{"paper_id":"b7cb2991-9b57-4bb1-8202-19cba4d2f9a8","body_text":"International Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nSignificance\n \nof\n \nMRI\n \nDefecography\n \nin\n \nthe \nEvaluation of Pelvic Floor \nAbnormalities\n \n \nDr.\n \nSneha\n \nBhaskar\n1\n,\n \nDr. Sanjay Pasoria\n2\n \n \n1\nSenior Resident, Department \nof \nRadiodiagnosis, D.Y. Patil Medical College, School of Medicine, Navi Mumbai\n \n \n2\nAssociate Professor, Department \nof \nRadiodiagnosis\n, \nD.Y. Patil Medical College, School of Medicine, Navi Mumbai\n \n \n \nAbstract\n: \nObjective\n:\n \nTo\n \nevaluate\n \nthe\n \nsignificance\n \nof\n \nMRI\n \ndefecography\n \nin\n \ndetecting\n \nand\n \ncharacterizing pelvic floor abnormalities.\n \nMethods\n: An ambispective\n \nstudy was conducted on 20 patients (10 males, 10 females) presenting with symptoms suggestive of pelvic \nfloor dysfunction. All patients underwent MRI defecography. Patient demographics, clinical presentations, and MRI findings we\nre \nanalyzed.\n \nResults\n: The study population ranged from 20 to over 60 years old, with 75% of patients above 40 years. Constipation \n(85%), incomplete evacuation (65%), and chronic pain (50%) were the most common presenting complaints. MRI defecography \nrevealed rectal prolapse as the predominant abnormality (85% of patients), followed by rectocele (25%), cystocele (15%), and \nother \npelvic organ prolapses. 45% of patients had Grade 2 rectal prolapse. Multiparity (45%) and history of pelvic surgery (30%) we\nre \nidentified as potential risk factors.\n \nNo\n \nstatistically\n \nsignificant\n \nassociations\n \nwere\n \nfound\n \nbetween\n \npelvic\n \nabnormalities\n \nand age, BMI, or \nrisk factors.\n \nConclusion\n:\n \nMRI\n \ndefecography\n \nproved\n \nto\n \nbe\n \na\n \nvaluable\n \ntool\n \nin\n \ncomprehensively\n \nevaluating pelvic floor abnormalities, \nparticularly in detecting and grading rectal prolapse and other pelvic\n \norgan\n \nprolapses.\n \nThis\n \nimaging\n \ntechnique\n \nprovides\n \ndetailed\n \ninformation\n \nthat\n \ncan\n \naid\n \nin accurate diagnosis and treatment planning for patients with pelvic floor dysfunction.\n \n \nKeywords: \nMRI defecography, pelvic floor abnormalities, rectal prolapse, pelvic organ \nprolapse\n \n \n1.\n \nIntroduction\n \n \nDysfunctional pelvic floors are a serious health concern.\n1\n-\n3\n \nThe connective tissues, muscles, and ligaments that \nsupport the pelvic organs make up the pelvic floor. \nDysfunction of the pelvic floor may result from injury to \nany of these components.\n \nAlthough\n \nit\n \ncan\n \naffect\n \nmen\n \nas\n \nwell,\n \npelvic\n \nfloor\n \ndysfunction,\n \nwhich\n \nincludes\n \norgan prolapse, is more \ncommon in women. Clinically, it\n \nmanifests as a variety of \nsymptoms,\n \nsuch\n \nas\n \nblocked\n \nfaeces\n \nand\n \nprolonged\n \nconstipation.\n \n \nEvacuatory\n \ndysfunction\n \nis characterised\n \nby\n \nsymptoms\n \nsuch\n \nas\n \npainful\n \ndefecation,\n \nprolonged\n \nstraining,\n \ndifficulty initiating\n \nrectal\n \nemptying,\n \nand\n \na\n \nsense\n \nof\n \nincomplete\n \nevacuation.\n \nAn\n \nestimated\n \n50%\n \nof parous \nwomen experience some form of prolapse, and by the time \nthey are 80 years old, approximately 11% of them will \nhave had an operation for prolapse or incontinence.\n4,5\n \nIncontinence\n \nof\n \nthe\n \nbowels\n \nand\n \nurine,\n \nas\n \nwell\n \nas\n \npelvic\n \ndiscomfort\n \nand\n \npelvic\n \norgan prolapse,\n \nare\n \nsymptoms\n \nof\n \npelvic\n \nfloor\n \ndysfunction.\n1\n-\n3\n \nPelvic\n \nfloor\n \ndiseases\n \nare\n \nmore common as people age, and their prevalence is \nexpected to rise in the Western world as a result of \nchanging demographics.\n \n \nThe integrity of the pelvic floor can be damaged by age, \ngenetics, childbirth, obesity, pelvic surgery, constipation, \nand strenuous physical activity.\n6\n \nIt is difficult to clinically \nevaluate\n \npatients\n \nwith\n \npelvic\n \nfloor\n \ndysfunction.\n \nSymptoms\n \nlike\n \nconstipation, incontinence, and pain are \nnon\n-\nspecific in nature, and physical examination is \nfrequently not very accurate.\n7\n \n \nThree compartments make up the female pelvic floor: the \nanterior compartment, which houses the urethra and \nbladder, the middle compartment, which houses the uterus \nand vagina, and the posterior anorectal compartments. The \nprimary\n \nanomalies that occur in\n \nthe anterior and middle \ncompartments are cystocele and uterine/vaginal descent, \nrespectively; the posterior compartment is affected by \nrectocele, enterocele, intussusception, anismus, and \nanorectal junction descent.\n8\n \nRegardless of the presenting \nsymptoms, individuals typically show anomalies in many \ncompartments despite varying clinical presentations, hence \na thorough pelvic floor assessment is necessary. This is \nespecially important to consider while planning surgical \nmanagement.\n9\n \n \nConsequently, imaging has gained popularity recently as \nan extra tool for diagnosing pelvic floor disorders at \nacademic medical centres.\n2,10\n \n \nThe anal sphincter complex and associated pathologic \nchanges are depicted in exquisite anatomic detail on \nendoanal sonography and endoanal MRI\n11,12\n, but both \nmodalities are very restricted in the assessment of pelvic \nfloor function.\n \n \nA number of methods are employed to evaluate anomalies \nof the pelvic organs. Physical examinations are unreliable \nin assessing these anomalies because they can \nunderestimate or misdiagnose the prolapse site.