The cul-de-sac hernia may contain peritoneal fat (peritoneocele), small bowel (enterocele), or sigmoid colon (sigmoidocele). Infolding of the rectal wall into its lumen, rectal intussusception, can be partial thickness (involving only the mucosa) or full-wall thickness and may involve either only the anterior wall or both the anterior and posterior wall. Based on location, it may be classified as internal rectal prolapse (intrarectal, intra-anal), or external (extra-anal) intussusception (beyond the anal verge, also called complete rectal prolapse). The appearance of these findings is well described in the imaging literature [21,22]. Initial evaluation of patients with POP symptoms is clinical and begins with the physical examination. Imaging may be obtained when clinical evaluation is difficult or considered inadequate by the physician, or if patients present with persistent or recurrent prolapse symptoms after attempted surgical or nonsurgical treatments. Goals of imaging in this setting may include confirm clinically suspected Pelvic Floor Dysfunction in Females prolapse, assess severity of prolapse, evaluate for associated structural defects or functional abnormalities, differentiate between cul-de-sac hernias and anterior rectoceles (both of which can present clinically with posterior vaginal bulge), determine contents of cul-de-sac hernias, and evaluate for occult pelvic floor disorders in compartments other than those apparent on physical examination. CT Pelvis Although CT may be able to depict large levator muscle defects, to our knowledge there is no relevant literature regarding the use of CT, either with or without IV contrast, for assessment of a protruding or bulging vaginal mass or clinically suspected POP. Fluoroscopy Cystocolpoproctography Dynamic CCP is one of the imaging tests of choice for evaluation of a protruding or bulging vaginal mass or clinically suspected POP and may be an initial imaging test in the setting of posterior compartment prolapse.
Pelvic Floor Dysfunction in Females. The cul-de-sac hernia may contain peritoneal fat (peritoneocele), small bowel (enterocele), or sigmoid colon (sigmoidocele). Infolding of the rectal wall into its lumen, rectal intussusception, can be partial thickness (involving only the mucosa) or full-wall thickness and may involve either only the anterior wall or both the anterior and posterior wall. Based on location, it may be classified as internal rectal prolapse (intrarectal, intra-anal), or external (extra-anal) intussusception (beyond the anal verge, also called complete rectal prolapse). The appearance of these findings is well described in the imaging literature [21,22]. Initial evaluation of patients with POP symptoms is clinical and begins with the physical examination. Imaging may be obtained when clinical evaluation is difficult or considered inadequate by the physician, or if patients present with persistent or recurrent prolapse symptoms after attempted surgical or nonsurgical treatments. Goals of imaging in this setting may include confirm clinically suspected Pelvic Floor Dysfunction in Females prolapse, assess severity of prolapse, evaluate for associated structural defects or functional abnormalities, differentiate between cul-de-sac hernias and anterior rectoceles (both of which can present clinically with posterior vaginal bulge), determine contents of cul-de-sac hernias, and evaluate for occult pelvic floor disorders in compartments other than those apparent on physical examination. CT Pelvis Although CT may be able to depict large levator muscle defects, to our knowledge there is no relevant literature regarding the use of CT, either with or without IV contrast, for assessment of a protruding or bulging vaginal mass or clinically suspected POP. Fluoroscopy Cystocolpoproctography Dynamic CCP is one of the imaging tests of choice for evaluation of a protruding or bulging vaginal mass or clinically suspected POP and may be an initial imaging test in the setting of posterior compartment prolapse.