Pelvic floor dysfunction: Anatomical characterization and functional imaging with MRI defecography

Pelvic floor dysfunction encompasses a spectrum of disorders characterized by organ descent, muscular weakness, and impaired coordination across the anterior, middle, and posterior compartments. MRI defecography has become an established non-invasive technique for comprehensive assessment of both static anatomy and dynamic function of the pelvic floor. This review describes the MRI defecography technique, protocol components, and quantitative parameters that provide an objective evaluation of pelvic floor dysfunction. Standard MRI defecography protocol incorporates resting, contraction, straining, and evacuation phases, with single-shot fast spin-echo and real-time sequences enabling visualization of pelvic structures throughout motion. Quantitative parameters, including the anorectal angle, pubococcygeal line, H and M lines, minimal prolapse level, and levator plate angle, allow for objective evaluation of pelvic floor dysfunction. MRI defecography is particularly valuable in complex and postoperative scenarios, allowing detection of cystoceles, rectoceles, enteroceles, uterine or vaginal prolapse, intussusception, and post-surgical complications. In addition, MRI-defecography highlights the importance of stabilizing structures such as the urogenital diaphragm, endopelvic fascia, and levator ani complex. By integrating anatomic and functional findings, MRI defecography supports individualized therapeutic planning, guides surgical decision-making, and improves long-term outcomes. MRI defecography has thus emerged as a cornerstone in the multidisciplinary management of pelvic floor dysfunction.