\n13\n \nAlthough \nthe procedure has numerous limitations, fluoroscopic \ndefecography, which was initially reported in 1952\n14\n, has \nhistorically been crucial in the detection of functional \nabnormalities of the pelvic floor.\n15\nThe pelvic soft tissues \nare mostly depicted in a limited way since contrast \nmaterial can only be injected into a few anatomical \ncompartments, including the vagina, bladder, small \nintestine, and peritoneum, to enhance the tissues.\n15,\n \n16\nThis \nstep undoubtedly makes the examination\n \nmore intrusive. \nThe fluoroscopic procedure also subjects the patient to \nionising radiation. As a result, interest in MR \ndefecography grew. This method avoids the radiation \nPaper ID: SR251031101844\nDOI: https://dx.doi.org/10.21275/SR251031101844\n35 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nburden\n \nof traditional fluoroscopic defecography by using \nthe superior multiplanar soft\n-\ntissue contrast of magnetic \nresonance imaging (MRI) to see the pelvic viscera and \nsupporting soft\n-\ntissue structures.\n17\nMRI is an excellent \ntechnique in evaluation of pelvic floor abnormalities. The \nother technique for studying these abnormalities, \nfluoroscopic defecography, frequently misses some \nconcomitant multicompartmental abnormalities. In \naddition, it takes a lot of time\n \nand employs ionising \nradiation, which is dangerous, especially for young girls. \nHowever, because of its superior soft tissue resolution in \nmany imaging planes and lack of\n \nhazardous ionising \nradiation\n22\n, MR defecography (MRD) is a great technique \nfor evaluating pelvic organ anomalies. Additionally, it \nenables the dynamic evaluation of the pelvic organs' \nbehaviour, offering an objective grading system for pelvic \norgan\n \nprolapse.\n5,22\n \n \nThe purpose of our study was to assess the importance of \nMRI Defecography in the evaluation of pelvic floor \ndisorders.\n \n \n2.\n \nMethodology\n \n \n•\n \nStudy\n \ndesign:\n \nAmbispective\n \nstudy.\n \n•\n \nStudy\n \narea:\n \nDepartment\n \nof\n \nradio\n-\ndiagnosis,\n \nDr.\n \nD.Y.\n \nPatil\n \nHospital,\n \nNavi\n \nMumbai.\n \n•\n \nStudy period: \nResearch study was conducted between \nSeptember 2022 to June 2024 Below is the work plan.\n \n \nTable\n \n1:\n \nWork\n \nplan\n \nof\n \nthe\n \nstudy\n \nwith\n \npercentage\n \nof\n \nallocation\n \nof\n \nstudy\n \ntime\n \nand duration in months\n \nWork\n \nplan\n \n%\n \nof\n \nallocation\n \nof\n \nstudy\n \ntime\n \nDuration\n \nin\n \nmonths\n \nUnderstanding\n \nthe\n \nproblem,\n \npreparation\n \nof\n \nquestionnaire.\n \n5\n-\n10%\n \nSeptember\n \n2022\n \nto\n \nNovember\n \n2022\n \nPilot\n \nstudy,\n \nValidation\n \nof\n \nquestionnaire, data collection and manipulation\n \nUpto\n \n80%\n \nDecember 2022 to December \n2023\n \nAnalysis\n \nand\n \ninterpretation\n \n5\n-\n10%\n \nJanuary\n \n2024\n \nto\n \nMarch\n \n2024\n \nDissertation\n \nwrite\n-\nup\n \nand\n \nsubmission\n \n5\n-\n10%\n \nApril\n \n2024\n \nto\n \nJune\n \n2024\n \n \n•\n \nSample\n \nsize\n:\n \n20 patients\n \n \nInclusion\n \ncriteria:\n \n•\n \nPatients presenting with suspected pelvic floor \ndysfunction\n \n•\n \nThose who have given their consent MRI defecography\n \n \nExclusion\n \ncriteria:\n \n•\n \nPatients with Claustrophobia.\n \n•\n \nOther contraindications for MRI defecography such as \nthose with metallic implants\n \n \nSource\n \nof\n \ndata\n:\n \nSource\n \nof\n \ndata\n \nfor\n \ncases\n \nin\n \nthis\n \nresearch\n \nstudy\n \nwas\n \nsupported\n \nby\n \nprimary\n \ndata\n \nsource.\n \n \nPrimary source of data: \nThe material for the present \nstudy is from patients with clinical suspicion\n \nof\n \npelvic\n \nfloor\n \nabnormalities\n \nreferred\n \nto\n \ndepartment\n \nof\n \nradio\n-\ndiagnosis,\n \nDr.\n \nD.Y.\n \nPatil\n \nHospital,\n \nNavi\n \nMumbai\n \nfor\n \nMRI\n \ndefecography.\n \n \nTo meet the objectives of our study, a primary source of \ninformation technique was adopted with direct interview \nmethod using pre\n-\ntested semi\n-\nstructured questionnaire.\n \nSecondary source of data: \nSecondary data source was \nused to estimate the sample size and also to frame the \nquestionnaire. The sources of secondary data were \nmultiple\n-\n \njournals, academic books, research articles, \nreview articles, newspapers and references from the web, \nall of which are listed in the bibliography.\n \n \nMethod of Data collection:\n \nAfter obtaining approval and clearance from the \ninstitutional ethics committee, the\n \npatients fulfilling the \ninclusion criteria were enrolled for the study after \nobtaining\n \ninformed consent. (Annexure 1)\n \n \nTo collect the required information from\n \nthe study subjects \nthe “Direct interview method” of Primary source of \ninformation technique was used. The patients were \ninterviewed for collection of necessary information using \nthe pre\n-\ntested, semi structured questionnaire method. The \nquestionnaire was prepared by a thorough review of \nliterature.\n \n \nIn order to obtain co\n-\noperation of the patient,\n \npatient was \nmade comfortable and a\n \npositive reinforcement was \nexerted. No answers were influenced and patient was \nhelped during \ndifficulty.\n \n \nDemographic data were collected using a questionnaire \nthat was administered by the principal researcher to the \npatients after signing the informed consent. Detailed \nhistory regarding symptoms like constipation, straining, \nmass descending per rectum,\n \ndyspepsis\n\\\na, low backache, \nurge incontinence, anal region pain and dirhhoea, clinical \nand radiological examination was done for all patients.