 Support to the pelvic floor is provided by a combination of muscular and connective tissue structures. Direct or denervation injury to the pelvic floor musculature is postulated to increase stress on the fascia and lead to weakening of the pelvic floor. Risk factors for pelvic floor dysfunction include advanced age, menopause, vaginal multiparity, obesity, chronic straining, and conditions that result in chronic increase in intra-abdominal pressures [10]. Special Imaging Considerations Use of Contrast Material Pelvic floor imaging may require the instillation of contrast media in the bladder, vagina, rectum, and small bowel, depending on the specific examination to be performed. Fluoroscopy of the pelvic floor may be performed with Reprint requests to: publications@acr.org Pelvic Floor Dysfunction in Females oral, rectal, bladder, and vaginal contrast (cystocolpoproctography [CCP]), or only with rectal contrast (defecography or proctography), or any combination thereof. For these guidelines, fluoroscopic CCP will be the default fluoroscopic defecation examination of the pelvis unless noted. Voiding cystourethrogram (VCUG) has been used for evaluation of the anterior compartment and necessitates instillation of radiopaque contrast in the urinary bladder [14]. MRI of the pelvic floor allows for direct visualization of the intrapelvic contents, precluding need for contrast within the bladder, vagina, and small bowel; however, use of contrast in the rectum for MR defecography facilitates defecation and improves detection of prolapse compared with dynamic pelvic floor MRI without rectal contrast [15]. Various types and volumes of contrast media have been reported and may depend on the preference of the institution, although US gel or sterile lubricating jelly are the most commonly used rectal contrast agents for MR defecography. MR defecography is performed without IV contrast.
Pelvic Floor Dysfunction in Females.  Support to the pelvic floor is provided by a combination of muscular and connective tissue structures. Direct or denervation injury to the pelvic floor musculature is postulated to increase stress on the fascia and lead to weakening of the pelvic floor. Risk factors for pelvic floor dysfunction include advanced age, menopause, vaginal multiparity, obesity, chronic straining, and conditions that result in chronic increase in intra-abdominal pressures [10]. Special Imaging Considerations Use of Contrast Material Pelvic floor imaging may require the instillation of contrast media in the bladder, vagina, rectum, and small bowel, depending on the specific examination to be performed. Fluoroscopy of the pelvic floor may be performed with Reprint requests to: publications@acr.org Pelvic Floor Dysfunction in Females oral, rectal, bladder, and vaginal contrast (cystocolpoproctography [CCP]), or only with rectal contrast (defecography or proctography), or any combination thereof. For these guidelines, fluoroscopic CCP will be the default fluoroscopic defecation examination of the pelvis unless noted. Voiding cystourethrogram (VCUG) has been used for evaluation of the anterior compartment and necessitates instillation of radiopaque contrast in the urinary bladder [14]. MRI of the pelvic floor allows for direct visualization of the intrapelvic contents, precluding need for contrast within the bladder, vagina, and small bowel; however, use of contrast in the rectum for MR defecography facilitates defecation and improves detection of prolapse compared with dynamic pelvic floor MRI without rectal contrast [15]. Various types and volumes of contrast media have been reported and may depend on the preference of the institution, although US gel or sterile lubricating jelly are the most commonly used rectal contrast agents for MR defecography. MR defecography is performed without IV contrast.