MR Defecography

This is one of the rarely performed procedure and Dr MGK Murthy has graciously shared this video and key points about the procedure.

Teaching points

1. Dynamic MR Defecography is  accepted for study of pelvic floor disorders
2. Approximately 10 to 20 % of  OPD patients (Females more than males) (Post surgery more than others) have  these disorders. Supine Technique with   endorectal filling of ultrasound jelly(120ml average) or mashed potatoes  doped with Gadolinium (about1.5 ml) would simulate the normal process 
3. At Rest /During  maximum sphincter contraction, during Straining  and during Defaectaion  are  studied   in mid-sagittal plane multiphase T1 SPGR  acquisitions  as cine loop (15 mm thick planned on Axial localiser)
4. Anorectal angle (ARA)(between the post border of distal rectum and the central axis of anal canal ) and Pubcoccygeal line (PCL) (inferior  pubic symphysis to last coccygeal joint)  are the mainstay for study with normal ARA (posteriorly)   at rest 90-100 degree,  during straining 70-90 degree   to  during defecation 110-180 degrees.

Disorders to study:

 1) Rectoceles( significant if more than 2cms or retention of contrast or reproducibility of symptoms or need  for evacuation help by pressing the post vaginal wall)

2)Descending Perineum syndrome (bulging of perineum at rest instead of only at straining)

3) Intussuception (Intra rectal  is recto-rectal and extrarectal is clinical  rectal prolapse)

4) Spastic Pelvic Floor syndrome (puborectalis which  normally  maintains continence by pulling the anterior rectal margin, fails to relax during defecation leading to retention of faeces)

5)Others including enteroceles/ inflammations etc