\n \n \nThey were assessed and followed by MRI defecography \nfor further evaluation. The procedure\n \nof\n \nMRI\n \ndefecography\n \nwas\n \nexplained\n \nto\n \nthe\n \npatient\n \nin\n \nhis/her\n \nvernacular\n \nlanguage to make him/her relaxed and be \ncooperative with the examiner while\n \nperforming \nMRI.\n \n \nFor the study, patients were first positioned in left lateral \nposition and ultrasound gel was introduced into the rectum \nby a rectal catheter till the patient felt full (approximately \n200\n-\n \n250 ml of jelly). On conclusion, the patient was \ninstructed to wear an adult diaper. The patient was then \ntaken into the MRI room and told to lie supine on the MRI \ngantry. Axial, coronal and sagittal T2W sequences of the \npelvis are developed to look for structural abnormalities of \nthe musculature, endopelvic fascia, and pelvic viscera.\n \n \nProcedure\n \ndetails:\n \n1)\n \nPatient\n \nPreparation:\n \n•\n \nExplained\n \nthe\n \nprocedure\n \nto\n \nthe\n \npatient\n \nand\n \nobtained\n \ninformed\n \nconsent.\n \n•\n \nScreened\n \nfor\n \ncontraindications\n \nto\n \nMRI\n \n(e.g.,\n \nmetal\n \nPaper ID: SR251031101844\nDOI: https://dx.doi.org/10.21275/SR251031101844\n36 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nimplants,\n \nclaustrophobia).\n \n•\n \nInstructed\n \nthe\n \npatient\n \nto\n \nfast\n \nfor\n \n4\n-\n6\n \nhours\n \nbefore\n \nthe\n \nexam.\n \n•\n \nAsked\n \nthe\n \npatient\n \nto\n \nempty\n \ntheir\n \nbladder\n \nbefore\n \nthe\n \nprocedure.\n \n \n2)\n \nUltrasound gel Administration:\n \n•\n \nPrepared\n \n200\n-\n250\n \nmL\n \nof\n \nultrasound\n \ngel\n \nmixed\n \nwith\n \nminimal\n \nnormal\n \nsaline.\n \n•\n \nUsing\n \na\n \nrectal\n \ncatheter\n \ninstilled\n \nthe\n \ngel\n \nmixture\n \ninto\n \nthe\n \npatient's\n \nrectum.\n \n•\n \nInstructed\n \nthe\n \npatient\n \nto\n \nretain\n \nthe\n \nmixture.\n \n \n3)\n \nPatient Positioning:\n \n•\n \nPositioned\n \nthe\n \npatient\n \nin\n \nthe\n \nMRI\n \nscanner\n \nin\n \na\n \nsupine\n \nposition.\n \n•\n \nUse\n \na\n \npelvic\n \nphased\n-\narray\n \ncoil\n \nfor\n \noptimal\n \nimage\n \nquality.\n \n•\n \nEnsured\n \npatient\n \ncomfort\n \nand\n \nprovide\n \nan\n \nemergency\n \ncall\n \nbutton.\n \n \n4)\n \nScout Images:\n \n•\n \nObtained\n \ninitial\n \nlocalizer\n \nimages\n \nin\n \nthree\n \nplanes\n \n(sagittal,\n \ncoronal,\n \naxial).\n \n•\n \nUsed\n \nthese\n \nimages\n \nto\n \nplan\n \nsubsequent\n \nsequences.\n \n \n5)\n \nStatic Imaging:\n \n•\n \nPerformed\n \nT2\n-\nweighted\n \nturbo\n \nspin\n-\necho\n \nsequences\n \nin\n \nsagittal,\n \ncoronal,\n \nand\n \naxial\n \nplanes.\n \n•\n \nUsed\n \nhigh\n-\nresolution\n \nsequences\n \nwith\n \nslice\n \nthickness\n \nof\n \n3\n-\n4\n \nmm.\n \n•\n \nCover\n \nthe\n \nentire\n \npelvis\n \nfrom\n \nthe\n \niliac\n \ncrests\n \nto\n \nbelow\n \nthe\n \nanal\n \nverge.\n \n \n6)\n \nDynamic Imaging:\n \n•\n \nUsed\n \na\n \nT2\n-\nweighted\n \nsingle\n-\nshot\n \nfast\n \nspin\n-\necho\n \nsequence\n \nin\n \nthe\n \nmidsagittal\n \nplane.\n \n•\n \nSet\n \nup\n \nthe\n \nsequence\n \nfor\n \ncontinuous\n \nacquisition\n \n(2\n-\n3\n \nimages\n \nper\n \nsecond).\n \n•\n \nTotal\n \nacquisition\n \ntime\n \nshould\n \nbe\n \nabout\n \n2\n-\n3\n \nminutes.\n \n \n7)\n \nDefecation\n \nPhase:\n \na)\n \nInstruct\n \nthe\n \npatient\n \nto\n \nperform\n \nthe\n \nfollowing\n \nmaneuvers\n \nduring\n \ndynamic\n \nimaging:\n \n•\n \nRest:\n \nThe\n \nrest\n \nphase\n \nforms\n \nthe\n \nfoundation\n \nof\n \nthe\n \nexamination.\n \nDuring\n \nthis\n \nphase,\n \nthe\n \npatient\n \nlies\n \nstill\n \nand\n \nrelaxed,\n \nwith\n \nno\n \nactive\n \nmuscle\n \ncontraction.\n \nThis\n \nallows\n \nfor\n \nassessment\n \nof\n \nthe\n \nnormal\n \nanatomical\n \nposition\n \nof\n \npelvic\n \norgans\n \nand\n \nthe\n \nanorectal\n \nangle\n \nin\n \ntheir\n \nbaseline\n \nstate.\n \nThe\n \nresting\n \nimages\n \nprovide\n \na\n \ncrucial\n \nreference\n \npoint\n \nfor\n \ncomparing\n \nchanges\n \nobserved\n \nin\n \nsubsequent\n \nphases.\n \nRadiologists\n \ncarefully\n \nexamine\n \nthe\n \nposition\n \nof\n \npelvic\n \norgans,\n \nthe\n \nanorectal\n \nangle,\n \nand\n \nthe\n \nconfiguration\n \nof\n \npelvic\n \nfloor\n \nmuscles\n \nin\n \ntheir\n \nnatural,\n \nuncontracted\n \nstate.\n \n•\n \nSqueeze\n \n(pelvic\n \nfloor\n \ncontraction):\n \nIn\n \nthe\n \nsqueeze\n \nphase,\n \nalso\n \nknown\n \nas\n \nthe\n \npelvic\n \nfloor\n \ncontraction\n \nphase,\n \nthe\n \npatient\n \nis\n \ninstructed\n \nto\n \ncontract\n \ntheir\n \npelvic\n \nfloor\n \nmuscles\n \nas\n \nif\n \ntrying\n \nto\n \nhold\n \nin\n \nurine\n \nor\n \nstool.\n \nThis\n \nphase\n \nevaluates\n \nthe\n \nstrength\n \nand\n \ne\nffectiveness\n \nof\n \npelvic\n \nfloor\n \nmuscle\n \ncontraction.\n \nObservers\n \nlook\n \nfor\n \nelevation\n \nof\n \nthe\n \npelvic\n \nfloor,\n \nnarrowing\n \nof\n \nthe\n \nanorectal\n \nangle,\n \nand\n \ncontraction\n \nof\n \nthe\n \npuborectalis\n \nmuscle.\n \nAny\n \nasymmetry\n \nor\n \nweakness\n \nin\n \nmuscle\n \nfunction\n \nbecomes\n \napparent\n \nduring\n \nthis\n \nphase,\n \nproviding\n \nvaluable\n \ninformation\n \nabout\n \nthe\n \npatient's\n \nability\n \nto\n \nvoluntarily\n \ncontrol\n \ntheir\n \npelvic\n \nfloor\n \nmuscles.