CT may depict masses or other anatomic conditions in the pelvic floor at rest that may result in obstructed defecation or fecal incontinence; however, CT is not a test of choice for evaluation of anal sphincter defects. Fluoroscopy Cystocolpoproctography Fluoroscopic CCP is one of the initial imaging tests of choice for evaluation of defecatory dysfunction and augments the clinical examination by revealing clinically occult sigmoidoceles, enteroceles, and rectoanal intussusceptions, which can be present in isolation or in combination with other abnormalities [81,82]. The detection of these diagnoses on defecography has been shown to alter or clarify the initial clinical assessment in a significant percentage of patients with constipation [83]. Approximately one-third of patients with bulging of the posterior vaginal wall have been shown to have enteroceles or sigmoidoceles [11]. Opacification of small bowel with oral contrast allows for easier detection of enteroceles. A significant proportion of enteroceles may be seen only upon complete rectal emptying or on postdefecation strain images [11], because rectal or bladder distention with contrast may prevent the peritoneal sac from herniating into the rectovaginal space [22]. CCP can also be used to assess for presence and size of rectocele and to evaluate for contrast material retention within rectoceles. CCP may be obtained in patients with suspected dyssynergic defecation. Unlike manometry and the balloon expulsion test, defecography directly images the process of rectal evacuation and may identify associated structural abnormalities in the pelvic floor. Failed or prolonged evacuation of contrast on CCP is sensitive and specific for Pelvic Floor Dysfunction in Females diagnosing dyssynergia [84]. However, a meta-analysis demonstrated lower prevalence of findings of dyssynergic defecation on CCP compared with the balloon expulsion test and anal manometry [80].
Pelvic Floor Dysfunction in Females. CT may depict masses or other anatomic conditions in the pelvic floor at rest that may result in obstructed defecation or fecal incontinence; however, CT is not a test of choice for evaluation of anal sphincter defects. Fluoroscopy Cystocolpoproctography Fluoroscopic CCP is one of the initial imaging tests of choice for evaluation of defecatory dysfunction and augments the clinical examination by revealing clinically occult sigmoidoceles, enteroceles, and rectoanal intussusceptions, which can be present in isolation or in combination with other abnormalities [81,82]. The detection of these diagnoses on defecography has been shown to alter or clarify the initial clinical assessment in a significant percentage of patients with constipation [83]. Approximately one-third of patients with bulging of the posterior vaginal wall have been shown to have enteroceles or sigmoidoceles [11]. Opacification of small bowel with oral contrast allows for easier detection of enteroceles. A significant proportion of enteroceles may be seen only upon complete rectal emptying or on postdefecation strain images [11], because rectal or bladder distention with contrast may prevent the peritoneal sac from herniating into the rectovaginal space [22]. CCP can also be used to assess for presence and size of rectocele and to evaluate for contrast material retention within rectoceles. CCP may be obtained in patients with suspected dyssynergic defecation. Unlike manometry and the balloon expulsion test, defecography directly images the process of rectal evacuation and may identify associated structural abnormalities in the pelvic floor. Failed or prolonged evacuation of contrast on CCP is sensitive and specific for Pelvic Floor Dysfunction in Females diagnosing dyssynergia [84]. However, a meta-analysis demonstrated lower prevalence of findings of dyssynergic defecation on CCP compared with the balloon expulsion test and anal manometry [80].