence. MR defecography can confirm suspected structural and functional abnormalities in patients with defecatory dysfunction such as rectal intussusception or prolapse, rectocele, and pelvic floor dyssynergia. Findings of pelvic floor dyssynergia on MR defecography include impaired evacuation, abnormal anorectal angle change, and paradoxical sphincter contraction [86].