\n \n•\n \nStrain\n \n(bearing\n \ndown\n \nwithout\n \nevacuation):\n \nThe\n \nstrain\n \nphase\n \ninvolves\n \nthe\n \npatient\n \nbearing\n \ndown\n \nor\n \npushing\n \nas\n \nif\n \nhaving\n \na\n \nbowel\n \nmovement,\n \nbut\n \nwithout\n \nactually\n \nevacuating.\n \nThis\n \nphase\n \nis\n \ncritical\n \nfor\n \nassessing\n \npelvic\n \norgan\n \ndescent\n \nand\n \nidentifying\n \nany\n \nstructural\n \nabnormalities\n \nunder\n \npressure.\n \nRadiologists\n \nobserve\n \nthe\n \ndescent\n \nof\n \npelvic\n \norgans\n \nsuch\n \nas\n \nthe\n \nbladder,\n \nuterus\n \n(in\n \nfemales),\n \nand\n \nrectum.\n \nThey\n \nalso\n \nnote\n \nchanges\n \nin\n \nthe\n \nanorectal\n \nangle\n \nand\n \nlook\n \nfor\n \nthe\n \npresence\n \nof\n \nconditions\n \nlike\n \nrectocele,\n \ncystocele,\n \nuterine\n \nprolapse,\n \nintussusception,\n \nor\n \nrectal\n \nprolapse.\n \nThe\n \nstrain\n \nphase\n \noften\n \nreveals\n \nabnormalities\n \nthat\n \nmay\n \nnot\n \nbe\n \napparent\n \nat\n \nrest.\n \n \n•\n \nDefecate\n \n(evacuation\n \nof\n \nrectal\n \ncontrast):\n \nFinally,\n \nthe\n \ndefecation\n \nphase,\n \nor\n \nevacuation\n \nphase,\n \nis\n \nwhere\n \nthe\n \npatient\n \nis\n \ninstructed\n \nto\n \nevacuate\n \nthe\n \ncontrast\n \nmaterial\n \nfrom\n \nthe\n \nrectum.This\n \nphase\n \nevaluates\n \nthe\n \ncoordinated\n \nfunction\n \nof\n \npelvic\n \nfloor\n \nmuscles\n \nduring\n \ndefecation\n \nand\n \nassesses\n \nevacuation\n \nefficiency.\n \nObservers\n \nlook\n \nfor\n \nwidening\n \nof\n \nthe\n \nanorectal\n \nangle,\n \ndescent\n \nof\n \nthe\n \npelvic\n \nfloor,\n \nand\n \nrelaxation\n \nof\n \nthe\n \npuborectalis\n \nmuscle.\n \nThe\n \nefficiency\n \nand\n \ncompleteness\n \nof\n \nevacuation\n \nare\n \ncarefully\n \nnoted,\n \nas\n \nare\n \nany\n \nobstructive\n \nfeatures\n \nsuch\n \nas\n \nnon\n-\nrelaxing\n \npuborectalis\n \nmuscle.\n \nThis\n \nphase\n \nis\n \nparticularly\n \nimportant\n \nfor\n \ndiagnosing\n \nfunctional\n \ndefecation\n \ndisorders\n \nand\n \nunderstanding\n \nthe\n \npatient's\n \nability\n \nto\n \ncoordinate\n \npelvic\n \nfloor\n \nrelaxation\n \nwith\n \nevacuation\n \nefforts.\n \n•\n \nProvided\n \nclear\n \ninstructions\n \nthrough\n \nthe\n \nintercom\n \nsystem.\n \n•\n \nEncouraged\n \nthe\n \npatient\n \nto\n \nperform\n \neach\n \nmaneuver\n \nfor\n \n20\n-\n30\n \nseconds.\n \n \nb)\n \nPost\n-\nEvacuation\n \nImaging:\n \n•\n \nAfter\n \ndefecation,\n \nperform\n \nanother\n \nset\n \nof\n \nstatic\n \nT2\n-\nweighted\n \nimages.\n \n•\n \nThis\n \nhelps\n \nassess\n \nresidual\n \ncontrast\n \nand\n \npost\n-\nevacuation\n \nanatomy.\n \n \n8)\n \nAdditional\n \nSequences\n \n(if\n \nneeded):\n \n•\n \nConsider adding diffusion\n-\nweighted imaging or T1\n-\nweighted post\n-\ncontrast sequences if\n \nthere's suspicion \nof pelvic pathology.\n \n \n9)\n \nImage\n \nProcessing\n \nand\n \nAnalysis:\n \n•\n \nTransfer\n \nimages\n \nto\n \na\n \nworkstation\n \nfor\n \npost\n-\nprocessing.\n \n•\n \nUse\n \ncine\n-\nloop\n \ndisplay\n \nfor\n \ndynamic\n \nimages.\n \n \n10)\n \nMeasure\n \nand\n \nanalyze:\n \n•\n \nAnorectal\n \nangle\n \nat\n \nrest\n \nand\n \nduring\n \nmaneuvers\n \n•\n \nPelvic\n \norgan\n \ndescent\n \n•\n \nPresence\n \nof\n \nrectocele,\n \nintussusception,\n \nor\n \nprolapse\n \n•\n \nPuborectalis\n \nrelaxation\n \n•\n \nEvacuation\n \nefficiency\n \n \n11)\n \nPatient\n \nCare\n \nPost\n-\nProcedure:\n \n•\n \nAssist\n \nthe\n \npatient\n \noff\n \nthe\n \nMRI\n \ntable\n \nand\n \nprovide\n \nprivacy\n \nfor\n \ncleaning.\n \nPaper ID: SR251031101844\nDOI: https://dx.doi.org/10.21275/SR251031101844\n37 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \n•\n \nOffer\n \nsanitary\n \nfacilities\n \nand\n \nsupplies.\n \n•\n \nInstruct\n \nthe\n \npatient\n \nabout\n \npossible\n \nshort\n-\nterm\n \neffects\n \n(e.g.,\n \nloose\n \nstools).\n \n \n12)\n \nReporting:\n \n•\n \nGenerate\n \na\n \ncomprehensive\n \nreport\n \nincluding\n \nboth\n \nstatic\n \nand\n \ndynamic\n \nfindings.\n \n•\n \nCompare\n \nmeasurements\n \nto\n \nestablished\n \nnormal\n \nvalues.\n \n•\n \nProvide\n \nrelevant\n \nimages\n \nand\n \ncine\n-\nloops\n \nwith\n \nthe\n \nreport.\n \n \nGrading\n \nof\n \nRectal\n \nProlapse:\n \nThe\n \nrecommended\n \ngrading\n \nsystem\n \nfor\n \nrectal\n \ndescent\n \nis\n \ntherefore\n \nas\n \nfollows:\n \n°0\n \n=\n \nup\n \nto\n \n+3\n \ncm\n \nbelow\n \nthe\n \nPCL,\n \n°I\n \n=\n \nbetween\n \n+3\n \nand\n \n+5\n \ncm\n \nbelow\n \nthe\n \nPCL,\n \nand\n \n°II\n \n=\n \nmore\n \nthan\n \n+5\n \ncm\n \nbelow\n \nthe\n \nPCL\n \n \nFigure\n \n1:\n \nMR\n \nDefecography\n \n \nRest\n \nphase\n \nin\n \nsitting\n \n(a) and\n \nsupine\n \n(b)\n \nposition.\n \nEvacuation phase\n \nin sitting\n \n(c)\n \nand\n \nsupine\n \n(d) position.\n \nThe pathological fixed descent was detected only in sitting \nposition in rest phase (a). In evacuation phase, a cystocele \nbecame evident (d), whereas the maximal descent of the \nARJ is similar in both sitting and supine position (c, d). \nBB: bladder base; VF: vaginal fornix; ARJ: anorectal \njunction\n \n \n \nFigure 2\n:\n \nPhases of defecation seen in MRI defecography \n–\n \nin rest phase, squeeze phase, strain phase and defecation \nphase\n \n \nImaging\n \nTechnique:\n \nA 3T MRI scanner (Signa Pioneer) was used for each \nexamination, and the patient was placed in the supine \nposition. The patients were told not to use the loo an hour \nbefore to the examination. There was no use of oral or \nintravenous contrast media, nor was there\n \nany bowel \npreparation. With the patient lying on the scanner table in a \nlateral decubitus position, a flexible tube was used to insert \n200 cc of sonographic gel into the rectum. The test \ninvolved encircling the pelvis with a body array coil. A \nmidline sagittal plane including the symphysis pubis, \ncoccyx, rectum, vagina, and bladder neck was identified \nusing scout pictures. During pelvic floor squeezing, \nstraining, and faeces, pictures were acquired using this \nplane while the subject was at rest.