Defecation versus pre- and post-defecation Valsalva maneuvers for dynamic MR assessment of pelvic floor dysfunction

ACR Appropriateness Criteria® Pelvic Floor Dysfunction in Females

“…MR defecography is a specialized type of dynamic MRI of the pelvic floor that is typically performed with rectal contrast but without IV contrast and includes MRI acquisition during active defecation of rectal contrast. Multiple studies have demonstrated the added benefit of MRI with rectal contrast and the defecation phase for assessment of POP compared with dynamic straining MRI without rectal contrast or defecation [15,[26][27][28][29].…”

“…Furthermore, the detection rate of POP has been reported to be lower on MRI scans without rectal contrast than with rectal contrast [15]. Multiple studies have shown that dynamic pelvic floor MRI with straining rather than defecation demonstrates lower prevalence of prolapse in multiple compartments [12,15,[26][27][28][29]. Thus, although it may be used for assessment of POP, dynamic pelvic floor MRI during straining (without defecation) is inferior to MR defecography for evaluation of a protruding or bulging vaginal mass or clinically suspected POP and is not considered the initial imaging examination of choice.…”

“…To our knowledge, there is no relevant literature regarding the utility of MRI pelvis with dynamic maneuvers (dynamic pelvic floor MRI) specifically in patients with UI or voiding dysfunction; however, dynamic pelvic floor MRI allows for global functional and anatomic assessment of the pelvic floor, including depiction of cystoceles, location of urethrovesical junction, assessment of urethral angle, urethral hypermobility and/or kinking [50,61]. Dynamic pelvic floor MRI with straining rather than defecation demonstrates lower prevalence of prolapse in multiple compartments [12,15,[26][27][28][29]. This may lower detection rates of cystoceles in patients with UI, although the clinical impact of this lower detection rate has not been reported in the literature to our knowledge.…”

“…Use of rectal contrast and imaging during defecation are particularly important when performing MR defecography for assessment of defecatory dysfunction [89]. Multiple studies have demonstrated the added benefit of MRI with rectal contrast and the defecation phase for assessment of POP compared with dynamic straining MRI without rectal contrast or defecation [15,[26][27][28][29].…”

The diagnostic value of four-dimensional ultrasound examination of perineum in the diagnosis of postpartum pelvic floor dysfunction

“…It also helps to clarify the pelvic floor tissue damage in time and guides the pelvic floor as soon as possible after childbirth. Functional training provides a reference basis and is of great significance for preventing the occurrence of PFD [3][4]. Transperineal ultrasound has been shown to be a valid, reliable and non-invasive tool for the assessment of pelvic floor morphometry, assessment of the pelvic floor by four-dimensional ultrasound (4D-US) and its application to pelvic pain syndromes constitute a new area of investigation.…”