Objective: Dyssynergic defecation (DD) and pelvic floor prolapse often coexist in female functional defecation disorder. A retrospective study was performed to evaluate the ability of dynamic MR sequences with the straining and defecation phase to detect paradoxical puborectalis contraction and occult multiple-compartments disorders. Methods: Fifty-three females clinically diagnosed with DD underwent magnetic resonance defecography. The dynamic sequences consist of rest, squeeze, straining, and defecation. The straining phase (pre rectal filling) and defecation phase (post rectal filling) were acquired to assess for pelvic floor relaxation and pelvic organ descent. MR images were analyzed by 2 radiologists with regard to paradoxical puborectalis contraction (changes in the anorectal angle [ARA]) and the presence of pelvic organ prolapse in straining phase and defecation phase independently. Statistical analysis was performed using Wilcoxon’s matched-pairs signed-ranks test and Crosstabs test for matched pairs. Results: Among the 53 patients with DD, 24 individuals (45.3%) were diagnosed DD with multifocal disorders. Comparison between the straining and the defecation phase revealed that there was no significant difference in the change of the ARA (p > 0.05), while significant differences were found in cystocele, vaginal or cervical prolapse, rectocele and descending perineum syndrome between the straining and the defecation phase (p < 0.05). The defecation phase with impaired evacuation distinguished additional anterior/middle compartments findings in female DD patients. Conclusion: The straining phase and the defecation phase have the same ability in assessing paradoxical puborectalis contraction of the DD. Compared with the straining phase, the defecation phase provides the maximum stress to the pelvic floor resulting in complete levator ani relaxation. In addition to diagnosing the abnormal anorectal function, the defecation phase with the discharge of the rectal filling demonstrates maximum anterior/middle pelvic organ descent in DD patients.

1.
Rao SS, Patcharatrakul T: Diagnosis and treatment of dyssynergic defecation. J Neurogastroenterol Motil 2016; 22: 423–435.
2.
Rao SS, Tuteja AK, Vellema T, et al: Dyssynergic defecation: demographics, symptoms, stool patterns, and quality of life. J Clin Gastroenterol.2004; 38: 680–685.
3.
Minguez M, Herreros B, Sanchiz V, et al: Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation. Gastroenterology 2004; 126: 57–56.
4.
Rao SS: Dyssynergic defecation. Gastroenterol Clin North Am 2001; 30: 97–114.
5.
Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V: Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 2008; 10: 84–88.
6.
Koch A, Voderholzer WA, Klauser AG, Müller-Lissner S: Symptoms in chronic constipation. Dis Colon Rectum 1997; 40: 902–906.
7.
Healy JC, Halligan S, Reznek RH, et al: Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement. AJR Am J Roentgenol 1997; 169: 775–779.
8.
Colaiacomo MC, Masselli G, Polettini E, et al: Dynamic MR imaging of the pelvic floor: a pictorial review. RadioGraphics 2009; 29:e35.
9.
Rentsch M, Paetzel C, Lenhart M, Feuerbach S, Jauch KW, Fürst A: Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology. Dis Colon Rectum 2001; 44: 999–1007.
10.
Reiner CS, Weishaupt D: Dynamic pelvic floor imaging: MRI techniques and imaging parameters. Abdom Imaging 2013; 38: 903–911.
11.
Foti PV, Farina R, Riva G, et al: Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet obstruction syndrome. Radiol Med 2013; 118: 23–39.
12.
Reiner CS, Tutuian R, Solopova AE, Pohl D, Marincek B, Weishaupt D: MR defecography in patients with dyssynergic defecation: spectrum of imaging findings and diagnostic value. Br J Radiol 2011; 84: 136–144.
13.
Kobi M, Flusberg M, Paroder V, Chernyak V: Practical guide to dynamic pelvic floor MRI. J Magn Reson Imaging 2018; 47: 1155–1170.
14.
Bhan SN, Mnatzakanian GN, Nisenbaum R, Lee AB, Colak E: MRI for pelvic floor dysfunction: can the strain phase be eliminated? Abdom Radiol (NY) 2016; 41: 215–220.
15.
Flusberg M, Sahni VA, Erturk SM, Mortele KJ: Dynamic MR defecography: assessment of the usefulness of the defecation phase. AmJ Roentgenol 2011; 196:W394–W399.
16.
Hassan HH, Elnekiedy AM, Elshazly WG, Naguib NN: Modified MR defecography without rectal filling in obstructed defecation syndrome: initial experience. Eur J Radiol 2016; 85: 1673–1681.
17.
Payne I, Grimm LM Jr: Functional disorders of constipation: paradoxical puborectalis contraction and increased perineal descent. Clin Colon Rectal Surg 2017; 30: 22–29.
18.
Şahin M, Doğan İ, Cengiz M, Ünal S: The impact of anorectal biofeedback therapy on the quality of life of patients with dyssynergic defecation. Turk J Gastroenterol 2015; 26: 140–144.
19.
Rao SS: Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Clin Gastroenterol Hepatol 2010; 8: 910–919.
20.
Halligan S, Bartram CI, Park HJ, Kamm MA: Proctographic features of anismus. Radiology 1995; 197: 679–682.
21.
Pannu HK, Scatarige JC, Eng J: Comparison of supine magnetic resonance imaging with and without rectal contrast to fluoroscopic cystocolpoproctography for the diagnosis of pelvic organ prolapse. J Comput Assist Tomogr.2009; 33: 125–130.
22.
Schoenenberger AW, Debatin JF, Guldenschuh I, Hany TF, Steiner P, Krestin GP: Dynamic MR defecography with a superconducting, open-configuration MR system. Radiology 1998; 206: 641–646.
23.
Bertschinger KM, Hetzer FH, Roos JE, Treiber K, Marincek B, Hilfiker PR: Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 2002; 223: 501–508.
24.
Kelvin FM, Maglinte DD, Hale DS, Benson JT: Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol 2000; 174: 81–88.
You do not currently have access to this content.