MRI Pelvis To our knowledge, there is no relevant literature to support the use of MRI pelvis without defecation or straining for functional evaluation of patients with defecatory dysfunction who are medically able to participate in dynamic imaging exams. MRI pelvis either without or with IV contrast may be used for anatomic evaluation of the pelvic organs and pelvic floor. Pelvic masses that may cause rectal obstruction would be well seen on MRI. Levator muscle defects may be well depicted in patients with fecal incontinence. Muscle thickness is measured reliably on external phased array MRI [41]. US Pelvis Transabdominal To our knowledge, there is no relevant literature to support the use of TAUS for assessment of defecatory dysfunction. US Pelvis Transperineal TPUS images are obtained via cine loops in multiple planes during rest, strain, and Kegel maneuvers with both 2- D and 3-D imaging for anatomic and functional pelvic floor assessment. Patients may be positioned semi-upright or in the dorsal lithotomy position. In a study by Beer-Gabel et al [53], dynamic TPUS showed concordance with CCP for presence of enteroceles in patients with defecatory dysfunction; however, it was discordant with regard to the contents and size of the cul-de-sac hernia in 45% of cases. There was variable agreement for demonstration of rectoceles, descending perineum syndrome, and rectal prolapse [53]. A study by Steensma et al [52] showed that TPUS had moderate to good correlation with CCP for detection of enterocele and rectocele. Another study in patients with defecatory disorders demonstrated that, although translabial US had high positive predictive value for rectocele and rectal intussusception, negative predictive value was low and there was poor agreement with CCP [51]. TPUS may be obtained for anatomic evaluation of patients with high suspicion of levator muscle defects based on clinical evaluation.
Pelvic Floor Dysfunction in Females. MRI Pelvis To our knowledge, there is no relevant literature to support the use of MRI pelvis without defecation or straining for functional evaluation of patients with defecatory dysfunction who are medically able to participate in dynamic imaging exams. MRI pelvis either without or with IV contrast may be used for anatomic evaluation of the pelvic organs and pelvic floor. Pelvic masses that may cause rectal obstruction would be well seen on MRI. Levator muscle defects may be well depicted in patients with fecal incontinence. Muscle thickness is measured reliably on external phased array MRI [41]. US Pelvis Transabdominal To our knowledge, there is no relevant literature to support the use of TAUS for assessment of defecatory dysfunction. US Pelvis Transperineal TPUS images are obtained via cine loops in multiple planes during rest, strain, and Kegel maneuvers with both 2- D and 3-D imaging for anatomic and functional pelvic floor assessment. Patients may be positioned semi-upright or in the dorsal lithotomy position. In a study by Beer-Gabel et al [53], dynamic TPUS showed concordance with CCP for presence of enteroceles in patients with defecatory dysfunction; however, it was discordant with regard to the contents and size of the cul-de-sac hernia in 45% of cases. There was variable agreement for demonstration of rectoceles, descending perineum syndrome, and rectal prolapse [53]. A study by Steensma et al [52] showed that TPUS had moderate to good correlation with CCP for detection of enterocele and rectocele. Another study in patients with defecatory disorders demonstrated that, although translabial US had high positive predictive value for rectocele and rectal intussusception, negative predictive value was low and there was poor agreement with CCP [51]. TPUS may be obtained for anatomic evaluation of patients with high suspicion of levator muscle defects based on clinical evaluation.