Hemanth Kumar Arumugam1, Lakshmi Narasimhan Ranganathan1, Srinivasaraman Govindarajan2, Suriyakumar Govindarajulu2, Sundar Shanmugam1, Philo Hazeena1, Rithvik Ramesh1, Deepa Avadhani1, Bagath Srinivasan Balaji1, Abhinav Mahesh1
1Neurology, Sri Ramachandra Medical College and Research Institute, 2Radiology, Anderson Diagnostics and Labs, Chennai
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.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.