\n \n \nFor the pelvis, 25 slices of 4.5 mm thickness were acquired \nusing triplanar T2W images (TR/TE = 3700/105; 230 mm \nfield of view; 384*384 image matrix). True FISP (Fast \nImaging with Steady\n-\nstate Precession; TR/TE = \n55.95/1.66; 400 mm field of view; 218*384\n \nmatrix)\n \nwas\n \nused\n \nto\n \nprovide\n \ndynamic\n \nimaging\n \nof\n \n10\n \nmm\n \nslices.\n \nA\n \none\n-\nsecond\n \nimage update was given, and 100 repetitions \nwere obtained in the first five seconds beginning with \ncomplete rest. In order to account for any improper patient \nmotion or miscommunication, three to four recordings \nwere typically taken for each patient.\n \n \nInterpretation:\n \nAny\n \nprotrusion\n \nof a pelvic organ\n—\nthe bladder,\n \nuterus, \nrectum,\n \nor small bowel\n—\nbelow the level of the pelvic \nfloor through the levator hiatus is referred to as pelvic \norgan prolapse. Rectal wall bulging, either anterior or \nposterior, is also included in this. The HMO\n \n(H line,\n \nM \nline,\n \norgan prolapse)\n \ngrading method, shown\n \nin Fig. 1,\n \nwas \nused to\n \ngrade pelvic organ prolapse based on a midsagittal \nplane pelvic picture taken during maximal straining or \ndefecation. An organ's prolapse was categorised as mild (6 \ncm) depending on how much below the pubococcygeal \nline it was. The size of the anterior rectal wall's (4 cm) \nPaper ID: SR251031101844\nDOI: https://dx.doi.org/10.21275/SR251031101844\n38 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nprotrusion towards the vagina was used to grade rectocele. \nAt repose, the anorectal angle (ARA) typically ranges from \n108 to 127. When paradoxical contraction of the \npuborectalis muscle, paradoxical\n \nreduction of the ARA \nduring defecation, and absence of lowering of the pelvic \nfloor during straining and faeces were noted, anismus was \nidentified. There are two types of rectal invagination \n(intussusception): full/partial thickness rectal wall prolapse \noccurring extra\n-\nanally, and intra\n-\nrectal intra\n-\nanal.\n \n \nParameters\n \nassessed\n \nwere:\n \n1)\n \nAnterior, middle and posterior compartments of the \npelvis were assessed for any pelvic\n \nfloor dysfunction.\n \n2)\n \nAfter\n \nthe\n \nacquisition\n \nof\n \nthe\n \nappropriate\n \nimages,\n \nthe\n \nfollowing\n \nlines\n \nwere\n \ndrawn\n \nand measurements were \ntaken for the evaluation and assessment of the \noutcome of this study.\n \na)\n \nPCL line: a line joining the inferior margin of the \npubic symphysis to the final coccygeal joint. This \nline corresponds to the plane of the levator muscle.\n \nb)\n \nMid pubic line: This line is drawn along the axis of \nthe pubic symphysis and then perpendicular lines \nare\n \ndrawn from\n \nthe\n \norgan specific reference points \nin the\n \nsame manner as the PCL.\n \nc)\n \nH\n \nLine:\n \nfrom\n \nthe\n \npubic\n \nsymphysis\n \nto\n \nthe\n \nposterior\n \naspect\n \nof\n \nthe\n \nanorectal\n \njunction\n \nand \ncorresponds to the AP diameter of the hiatus.\n \nd)\n \nM\n \nLine:\n \ndrawn\n \nperpendicular\n \nfrom\n \nthe\n \nPCL\n \nto\n \nthe\n \nposterior\n \nend\n \nof\n \nthe\n \nH\n \nline\n \nand\n \ncorresponds \nto pelvic hiatal descent during evacuation.\n \n \nThe\n \npubococcygeal\n \nline\n \n(PCL)\n \nis\n \ndrawn\n \nfrom\n \nthe\n \ninferior\n \nmargin\n \nof\n \nthe\n \nsymphysis\n \npubis\n \n(A) to the last coccygeal \njoint (B). H line represents the anteroposterior hiatal width \nthat extends from point (A) to the posterior aspect of the \npuborectalis muscle sling (C). M line is the perpendicular\n \ndistance\n \nfrom\n \nthe posterior\n \nend of\n \nH line\n \n(C)\n \nto the PCL \nand measures pelvic floor descent.\n \n \n \nFigure\n \n2:\n \nReference\n \npoints\n \nof\n \nthe\n \nHMO\n \nsystem\n \n \n \nFigure 3:\n \nThe pubococcygeal line (PCL) is drawn from \nthe inferior margin of the symphysis pubis to the last \ncoccygeal joint. H line represents the anteroposterior hiatal \nwidth that extends from the inferior margin of the \nsymphysis pubis to the posterior aspect of the puborectalis \nmuscle sling. M line is the perpendicular distance from the \nposterior end of H line to the PCL and measures pelvic \nfloor descent.\n \n \nAnorectal\n \nAngle:\n \nThe anorectal angle is defined as the angle formed between \nthe longitudinal axis of the anal canal and the posterior \nrectal wall. More specifically, it's the angle between a line \ndrawn along the posterior border of the distal rectum and a \nline drawn through the central axis of the anal canal.