Patients with SUI demonstrate thinner urethral rhabdosphincter muscles than continent patients [75], and urethral sphincter volume on preoperatively TVUS can predict surgical outcomes [76]. Variant 3: Female. Defecatory dysfunction (incontinence of stool or liquid or gas, straining during defecation, difficulty initiating defecation, incomplete evacuation, or splinting or digital maneuvers to defecate). Initial imaging. Defecatory dysfunction may result from either structural or functional etiologies. Obstructed defecation is suspected in patients who have difficulty defecating and may require excessive straining or manual pressure for evacuation. Mechanical or structural etiologies include rectocele, enterocele, sigmoidocele, rectal intussusception, or rectal prolapse, whereas anatomically normal patients may have disordered defecation due to functional dyssynergia. Patients are assessed clinically with a digital rectal examination, anal manometry, and balloon expulsion test [77]. Imaging may be obtained for further evaluation, particularly in patients with discordant findings on manometry and the balloon expulsion test [78-80]. Imaging may also be obtained to either confirm clinically suspected or exclude occult structural or functional abnormalities such as rectal prolapse, excessive perineal descent, rectal intussusception, or pelvic floor dyssynergia, and to differentiate rectocele from cul-de-sac hernia in the posterior compartment. Finally, patients with fecal incontinence may present with anal sphincter abnormalities, and preoperative imaging may be obtained for surgical planning. Imaging may also be indicated in patients who present with persistent or recurrent defecatory dysfunction after attempted surgical or nonsurgical treatments. CT Pelvis To our knowledge, there is no relevant literature regarding the use of CT for functional assessment of defecatory dysfunction.
Pelvic Floor Dysfunction in Females. Patients with SUI demonstrate thinner urethral rhabdosphincter muscles than continent patients [75], and urethral sphincter volume on preoperatively TVUS can predict surgical outcomes [76]. Variant 3: Female. Defecatory dysfunction (incontinence of stool or liquid or gas, straining during defecation, difficulty initiating defecation, incomplete evacuation, or splinting or digital maneuvers to defecate). Initial imaging. Defecatory dysfunction may result from either structural or functional etiologies. Obstructed defecation is suspected in patients who have difficulty defecating and may require excessive straining or manual pressure for evacuation. Mechanical or structural etiologies include rectocele, enterocele, sigmoidocele, rectal intussusception, or rectal prolapse, whereas anatomically normal patients may have disordered defecation due to functional dyssynergia. Patients are assessed clinically with a digital rectal examination, anal manometry, and balloon expulsion test [77]. Imaging may be obtained for further evaluation, particularly in patients with discordant findings on manometry and the balloon expulsion test [78-80]. Imaging may also be obtained to either confirm clinically suspected or exclude occult structural or functional abnormalities such as rectal prolapse, excessive perineal descent, rectal intussusception, or pelvic floor dyssynergia, and to differentiate rectocele from cul-de-sac hernia in the posterior compartment. Finally, patients with fecal incontinence may present with anal sphincter abnormalities, and preoperative imaging may be obtained for surgical planning. Imaging may also be indicated in patients who present with persistent or recurrent defecatory dysfunction after attempted surgical or nonsurgical treatments. CT Pelvis To our knowledge, there is no relevant literature regarding the use of CT for functional assessment of defecatory dysfunction.