Patterns of prolapse in women with symptoms of pelvic floor weakness: assessment with MR imaging.
OBJECTIVE
To show the magnetic resonance (MR) imaging patterns of prolapse and to correlate them with symptoms in patients with constipation or fecal incontinence.


METHODS
Thirty women underwent MR imaging with fast spoiled gradient-recalled acquisition in the steady state. The women were divided into three groups: 10 were asymptomatic volunteers, 10 had constipation, and 10 had fecal incontinence. Visceral prolapse and the configuration of the pelvic floor muscles were identified at rest and during straining. Visceral descent was compared between the three groups.


RESULTS
Visceral prolapse was seen at multiple sites, most frequently in constipated patients. There was significantly greater bladder base descent (P < .01), uterocervical descent (P < .001), and puborectalis muscle ballooning (P < .05) in the group of constipated patients when compared with the group with fecal incontinence or the asymptomatic group. The degree of anorectal junction descent was significantly greater (P < .05) in the group of incontinent patients when compared with the asymptomatic group.


CONCLUSIONS
MR imaging clearly shows pelvic visceral prolapse and pelvic floor configuration on straining. Prolapse frequently involves multiple sites in constipated patients, which is suggestive of global pelvic floor weakness. In contrast, the weakness is frequently posterior in fecally incontinent patients.
Healy
J C
JC
Academic Department of Radiology, St Bartholomew's Hospital, London, England.
Halligan
S
S
Reznek
R H
RH
Watson
S
S
Phillips
R K
RK
Armstrong
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006547:Hernia / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017773:Pelvic Floor / Q000473:pathology*; D011391:Prolapse; D012002:Rectal Diseases / Q000175:diagnosis; D012005:Rectal Prolapse / Q000175:diagnosis; D001745:Urinary Bladder Diseases / Q000175:diagnosis; D014596:Uterine Prolapse / Q000175:diagnosis