\n \n \nCut\n-\noff (Normal Values): The normal values for the \nanorectal angle vary depending on\n \nthe patient's position \nand the phase of defecation. Generally accepted normal \nranges are:\n \n1)\n \nAt\n \nrest:\n \n•\n \nNormal\n \nrange:\n \n90\n-\n110\n \ndegrees\n \n•\n \nSome\n \nsources\n \ncite\n \na\n \nwider\n \nrange\n \nof\n \n90\n-\n135\n \ndegrees\n \n2)\n \nDuring\n \nsqueeze\n \n(contraction):\n \n•\n \nThe\n \nangle\n \nshould\n \ndecrease\n \nby\n \n10\n-\n15\n \ndegrees\n \nfrom\n \nthe\n \nresting\n \nangle\n \n•\n \nTypically\n \nbecomes\n \nmore\n \nacute,\n \noften\n \naround\n \n75\n-\n100\n \ndegrees\n \n3)\n \nDuring\n \nstraining/defecation:\n \n•\n \nThe\n \nangle\n \nshould\n \nincrease\n \nby\n \n15\n-\n20\n \ndegrees\n \nfrom\n \nthe\n \nresting\n \nangle\n \n•\n \nTypically\n \nbecomes\n \nmore\n \nobtuse,\n \noften\n \naround\n \n110\n-\n130\n \ndegrees\n \nor\n \nmore\n \n \nEthical\n \nConsideration\n \nEthical clearance was taken from Ethical Committee of Dr. \nD.Y. Patil Hospital, Navi Mumbai before conducting the \nstudy. There are four universal ethical principles in \nbiomedical\n \nresearch\n \ndescribed\n \nin\n \nthe\n \nlandmark\n \nbook\n-\nPrinciples\n \nof\n \nbiomedical\n \nethics\n \nby Beauchamp and \nChildress.\n \na)\n \nRespect\n \nfor\n \nautonomy\n \nb)\n \nBeneficence\n \nc)\n \nNon\n-\nmaleficence\n \nd)\n \nJustice\n \n \na)\n \nRespect\n \nf\nor\n \nAutonomy\n \nThe study subjects were explained in local language \nabout the study and prior written informed consent \nPaper ID: SR251031101844\nDOI: https://dx.doi.org/10.21275/SR251031101844\n39 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nwas taken from the respondent. Confidentiality of the \ninformation collected\n \nthrough\n \nthe\n \nquestionnaire\n \nwas\n \nstrictly\n \nfollowed\n \nthroughout.\n \nb)\n \nBeneficence\n \nIndividuals\n \nwho\n \nwere\n \nfound\n \nto\n \nhave\n \nabnormal\n \nlipid\n \nprofile\n \nwere\n \ntreated\n \nfor\n \nthe\n \nsame and educated \nabout complications of stroke. Since it was not a \nfunded project study subjects\n \nwere\n \ninformed\n \nthat\n \nthey\n \nwill\n \nnot\n \nbe\n \ngetting\n \nany\n \nfinancial\n \nbenefit\n \nby \nparticipating in the study.\n \nc)\n \nNon\n-\n \nMaleficence\n \nDue\n \ncare\n \nwas\n \ntaken\n \nto\n \nprotect\n \nthe\n \nprivacy\n \nof\n \nthe\n \nstudy\n \nsubjects.\n \nd)\n \nJustice\n \nDue\n \ncare\n \nwas\n \ntaken\n \nwhile\n \nrecruiting\n \nthe\n \nparticipants\n \nand\n \nspecial\n \nprotection\n \nfor vulnerable \ngroups.\n \n \nAnalysis\n \nThe data was analyzed using SPSS software version 21.0. \nDescriptive statistics were used to describe the sample. \nThe correlation between ARJ descent, cystocele, uterine \ndescent, anterior and posterior rectocele, and patient \nsymptoms was done, and the Chi\n-\nsquare test was \nemployed to analyse differences in the frequency of \nanomalies according to gender and age. A statistically \nsignificant result was defined as one with a p value of less \nthan \n0.05.\n \n \n3.\n \nResults\n \n \nThe\n \nfollowing\n \nresults\n \nwere\n \nnoted:\n \n1)\n \nDemographics:\n \n•\n \nThe\n \nstudy\n \nincluded\n \nan\n \nequal\n \ndistribution\n \nof\n \nmale\n \nand\n \nfemale\n \npatients\n \n(50%\n \neach).\n \n•\n \nThe majority of patients (75%) were over 40 years \nold, with the\n \nhighest percentage (30%) in the 41\n-\n50 \nage group.\n \n•\n \n55% of patients were overweight (BMI 25\n-\n29.9), \nwhile 45% had normal BMI.\n \n2)\n \nPresenting complaints:\n \n•\n \nThe most common complaints were constipation \n(85%), incomplete evacuation (65%), and chronic \npain (50%).\n \n•\n \nPelvic organ prolapse was reported in 45% of cases.\n \n3)\n \nPelvic floor abnormalities:\n \n•\n \nRectal prolapse was the most prevalent abnormality, \nfound in 85% of patients.\n \n•\n \nOther abnormalities included rectocele (25%), \ncystocele (15%), enterocele (5%), and vaginal organ \nprolapse (5%).\n \n•\n \n95% of patients had a normal anorectal angle, with \nonly 5% showing abnormality.\n \n4)\n \nGrades of rectal prolapse:\n \n•\n \n45% of patients had Grade 2 rectal prolapse, 40% \nhad Grade 1, and 15% had Grade 0.\n \n5)\n \nRisk factors:\n \n•\n \nMultiparity was identified as a risk factor in 45% of \npatients.\n \n•\n \nHistory of pelvic surgery was present in 30% of \npatients.\n \n6)\n \nAssociations:\n \n•\n \nNo statistically significant associations were found \nbetween pelvic abnormalities and age, BMI, or risk \nfactors (p\n-\nvalues > 0.05).\n \n \n4.\n \nDiscussion\n \n \nPelvic floor disorders are a group of conditions that affect \nthe normal functioning of the pelvic organs and their \nsupporting structures. These disorders can significantly \nimpact quality of life and are often underdiagnosed due to \ntheir complex nature and patients' reluctance to discuss \nsymptoms. Magnetic Resonance Imaging (MRI) \ndefecography has emerged as a valuable diagnostic tool in \nthe evaluation of pelvic floor abnormalities,\n \noffering \ndetailed visualization of the pelvic anatomy and dynamic \nassessment of pelvic\n \norgan function. Because all three \ncompartments can be clearly seen without the need for \nadditional contrast to be added to the anterior and middle \ncompartments, MRI defecography can overcome some of \nthe limitations of conventional defecography and \nultrasonography.\n \nAs a result, many other disorders that \nmay affect the patient's management can be identified.\n58\n \nThis study aimed to evaluate the significance of MRI \ndefecography in diagnosing and characterizing pelvic floor \nabnormalities, with\n \na focus on its ability to detect various \npelvic compartment disorders and their associations with \ndemographic and clinical \nfactors.\n \n \nOur study included 20 patients who underwent MRI \ndefecography for evaluation of pelvic floor abnormalities. \nThe demographic profile of our patient cohort revealed a \nbalanced gender distribution (50% female, 50% male) and \na predominance of patients in the 41\n-\n50\n \nage group (30%). \nThis age distribution is consistent with the findings of \nM.S.Al\n-\nNajar et al.