Pelvic floor disorders: what’s the best test?

Abstract

Pelvic floor dysfunctions represent a common health problem affecting particularly post-menopausal women impacting significantly the quality of life. A large number of these patients suffer for many years without proper treatment often due to the lack of objective findings necessary to plan proper treatment. Because abnormalities of the different pelvic compartments are frequently associated, thorough diagnostic characterization of how many compartments are affected is paramount in order to plan the management approach that can include a multidisciplinary surgical approach. This pictorial essay will review the different imaging methods used for the characterization of these disorders, how to do them and its rationale providing a clinically understandable interpretation with clinical correlates and a correlation between fluoroscopic and MR defecography in order to illustrate the strengths and shortcomings of each. The need to use a standardized, reliable, and clinically understandable method of quantification has become more obvious in the last decades with the increasing rate of scientific and professional interchanges. A review of the grading systems used to convey the imaging findings also highlights the importance of using a standardized tool for comparing and communicating clinical findings understandable to referring physicians with proven inter-observer and intra-observer agreement of the examinations.

MR Imaging in Diagnosis of Pelvic Floor Descent: Supine versus Sitting Position

“…The diagnostic limitation of the pelvic examination alone has led to the need of using more direct and comprehensive diagnostic methods [ 3 ]. In the assessment of patient with pelvic floor disease, several radiological investigations are used [ 9 ]: RX-Defecography is considered the “gold standard” in the evaluation of pelvic floor diseases, being a cost-effective procedure, easy to perform, and widely available. However, it is an invasive procedure due to the ionizing radiations and the administration of four contrasts and it allows one to evaluate only the opacified organs, neither muscular structures nor soft tissues of the pelvic floor [ 36 ].…”

“…Risk factors for pelvic floor dysfunction include pregnancy, multiparity, advanced age, menopause, obesity, connective tissue disorders, smoking, and chronic obstructive pulmonary disease, as well as any other component that results in a chronic rise in intra-abdominal pressure [ 2 , 6 , 7 ]. Although the collection of the clinical history and the physical examination represent the first step in the evaluation of patients with pelvic floor dysfunctions [ 8 ], a multidisciplinary approach and the employment of panoramic radiological investigations with a wide and detailed view of the pelvis are needed for a more detailed diagnosis and grading of pelvic floor disorders [ 2 , 9 – 11 ] and for the surgical planning [ 12 – 16 ].…”

New Technique for Pelvic Floor Measurement - Transperineal Dynamic Ultrasound Measurement Method to Detection and Quantification of Rectocele, Cystocele, Enterocele and Perineal Descensus

“…We realized, over time, that isolated changes in the pelvic floor rarely occur even when a global and standard examination was deemed necessary [12,13]. Accurate knowledge of all anatomical and physiological changes is essential for an optimal and personalized treatment strategy [11].…”

Prevalence and triage of first‐contact complaints on pelvic floor dysfunctions in female patients at a Pelvic Care Centre

“…According to this, the worldwide burden of PFDs is estimated to increase significantly over time as life expectancy is still rising . In the coming decade public‐health and clinical management implications need to be considered in order to manage these conditions effectively . However, the multifactorial character of many PF dysfunctions is often still not revealed .…”