Pelvic floor experts issue new recommendations for magnetic resonance defecography

by Wolters Kluwer Health

Credit: CC0 Public Domain

Magnetic resonance defecography (MRD) has emerged as a powerful, noninvasive imaging technique to evaluate the many possible causes of problems in passing bowel movements. A new set of consensus recommendations for performing and interpreting the results of MRD has been published by Diseases of the Colon & Rectum (DC&R), the official journal of the American Society of Colon and Rectal Surgeons (ASCRS).

26 sep 2021--The recommendations were developed by the Pelvic Floor Disorders Consortium (PFDC), a multidisciplinary organization representing the wide range of professionals involved in diagnosis and treatment of pelvic floor disorders. The new recommendations are now available on the DC&R website and appear in the journal's October issue. Liliana Bordeianou, MD, MPH, of Massachusetts General Hospital Pelvic Floor Disorders Center and Harvard Medical School was senior author of the consensus statement.

Recommendations include consensus definitions and interpretation templates for MRD

Magnetic resonance defecography is a special type of MRI scan that provides detailed, high-contrast images of the complex anatomy of the pelvic floor. Images are obtained at various stages of defecation, providing detailed information for physicians to diagnose the cause of incontinence, constipation, pelvic organ prolapse, and other conditions that interfere with the ability to pass stool. Compared to other tests, MRD provides both functional and structural information in patients with symptoms of defecatory dysfunction

Previous guidelines for performing MRD have lacked input from the many specialties—including colon and rectal surgeons, gynecologists, radiologists, urologists, and others—involved in the diagnosis and treatment of pelvic floor disorders. Differences between and among specialties may lead to variations in how the physicians interpret and use the findings of MRD. That's a special concern in the care of patients with pelvic floor disorders, who often have complex symptoms and seek care from several different professionals.

The recommendations were developed "with the explicit goal of inviting and including representatives from all relevant clinical specialties for whom MRD holds clinical significance," according to the new statement. The PFDC Working Group comprised an international roster of 24 multidisciplinary experts, who followed a formal process to develop and approve consensus recommendations in key areas.

The recommendations address important factors in performing the MRD technique, including patient positioning and the use of contrast material to provide high-quality images of the pelvic floor anatomy and function. The Working Group emphasizes the importance of education and coaching to ensure that patients understand and can follow the maneuvers needed to perform the examination.

The new document includes recommendations for interpretation of MRD scans, enabling identification and grading of any abnormalities: For example, problems with movement of the pelvic floor muscles (dyssynergia) or abnormalities interfering with stool evacuation (such as rectocele, intussusception, or rectal prolapse).

Figures and videos illustrating the MRD appearance of these findings are included in the print and online versions of the new document. The report also presents a standard template for reporting the findings and interpretation of the MRD, with the goal of promoting shared understanding and improved communication among all professionals involved in the care of patients with pelvic floor disorders. Endorsed by six national and international medical societies including ASCRS, the consensus statement is being simultaneously published in four leading specialty journals.

"The goal of this effort was to create a universal set of recommendations and language for MRD technique, interpretation, and reporting that can be utilized and carry the same significance across disciplines," Dr. Bordeianou and coauthors conclude. While the recommendations are not comprehensive, they "should be advocated as the minimum requirements when performing and interpreting MRD in patients with evacuation disorders of the pelvic floor."

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More information: Brooke H. Gurland et al, Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders, Diseases of the Colon & Rectum (2021). DOI: 10.1097/DCR.0000000000002155

Pelvic floor maladies can impact women's sex life

By Amy Norton

09 may 2008--Incontinence and other disorders of the pelvic organs can take a toll on a woman's sex life, a new study suggests.
Researchers found that among 300 women age 40 and older, those with symptoms of a pelvic floor disorder were more likely to have a diminished libido, pain during sex, or problems reaching orgasm.
Pelvic floor disorders refer to problems with a woman's pelvic organs -- the uterus, bladder and rectum -- and the muscles and connective tissue that support them. Among the most common of these are urinary incontinence and pelvic organ prolapse, where weakened muscles and supporting tissue allow one or more pelvic organs to drop down and protrude into the vagina.
Some symptoms of prolapse include pressure in the vagina, pain in the lower abdomen or lower back, and chronic constipation.
It has been estimated that one-third of U.S. women have at least one type of pelvic floor disorder, but studies have come to conflicting conclusions as to whether the conditions hinder women's sex lives.
The new findings, reported in the journal Obstetrics & Gynecology, suggest that many women with these disorders do, in fact, have problems with sexual function.
However, the risk of sexual dysfunction was not elevated among women who had mild prolapse that was not causing symptoms, lead researcher Dr. Victoria Handa told Reuters Health.
This is important, she explained, because it indicates that women who have sexual complaints but no other potential symptoms of pelvic organ prolapse do not need to be evaluated for the disorder.
"Sexual function is unlikely to be impacted by mild prolapse," said Handa, an associate professor of gynecology and obstetrics at Johns Hopkins University in Baltimore.
The findings are based on 301 patients recruited from gynecology offices affiliated with Johns Hopkins. Eighty women were seeking care for a pelvic floor disorder, including bladder control problems and pelvic organ prolapse. The rest of the women had other conditions or were getting a routine checkup.
All of the women completed questionnaires on their overall health, pelvic symptoms and sexual function.
Overall, the researchers found, women with pelvic floor disorders were more likely to have symptoms of a decreased sex drive, pain during sex and infrequent orgasms -- regardless of age and whether they had gone through menopause.
The study does not prove that the pelvic floor disorders caused the women's sexual problems, Handa said. However, the conditions could impair women's sexual function for a number of reasons, from diminished body image to problems with muscle and nerve function.
According to Handa, women with pelvic floor disorders should talk with their doctors about any sexual difficulties they have.
In an earlier study, she and her colleagues found that women's sexual function often improved after having surgery to correct significant prolapse. But more research is needed into this area, Handa said.
If certain treatments for pelvic floor disorders are better than others for improving sexual function, she noted, that will be important to know.
SOURCE: Obstetrics & Gynecology, May 2008.