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Imaging of the pelvic floor

Radiology, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK

Correspondence: Dr E M Anderson, Radiology, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU

• Disorders of the pelvic floor are complicated and abnormalities rarely exist in isolation.
  
• Evacuation proctography combined with dynamic MRI allows a comprehensive imaging assessment.
  
• Patients are categorized into treatment-defined groups on the basis of imaging, physiological testing, history and physical examination.
  
• Endo-anal ultrasound or MRI is the most sensitive method for examining for sphincter tears in patients with faecal incontinence.
  

Disorders of the pelvic floor are common, particularly among women, and may manifest themselves as either constipation, faecal incontinence or a variety of other symptoms. Imaging plays an increasingly important role in the investigation of these disorders. Defecography provides both structural and functional information about rectal evacuation and prolapse. Dynamic MRI may be a valuable alternative, as this technique also allows the pelvic floor muscles to be visualized in detail. The treatment of constipation and prolapse is partly empirical, but imaging has a key role in categorizing the structural and functional causes of constipation and incontinence. In this article, common imaging modalities for investigating the pelvic floor are described, and pictorial illustrations of abnormal findings are presented.