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Updated: Jun 12, 2025
Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Magnetic resonance defecography: Post-defecation straining detects more and maximal prolapse in the anterior and
Pengfei Ye1, Gang Ning1, Tao Cui2
1Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
Objective:
To compare pre-defecation straining without rectal gel and post-defecation straining with the defecation phase, and to investigate their roles in evaluating pelvic organ prolapse (POP).
Material & Methods:
Magnetic Resonance Defecography (MRD) images of 65 patients with a clinical diagnosis of POP were retrospectively reviewed by two independent readers. Measurements were taken at rest, pre-defecation straining without rectal gel, defecation, and post-defecation straining. The presence, sizes, and/or grades of cystocele, uterovaginal prolapse, widened levator hiatus, perineal descent, cul-de-sac hernia, rectocele, and rectal intussusception were evaluated and compared across the four phases.
Results:
Compared to pre-defecation straining, both defecation and post-defecation straining detected more cases, larger sizes, and higher grades of prolapse in all compartments. When comparing defecation and post-defecation straining, the latter diagnosed four more cases of cystocele (80 % vs 73.9 %, p = 0.2) with larger size (-34.1 vs -29.0, p < 0.01) and higher grade (p = 0.19). Post-defecation straining also identified eight more cases of uterovaginal prolapse (89.2 % vs 73.9 %, p < 0.01) with larger size (-32.9 vs -26.4, p < 0.01) and higher grade (p < 0.01) compared to defecation. Conversely, defecation detected eight more cases of rectocele (46.2 % vs 33.9 %, p < 0.01) with larger size (9.2 vs 6.2 cm, p < 0.01) and higher grade (p = 0.26).
Conclusion:
Post-defecation straining effectively depicts the maximal extent of prolapse in the anterior and middle compartments, and should be performed whenever there is a clinical need for a comprehensive assessment of prolapse in these compartments.
Insights
Post-defecation straining is superior for detecting pelvic organ prolapse (POP) extent in anterior and middle compartments. This method, alongside defecation, offers a more comprehensive evaluation than pre-defecation straining alone.
Area of Science:
- Pelvic Floor Imaging
- Urogynecology
- Diagnostic Imaging
Background:
- Pelvic organ prolapse (POP) affects a significant number of women.
- Accurate assessment of POP is crucial for effective management.
- Current imaging techniques may have limitations in fully evaluating prolapse severity.
Purpose of the Study:
- To compare pre-defecation straining without rectal gel and post-defecation straining with the defecation phase.
- To investigate the diagnostic roles of different straining phases in evaluating pelvic organ prolapse (POP).
Main Methods:
- Retrospective review of Magnetic Resonance Defecography (MRD) images from 65 patients with diagnosed POP.
- Evaluation of prolapse in four phases: rest, pre-defecation straining, defecation, and post-defecation straining.
- Assessment of cystocele, uterovaginal prolapse, levator hiatus, perineal descent, cul-de-sac hernia, rectocele, and rectal intussusception.
Main Results:
- Both defecation and post-defecation straining detected more prolapse cases, larger sizes, and higher grades than pre-defecation straining.
- Post-defecation straining identified more cases and larger sizes of cystocele and uterovaginal prolapse compared to defecation.
- Defecation phase detected more cases and larger sizes of rectocele compared to post-defecation straining.
Conclusions:
- Post-defecation straining effectively visualizes the maximal prolapse extent in anterior and middle compartments.
- This technique should be utilized for comprehensive prolapse assessment when clinically indicated.
- MRD during different straining phases provides detailed insights into pelvic floor dynamics and prolapse.
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