The role of dynamic MRI defecography in the diagnostic algorithm of patients with anorectal dysfunction

Czech version

Authors: A. Berková ¹; P. Vlček ¹; V. Červeňák ²; I. Krejčová ¹; T. Vystrčilová ¹; J. Dolina ³; M. Szypulová ⁴; S. Tvarožek ⁴; M. Jurášková ⁵; Z. Chovanec ¹; I. Penka ¹
Authors‘ workplace: I. chirurgická klinika, LF MU a FN u sv. Anny v Brně ¹; Klinika zobrazovacích metod, LF MU a FN u sv. Anny v Brně ²; Interní gastroenterologická, klinika LF MU a FN Brno ³; Gynekologicko-porodnická, klinika LF MU a FN Brno ⁴; Rehabilitační klinika, LF MU a FN Brno ⁵
Published in: Rozhl. Chir., 2025, roč. 104, č. 7, s. 275-282.
Category: Original articles
doi: https://doi.org/10.48095/ccrvch2025275

Overview

Introduction and aim: For a correct assessment of anorectal dysfunction, adequate physical and imaging examinations are required. The aim of our study was to evaluate the use of MRI defecography in patients with anorectal dysfunction. Its comparison with anorectal manometry, standard clinical examination, and patients’ subjective perceptions.

Type of study: An observational, retrospective analysis.

Methods: Forty patients with symptoms of anorectal dysfunction referred to a colorectal clinic between 9/2022 and 5/2023 participated in the study. All underwent proctological examination, anorectal manometry and MRI defecography. The results of the study were statistically processed with Statistica 12.0 software.

Results: The average age of the patients was 55 years. Primary complaints were obstipation in 60% of patients, fecal incontinence in 33%, 1 patient had proctalgia and 2 patients presented for rectal prolapse. On clinical examination, 20% of patients had rectoanal intussusception and 15% had complete rectal prolapse. A total of 36% of patients reported concomitant urinary incontinence. Pelvic floor drop in the anterior compartment was also demonstrated in patients who had physiological internal sphincter function according to anorectal manometry, however, due to the small sample size, only a trend was observed and statistical significance of these differences was not reached (P = 0.109). Patients without evidence of obstructive defecation syndrome on anorectal manometry had complete rectal emptying on MRI defecography (P = 0.0598).

Conclusion: Dynamic MRI defecography can identify anatomical and functional abnormalities of the pelvic floor. The main use of the method is in the detection of multi-compartment pathology. Multidisciplinary collaboration is required to interpret the results and establish an accurate diagnosis.

Keywords:

pelvic floor – Incontinence – obstructive defecation syndrome – anorectal dysfunction – dynamic MRI defecography

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MUDr. Petr Vlček, Ph.D.

I. chirurgická klinika

LF MU a FN u sv. Anny v Brně

Pekařská 664/53

602 00 Brno

petr.vlcek@fnusa.cz

ORCID autorů

A. Berková 0000-0003-2787-0076

P. Vlček 0000-0002-7344-9752

I. Krejčová 0009-0001-9261-1727

J. Dolina 0000-0002-9061-5273

M. Szypulová 0000-0001-5458-2139