MR Defecography for Pelvic Organ Prolapse
Pelvic organ prolapse is more common than many women realize. It is a condition in which a woman’s pelvic diaphragm, which holds up the pelvic organs (including the bladder, rectum, small intestine, uterus and vagina), weakens and sags, allowing the organs to sink or prolapse.
The problem is often linked to straining during childbirth, although age, heavy lifting, surgery, and obesity can be factors as well. While pelvic organ prolapse isn’t usually a health threat, it can be associated with pelvic pain, chronic constipation and sometimes urinary or fecal incontinence.
Treatment may be necessary if any of these symptoms become bothersome. At Yale Medicine, our radiologists are skilled at a magnetic resonance imaging (MRI) test called a magnetic resonance defecography (MR defecography). The procedure helps our urologists better understand what’s going on in the pelvis in order to make the most accurate diagnosis possible and better focus treatment.
What is an MR defecography?
According to Mahan Mathur, MD, a Yale Medicine radiologist with specialized training in abdominal and pelvic area imaging, MR defecography is similar to a standard MRI. However, it is specifically tailored to produce the best images possible of the pelvic diaphragm and organs.
What happens during an MR defecography?
A woman having an MR defecogram is asked to don a hospital gown and then is asked to lie back on a moveable examination table with a sheet beneath her. She'll be asked to apply vaginal and rectal ultrasound gel, which helps to make the organs more visible. The table will then be moved into place in the MRI, which resembles a standard MRI tube.
“We image the patient while she’s on her back,” says Dr. Mathur. "The technologist asks her to perform certain maneuvers such as squeezing the pelvic muscles, so that we can image the organs and muscles in real time.”
Images are taken while the muscles are contracted as they would be during a bowel movement, and again while relaxed. The entire exam takes about half an hour to complete. Once complete, the radiologist interprets the results and updates the electronic medical records the same day, so that they are ready for your next visit with your urologist.
What are the benefits of MR defecography?
Quite simply, MR defecography gives doctors more information than previous methods of pelvic organ prolapse examination. “The standard for studying pelvic organ prolapse was with fluoroscopy,” Dr. Mathur says, “which uses continuous X-rays to view the muscles and organs in motion."
Some institutions still do this, but the literature has been clear that MRI is equivalent to or better than fluoroscopy, Dr. Mathur says. "For instance, you can’t see muscles or ligaments as clearly with fluoroscopy as you can with MR defecography. And so we get a better picture of the anatomy of the pelvic area," he adds.
MR defecography has another benefit: Fluoroscopy requires the use of ionizing radiation and contrast (orally and into the bladder via a catheter), which aren’t necessary with an MRI.
What makes Yale Medicine’s use of MR defecography unique?
Yale Medicine has made use of MRI technology for decades, and our radiologists have been performing MR defecography for nearly 10 years. Radiologists who work in this area have completed a general internship and specific training in the abdominal and pelvic areas.
“For the last couple of years, we’ve been performing an average of three or four exams a week,” Dr. Mathur says. “We use closed magnet imaging (which requires the patient to lie supine, on her back, as opposed to open magnet imaging, which is taken with the patient sitting back) because it provides superior images.”
Radiologists from Dr. Mathur’s team hold a monthly interdisciplinary conference to go over imaging findings and the results of any surgeries that have taken place during the period. “We have two colleagues in our department who regularly attend these meetings and report back to the team,” Dr. Mathur says. “Having a constant dialogue with the urologists helps to ensure we hone our understanding and skills and work toward standardizing how we interpret and report on the exams we do here."
Furthermore, the collaborative approach "ensures that our patients receive the highest quality care," he says.