Role of MR Defecography in the Assessment of Obstructed Defecation Syndrome

Abstract
Background: Obstructed Defecation Syndrome (ODS) is characterized by the urge to defecate but an impaired ability to expel the fecal bolus. Symptoms include unsuccessful fecal evacuation attempts, excessive straining, pain, bleeding after defecation, and a sense of incomplete fecal evacuation. ODS has been linked to anatomic abnormalities of rectocele, rec-toanal or recto-rectal intussusception, paradoxical puborectalis contraction, pelvic organ prolapse, descending perineum syndrome, solitary rectal ulcer syndrome, sigmoidocele, and enterocele. A functional abnormality such as pelvic floor dyssynergia, decreased rectal compliance and decreased rectal sensation has also been shown to contribute to symptoms of ODS.
Objective: To assess the role of MR defecography in finding functional abnormalities in patients with obstructed defecation syndrome.
Patients and Methods: A prospective study was carried out on 30 patients (20 females and 10 males) with clinical symptoms of obstructed defecation syndrome for a period longer than 6 months. Patients were assessed statically using T2 weighted images and dynamically by MR defecography using fast imaging via steady-state acquisition sequences. All patients had symptoms of obstructed defecation syndrome as unsuccessful fecal evacuation attempts, excessive straining, pain during defecation, a sense of incomplete fecal evacuation and digital rectal evacuation.
Results: A total of 30 patients with a mean age of 40.2 with 20 (66.7%) females and 10 (33.3%) males. MR defecog-raphy revealed rectocele in 19 (63.3%) of all patients and cystocele in 17 (56.7%) patients. Four patients (13.3%) had rectal intussusception. Spastic pelvic floor syndrome was found in 2 patients (6.75%). Multicompartmental dysfunction was observed in 18 (60%) of the female patients.
Conclusion: MR defecography was proven to be highly valuable in assessing patients with obstructed defecation syndrome, particularly females as it depicts multicompart-mental dysfunction in females with a seemingly single com-partment symptom ultimately changing the treatment approach.