Presacral space

The presacral space is located between the rectum and the sacrococcygeal part of the spine.

Gross anatomy


The presacral space contains a variety of tissue:

  • fat
  • mesenchymal tissue
  • lymph nodes
  • nerve plexuses
  • blood vessels
  • superior - peritoneal reflections
  • inferior - levator ani and coccygeus muscles
  • laterally - ureter, iliac vessels 1

Radiographic appearance

An increase in the width of the presacral space measurement is considered indicative of pathology in the rectum and/or other structures in the pelvis. This alteration is usually seen in lower GI barium enema studies and on plain film. 

The upper limits of normal for the presacral space width is 15mm in patients younger than 45 years 2. However, some patients have measurements over 15mm with no apparent reason (fewer still have measurements above 20 mm), which increases with older age. Factors such as sex and weight of the patient should also be taken into consideration 2.

Abdominal and pelvic anatomy

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