What is pelic organ prolapse?
When the pelvic floor muscles and ligaments supporting a woman’s pelvic organs weaken, the pelvic organs can drop out of place. This is a common condition called pelvic organ prolapse. Most women develop prolapse after menopause, childbirth, or hysterectomy. It can be debilitating as well as embarrassing and can significantly impact the quality of life.
The most common symptoms of pelvic organ prolapse are urinary incontinence, incomplete bladder emptying, pelvic pain, constipation, obstructed and difficult defecation, and fecal incontinence.
Once rarely discussed or recognized, this problem has now become a priority in women’s health. With advanced MRI scanning, we are able to provide a clear picture of the pelvic organs so you and your doctor can make the best treatment options. The new surgical specialty of urogynecology has arisen to correct prolapse conditions and the urinary incontinence that often results. By age 80, more than 1 in every 10 women will have undergone surgery for prolapse.
What is Dynamic Pelvic MRI/Defecography?
Until recently, fluoroscopic defecography was used for pelvic floor imaging, which exposed patients to radiation (X-rays). With rapid advances in MRI technology, both functional and anatomic evaluations can be performed in a single examination without using radiation.
MRI allows us to image in any plane, free from the confusion of overlying structures, and can detect structural abnormalities such as tumors, abscesses, hernias, and defects or lesions in the pelvic floor muscle. These findings can help you and your doctor plan for the best clinical treatment or surgery.
How do I prepare?
There is no special preparation except for thorough bowel movement to empty the rectum prior to the exam. If you have chronic constipation or difficulty defecating, ask your doctor for the appropriate laxative that works best for you or use a fleet enema either the night prior to or the morning of the exam. It is also important to have your bladder at least half full, but comfortable enough for you to remain still during the MRI for about 20-30 minutes. You may empty your bladder if you have to, but you need to drink two to three 8 oz glasses of water at least one hour prior to the exam.
Bring with you to your appointment:
What do I do when I arrive?
Present your prescription, insurance card and completed forms at the front desk. If any additional forms are required, they will be given to you at this time.
Be sure to inform the receptionist and technologist if you:
Plan to arrive 15 minutes before your scheduled appointment.
What happens during the test?
This study is performed on a high field 1.5 Tesla MRI with a wide and short bore design, which means that your head is outside the magnet while your pelvis is being imaged.
A female MRI technologist or nurse will explain each step of the examination to you and answer any questions that you may have. While lying on the MRI table on your side, a lubricated enema tube will be placed into the rectum for administration of about 150-200 cc of ultrasound gel. The tube is then removed. The gel allows for the visualization and distension of the rectum. Next you will lie on your back for administration of about 20 cc of ultrasound gel into the vagina through a syringe. You will then be positioned so your pelvis will be at the center of the magnet with your knees elevated and flexed over a knee cushion.
Part 1 of the MRI Exam
We acquire static MRI images at multiple planes through your pelvis for an anatomic evaluation of pelvic floor structure and pelvic organs including the uterus, ovaries, vagina, bladder, urethra, and anorectum.
Part 2 of the MRI ExamThe MRI technologist will then help you through the next few steps:
- You will be asked to perform Kegel exercises while images are taken. This is when you tighten the pelvic floor muscles, similar to stopping the urine flow while urinating. Read more about MRI.
- You will be asked to perform the Valsalva maneuver by taking a deep breath and bearing down without letting the gel out while images are taken. You may be asked to repeat this step.
- You will be asked to perform defecation while images are taken. You will take a deep breath and bear down towards the rectum and push the contrast gel out of the rectum. You may be asked to repeat this step.
What happens after the test?
One of our board certified radiologists interprets your images, compares them to any previous studies and dictates a report which is transcribed, proofread and signed. The report is then faxed and mailed to your referring doctor within one or two days. Your doctor will read the report and review the findings with you.