Imaging modalities for pelvic floor disorders

Pelvic floor disorders as pelvic organs prolapse, voiding, defecatory and sexual dysfunctions, urinary or anal incontinences, chronic pelvic pain can develop after obstetric trauma, pelvic surgery, aging, and hormonal changes and frequently coexist. Physical examination is often unable to detect the anatomical damages in the “complex” pelvis. Imaging plays an important role in the diagnosis of pelvic floor disorders to visualize abnormalities difficult to assess at the physical examination and/or to correlate symptoms with clinical findings. Technological innovations have improved the diagnostic accuracy of imaging modalities. Endoanal ultrasonography with three-dimensional reconstruction represents the “gold standard” assessment tool in patients with anal incontinence to evaluate the integrity of the anal sphincters and to visualize sphincter injuries (defects, scarring, thinning, thickening, and atrophy). It also allows the identification of undiagnosed tears (previously defined as occult) found up to 33% of females after their first vaginal delivery or to detect residual defect after repair of obstetric anal damages. Obstructed defecation is described as the difficulty in evacuation or emptying the rectum and is associated to the sensation of incomplete evacuation and/or anorectal blockage. Evacuation proctography remains the test of choice in cases of obstructed defecation disorders in order to diagnose rectocele, enterocele, intussusception or anismus. Dynamic MRI defecography and transperineal ultrasound did not meet the criteria to replace evacuation proctography, however these modalities may be used as triage or screening tests to reduce the number of women that must have an evacuation proctography. In the assessment of pelvic floor disorders, the integration of imaging techniques provides both anatomical and functional information for the optimal management of these conditions.