\n59\n, who reported mean age of 48years \n(20\n–\n81years). The majority of Rafiq S et al.\n60\n \npatients were \nin the 40\n–\n50 age range. In a research conducted solely on \nfemale patients, Abdelzaher et al.\n61\n \nfound that the patients' \nmean age was 38.7 years. Because of the relaxation of the \npelvic ligaments following childbirth, women are more \nlikely to suffer\n \nfrom pelvic floor diseases.\n \nHowever, our \ngender distribution differs from most published literature, \nwhich typically reports a female predominance in pelvic \nfloor disorders. M.S.Al\n-\nNajar et al.\n59\n \nreported 25 males\n \nand\n \n70\n \nfemales\n \namong\n \n95\n \npatients\n \nstudied.\n \nOf\n \nthe\n \n24\n \nindividuals\n \nanalysed,\n \nRafiq\n \nS et al.\n60\n \nobserved that 14 \nwere female and 11 were male. This discrepancy may be \ndue to our among\n \nmen\n \nwith\n \npelvic\n \nfloor\n \nsymptoms.\n \nThe \nBMI distribution in our study showed that 55% of patients \nwere overweight (BMI 25\n-\n \n29.9), while 45% had normal \nBMI. This aligns with the growing body of evidence \nsuggesting a strong association between increased BMI \nand pelvic floor disorders. Our findings underscore the \nimportance of weight management in the prevention and \nmanagement of pelvic floor abnormalities.\n \n \nPresenting complaints in our patient cohort was diverse, \nwith constipation (85%) and incomplete evacuation (65%) \nbeing the most common. These symptoms are typical of \nposterior compartment disorders, which our study found to \nbe prevalent\n. \nAccording to M.S. Al\n-\nNajar et al.\n59\n, blocked \ndefecation (29.5%; 21.1% among females and 54.2% \namong men) was the second most common presenting \nsymptom, after chronic constipation (56.8%; 62.0% among \nPaper ID: SR251031101844\nDOI: https://dx.doi.org/10.21275/SR251031101844\n40 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nfemales and 41.7% among males). According to a research \nby Abdelzaher et al.\n61\n, the most prevalent symptoms were \nfaecal incontinence (36%), stress UI (38%), and blocked \ndefecation (84%).\n \n \nThe high prevalence of these symptoms highlights the \nsignificant impact of pelvic floor disorders on bowel \nfunction and the need for comprehensive evaluation.\n \n \nDepending on how much the organ descends below the \nPCL Line, organ prolapse can be rated. Grading is crucial \nfor the treatment plan since bladder neck suspension \ntechniques\n \ncan be used to observe or treat grade 1 \ncystocele. On the other hand, grade 2 and 4 are fixed using \ntransvaginal or trans abdominal means using different \ntechniques. Our study found rectal\n \nprolapse\n \nto\n \nbe\n \nthe\n \nmost\n \ncommon\n \npelvic\n \ncompartment\n \nabnormality\n \n(85%),\n \nfollowed by rectocele (25%) and cystocele (15%). In this \ngroup, posterior compartment anomaly manifested as an \nanterior rectocele was shown to be the second most \nprevalent pelvic floor dysfunction, primarily affecting \nfemales, according to M.S. Al\n-\nNajar et al.\n59\n \nReiner et al.\n62\n \nalso reported a similar finding. Rectoceles (anterior and \nposterior) were rare, seen in just 17% of patients\n63\n \nin \nanother investigation with only men. The more common \ntype of rectocele was posterior.\n \n \nThe most frequent observation, according to Rafiq S et \nal.\n60\n, was organ prolapse in 9 out of the patients, including \n6 patients with anterior rectocele and 3 patients with rectal \nprolapse. Two patients also exhibited anterior (cystocele) \nand middle compartment descent (uterine prolapse). \nAccording to Abdelzaher et al.\n61\n, the incidence of \nrectocele, peritonocele, and enterocele was 52%, 34%, and \n4%, respectively. Rectoceles were demonstrated by \nPilkington et al.\n64\n \nto be incredibly prevalent.\n \n \nThis difference could be attributed to variations in patient \nselection criteria or regional differences in the prevalence \nof specific pelvic floor disorders.\n \n \nIn line with earlier research, M.S. Al\n-\nNajar et al.\n59\n \nfound \nthat the intermediate compartment was the least affected.\n65\n \nIt was typically linked to an anterior compartment \nanomaly, specifically cystocele. Maglinte et al.\n66\n \nobserved \nvaginal prolapse in 45% of patients with anterior \ncompartmental symptoms and cystocele in 91% of patients \npresenting with middle compartmental symptoms in a \ncystoproctography investigation. In fact, they discovered \nanomalies in all three compartments in 95% of patients \nwith pelvic floor dysfunction.\n \n \nThe grading of rectal prolapse in our study showed that \n45% of patients had grade 2 prolapse, while 40% had \ngrade 1. The ability of MRI defecography to accurately \ngrade\n \nrectal prolapse is crucial for treatment planning and \nsurgical decision\n-\nmaking.\n \n \nWe found no statistically significant association between \nage and specific pelvic abnormalities (p>0.05 for all \ncomparisons). This is similar with the findings of M.S.Al\n-\n \nNajar et al.\n59\n, who\n \nreported frequency of pelvic floor \nabnormality did not differ significantly between patients \nyounger than 50 years and patients 50 years or older.\n \n \nThe association between BMI and pelvic abnormalities \nwas also not statistically significant in our study. However, \nthere was a trend towards a higher prevalence of cystocele \nand rectocele in overweight patients. This trend aligns with \nthe findings of M.S.Al\n-\nNajar et al.\n59\n \nwho reported that \nrectocele had a significant strong association with obesity \nand parity.