Radiologic evaluation of anorectal disorders

Area of Science:

• Medical imaging
• Gastroenterology
• Pelvic floor disorders

Background:

• Defecation is a complex physiological process.
• Diagnosing defecation disorders requires assessing pelvic floor stress and rectal emptying.
• Current imaging techniques have limitations.

Purpose of the Study:

• To evaluate the diagnostic utility of different imaging modalities for defecation disorders.
• To compare fluoroscopic examination, MR imaging, and endoanal ultrasound.
• To determine the most reliable method for diagnosing conditions like anismus, rectocele trapping, and intussusception.

Main Methods:

• Evacuation proctography (a type of fluoroscopic examination) was used to simulate maximal pelvic floor stress and image rectal emptying.
• MR imaging was considered for its lack of ionizing radiation.
• Endoanal ultrasound was assessed for screening incontinence and evaluating sphincter integrity.

Main Results:

• Fluoroscopic examination is the simplest and most reliable method for diagnosing anismus, rectocele trapping, and intussusception.
• MR imaging is not suitable for diagnosing these specific conditions unless an evacuation study is performed.
• Endoanal ultrasound is effective for screening incontinence and identifying internal sphincter issues, but external sphincter atrophy diagnosis is still under investigation.

Conclusions:

• Fluoroscopic evacuation proctography remains the gold standard for evaluating difficult defecation.
• Endoanal ultrasound is a valuable screening tool for fecal incontinence.
• Endoanal MR imaging is indicated for diagnosing external sphincter atrophy when ultrasound is inconclusive.