Presentation
Chronic constipation and unsatisfactory evacuation.
Patient Data
On Valsalva/defecation maneuver there is descent of the anorectal junction below the pubococcygeal line (PCL) by 4 cms. Widening of the H line is noted on defecation measures 7.7 cms denoting widened hiatus. The M line = 3.9 cm denoting moderate degree of pelvic descent. The PCL = 10.3 cm. Bulging of the anterior wall of the lower aspect of the rectum beyond its confinement by 3.0 cm denoting laxity of supporting endopelvic fascia with moderate rectocele. Moderate descent of the anorectal junction is noted below the PCL.
Orange lines determine anterior rectocoele.
Case Discussion
MRI dynamic cine defecography is an excellent exam to detect causes of pelvic floor dysfunctions.
The midsagittal images show three references lines which are pubococcygeal line (PCL), H line which represents puborectal hiatal line and M line that represents muscular pelvic floor relaxation time.