Evaluation of anatomical changes dynamically by magnetic resonance defecography according to pelvic floor dysfunction...

Pelvic floor dysfunction, resulting from the weakening of pelvic support structures, leads to the loss of support and prolapse of intrapelvic organs. Magnetic resonance defecography (MRD) is effective in demonstrating changes during increased intra-pelvic pressure, such as defecation. In our study, we aimed to investigate changes occurring during defecation in different types of pelvic floor dysfunction.

Magnetic resonance defecography images of 206 female patients with and without pelvic floor dysfunction were retrospectively evaluated and categorized into four groups according to the involved prolapse compartments. The presence and severity of anterior, middle, and posterior compartment prolapse were assessed. Measurements of the H line, M line, and anorectal angle were obtained at rest, during squeezing, straining, and rectal evacuation phases. Intergroup comparisons were performed using ANOVA, LSD, Kruskal-Wallis, and Dunn tests.

The coexistence of different types of pelvic organ prolapse was associated with a more severe presentation (p = 0.001). All parameters were significantly different among the groups (p = 0.001). Moreover, the degree of dynamic change across defecation phases - particularly in the H line and anorectal angle - also differed significantly between groups (p = 0.001).

Dynamic MRD demonstrated that combined prolapse is associated with greater H line, M line, and anorectal angle values, which increase significantly during the straining and rectal evacuation phases.