\n \n \nMultiparity and history of pelvic surgery were identified as \nrisk factors in our study, present in 45% and 30% of \npatients, respectively. These findings are consistent with \nthose of M.S.\n \nAl\n-\nNajar et al.\n59\n, who identified multiparity \nas a significant risk factor for pelvic floor\n \ndisorders. The \nrole of previous pelvic surgery in predisposing individuals \nto pelvic floor abnormalities is also well\n-\ndocumented in \nthe literature.\n67\n \nAccording to M.S. Al\n-\nNajar et\n \nal.\n59\n, 79% \nof the women were parous, and 11% had previously \nundergone a hysterectomy. Not a single male patient had \nundergone prior pelvic surgery.\n \n \nThe high prevalence of normal anorectal angle (95%) in \nour study population was an unexpected finding. This \ncontrasts with the results of M.S.Al\n-\nNajar et al.\n59\n \nwho \nreported abnormal anorectal angles in 72.6% of patients \nwith obstructed defecation. They reported that anterior \nrectocele, cystocele, and uterine descent were more \ncommonly encountered in those with ARJ descent than \nthose without ARJ descent. This discrepancy may be due \nto differences in measurement techniques or patient \nselection criteria and warrants further investigation. \nAnother concept which has to be put in discussion is the \nabnormal anorectal angle which is seen in a patient of \nobstructed defecation syndrome\n \n \nIn conclusion, our study demonstrates the value of MRI \ndefecography in comprehensively evaluating pelvic floor \nabnormalities. The technique's ability to detect and \ncharacterize various pelvic compartment disorders, \nparticularly rectal prolapse and rectocele, makes it a \nvaluable tool in the diagnostic workup of patients with \npelvic floor symptoms. While our study did not find \nstatistically significant associations between demographic \nfactors and specific pelvic abnormalities, the trends \nobserved align with existing literature. Larger, prospective \nstudies are needed to further elucidate these relationships \nand to establish the role of MRI defecography in guiding \ntreatment decisions for pelvic floor disorders.\n \n \n5.\n \nCase Images\n \n \nCase\n \n1:\n \nA\n \n44\n \nyear\n \nold\n \nmale\n \npatient\n \nwith\n \nh/o\n \nsensation\n \nof\n \nincomplete\n \nevacuation, constipation and \nchronic pain.\n \n \nIn\n \nmid\n \nsagittal\n \nSSFP\n \nimages\n \nobtained\n \na)\n \nRest\n \nPhase\n \nb)\n \nSqueeze\n \nphase\n \nc)\n \nStrain\n \nphase\n \nd)\n \nDefecation\n \nphase\n-\n \nshowing\n \nARJ\n \nat\n \na\n \ndistance\n \nof\n \n6.1\n \ncm\n \nbelow\n \nPCL\n \nsuggestive\n \nof grade II rectal \nprolapse\n \nPaper ID: SR251031101844\nDOI: https://dx.doi.org/10.21275/SR251031101844\n41 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \n \na\n \nb\n \n \n \nc\n \nd\n \n \nCase\n \n2:\n \nA\n \n55\n-\nyear\n \nold\n \nfemale\n \nwith\n \nh/o\n \nsensation\n \nof\n \nincomplete\n \nevacuation, constipation and chronic pain.\n \n \nIn\n \nmid\n \nsagittal\n \nSSFP\n \nimages\n \nobtained\n \na)\n \nRest\n \nPhase\n \nb)\n \nSqueeze\n \nphase\n \nc)\n \nStrain\n \nphase\n \nd)\n \nDefecation phase\n-\n \nshowing ARJ at a distance of 5.1 \ncm below PCL suggestive of grade II rectal prolapse\n \ne)\n \nand f)\n \nMid sagittal T1W image a 2.6*0.7 cm size T1 \nhyperintense cyst appearing hypointense on STIR \nimages is noted in lower 1/3\nrd\n \nof vagina suggestive of \nBartholin cyst ? hemorrhagic components, (g) the \ninferior margin of which is seen descending\n \n2.2\n \ncm\n \nbelow\n \nthe\n \nPCL\n \nline\n \nsuggestive\n \nof\n \nVaginal\n \nprolapse\n \n \n \nA                                                 \nB\n \n \n \nC                                            \nD\n \n \n6.\n \nConclusion\n \n \nMRI defecography proved particularly valuable in \ndetecting and classifying rectal prolapse, which was the \nmost common abnormality observed in 85% of patients. \nThe technique also successfully identified other pelvic \ncompartment abnormalities such as rectocele, cystocele, \nand enterocele, albeit in smaller proportions. Notably, the \nstudy\n \nfound that 95% of patients had a normal anorectal \nangle, suggesting that this parameter may not be a primary \nindicator of pelvic floor dysfunction in most cases.\n \nPaper ID: SR251031101844\nDOI: https://dx.doi.org/10.21275/SR251031101844\n42 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \n \nThe study identified multiparity and history of pelvic \nsurgery as potential risk factors for pelvic floor \nabnormalities, present in 45% and 30% of patients \nrespectively. However, statistical analysis did not reveal \nsignificant associations between these risk factors or \ndemographic\n \ncharacteristics\n \n(age\n \nand\n \nBMI)\n \nand\n \nspecific\n \npelvic\n \nabnormalities.\n \nThis\n \nlack of clear associations might \nbe due to the limited sample size and warrants further \ninvestigation with larger cohorts.\n \n \nIn conclusion, this study underscores the significance of \nMRI defecography as a comprehensive diagnostic tool for \nevaluating pelvic floor disorders. Its ability to detect \nvarious\n \nabnormalities,\n \nparticularly rectal prolapse and \nother pelvic organ prolapses,\n \nmakes it a valuable asset in \nclinical practice. The detailed information provided by this \nimaging technique can greatly assist in accurate diagnosis \nand inform appropriate treatment planning for patients \nwith pelvic floor dysfunction. 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