Grading of pelvic floor dysfunction on dynamic magnetic resonance imaging

Background: Pelvic floor disorders are often complex due to symptoms ranging from vague low back pain to major faecal incontinence and urinary incontinence. It is important to perform a dynamic study because certain abnormalities can be identified only during the straining or defaecation phase; for example, rectal prolapse or intussusception. Methods: This observational and descriptive study conducted over 18 months had included 50 patients (34 females). Cystocele was graded as mild, moderate and severe based on descent of urinary bladder below the pubococcygeal line (PCL). All of them underwent dynamic magnetic resonance imaging (MRI) of the pelvic floor. Uterine and vaginal vault prolapse was graded as mild, moderate and severe based on uterus, cervix and vaginal vault prolapse below the PCL line. Results: Their mean age was 52.4 (range 11-86) years. Cystocele was present in 59% of females and 19% of males. Urethral hypermobility seen in 6% females and 9% males. Conclusions: Dynamic MRI can be used as an important investigation before surgery to plan an appropriate surgical procedure based on grading of the pelvic organ prolapsed and involved compartment.