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MR Defecography (Pelvic Floor MRI)

Dynamic pelvic floor MRI for evaluation of obstructed defecation, prolapse, and incontinence

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Radyoloji department. Book Appointment →

What is MR Defecography (Pelvic Floor MRI)?

MR defecography combines static and dynamic MRI sequences to assess the three pelvic compartments simultaneously: anterior (bladder, urethra), middle (uterus, vagina), and posterior (rectum, anal canal). Performed in supine position (or sitting in open-magnet MRI), with rectal contrast (ultrasound gel 200-300 mL) and dynamic Valsalva, squeeze, and defecation phases.

Sequences: high-resolution T2 axial/sagittal/coronal (anatomy), dynamic balanced steady-state free precession (bSSFP) or fast spoiled gradient-echo during Valsalva and evacuation. Reference lines: pubococcygeal line (PCL), midpubic line (MPL), H-line (puborectalis muscle), M-line (PCL to H-line). Pelvic organ descent measured at rest and on strain.

Findings: cystocele (bladder descent >1 cm below PCL), enterocele (small bowel between rectum and uterus), rectocele (anterior rectal wall bulge into vagina), rectal intussusception (telescoping), descending perineum syndrome, dyssynergic defecation (anismus, paradoxical contraction), uterine/vaginal vault prolapse. Quantification with HMO classification (H-line, M-line, organ prolapse). Compared to fluoroscopic defecography: MR avoids radiation, multi-planar evaluation, posterior compartment may be inferior.

Symptoms

(MR defecography is a diagnostic imaging technique, not a disease)
Performed for evaluation of:
Chronic constipation, obstructed defecation
Pelvic organ prolapse symptoms (bulge, pressure)
Fecal incontinence
Recurrent UTI with suspected cystocele
Vaginal vault prolapse post-hysterectomy
Splinting required to defecate
Sensation of incomplete evacuation
Pelvic floor dysfunction (failed conservative therapy)

Risk Factors

Indications for MR defecography:
Multiparity, vaginal delivery (pelvic floor injury)
Previous pelvic surgery (hysterectomy, prostatectomy, anti-incontinence)
Chronic straining, constipation
Connective tissue disorder (Ehlers-Danlos)
Postmenopausal estrogen deficiency
Obesity, chronic cough, heavy lifting (chronic increased intra-abdominal pressure)
Pre-surgical planning (prolapse repair, sling procedures)
Failed conservative therapy
Patient unable to tolerate fluoroscopic defecography (radiation, embarrassment)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent constipation with sensation of obstruction
  • Vaginal bulge or pressure interfering with daily life
  • Recurrent UTI with suspected cystocele
  • Need to splint perineum or vagina to defecate
  • Fecal or urinary incontinence affecting quality of life
  • Symptoms post-hysterectomy (vault prolapse)
  • Pre-surgical evaluation for prolapse repair
  • Failed pelvic floor physiotherapy

Treatment Methods

01
(MR defecography is diagnostic — not therapeutic)
02
Patient preparation: empty bladder, rectal enema 1-2 hours before
03
Position: supine (closed-magnet) or sitting (open-magnet, more physiologic)
04
Rectal contrast: ultrasound gel 200-300 mL via syringe
05
Sequences: T2 high-res anatomy, dynamic bSSFP/fast GRE
06
Phases: rest, Valsalva (strain), squeeze, defecation
07
Measurements: PCL, MPL, H-line, M-line, organ descent
08
Findings interpretation:
09
- Cystocele: bladder >1 cm below PCL
10
- Rectocele: >2 cm bulge
11
- Enterocele: small bowel descent
12
- Intussusception: rectal telescoping
13
- Anismus: paradoxical puborectalis contraction
14
Multidisciplinary team review: urogynecology, colorectal, pelvic floor PT
15
Treatment based on findings: pelvic floor PT, surgery (sacrocolpopexy, rectocele repair), biofeedback (anismus)
16
Reporting: HMO classification, all three compartments, dynamic findings

Which Department to Visit?

You can visit our Radyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.