Abstract Details

Title A Novel Approach for Dysfunctional Defecation – MR Defecography

Topic Autonomic Disorders

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 7-005

Objective

To evaluate the diagnostic patterns and functional outcomes of MR defecography in patients with dyssynergic defecation, spastic pelvic floor syndrome and neurogenic bowel.

Background Pelvic floor dysfunctions includes a spectrum of diseases affecting coordinated defecation, with spastic pelvic floor syndrome and dyssynergic defecation representing the majority of chronic functional bowel disorders. When compared to traditional tools, MR defecography offers a thorough assessment of structural and functional abnormalities without ionizing radiation exposure. Current literature lacks comprehensive imaging characteristics specific to neurological causes of pelvic floor dysfunction. Hence, detailed quantitative and functional defecatory study is essential.

Design/Methods MR defecography reports from 20 patients (13 males, 7 females; age: 46.2 ± 17.4 years) with clinically confirmed spastic, dyssynergic pelvic floor syndromes and constipation with concomitant neurological syndromes were identified. Axial T2, sagittal FIESTA and sagittal FIES (cine mode) images were taken during rest, strain, and evacuation phases following contrast rectal gel instillation. Functional and anatomical measurements were analyzed in Microsoft Excel.

Results Spastic pelvic floor syndrome was in 9 patients (45%), with overall spastic/dyssynergic patterns affecting 12 patients (60%). Males were predominant in spastic patterns (83.3%) and females showed predominance in pelvic floor weakness (66.7%). Severe paradoxical anorectal angle narrowing (>30°) during defecation is seen in 3 patients. 14 patients (70%) had impaired evacuation, with the spastic/dyssynergic group exhibiting 100% impairment. Anterior rectoceles (30%) and intrarectal intussusception (20%) were observed. Puborectalis muscle thickening (20%) linked to spastic pelvic floor patterns. Paradoxical puborectalis contraction (70%) are also linked to spastic/dyssynergic patterns. Imaging measurements and functional outcomes showed a strong correlation (r = 0.78, p < 0.01).

Conclusions MR defecography is a novel approach for identifying and quantifying neurological pelvic floor dysfunction patterns. Structural and functional findings have important therapeutic implications. Large scale studies will provide more insight in neurological bowel dysfunction.

Authors/Disclosures
Hemanth Kumar Arumugam, MBBS PRESENTER	Dr. Arumugam has nothing to disclose.
Lakshmi N. Ranganathan, MD, PhD, FAAN	Dr. Ranganathan has nothing to disclose.
Srinivasaraman Govindarajan, MD	Dr. Govindarajan has nothing to disclose.
Suriyakumar Govindarajulu, Sr., MD	Dr. Govindarajulu has nothing to disclose.
Sundar Shanmugam, MD	Dr. Shanmugam has nothing to disclose.
Philo Hazeena, MD	Dr. Hazeena has nothing to disclose.
Rithvik Ramesh, MD	Dr. Ramesh has nothing to disclose.
Deepa Avadhani, MD	Dr. Avadhani has nothing to disclose.
Bagath Srinivasan Balaji, MBBS	Dr. Balaji has nothing to disclose.
Abhinav Mahesh, MBBS	Dr. Mahesh has nothing to disclose.

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