PELVIC FLOOR LAXITY PATIENT COMPLAINTS

• Menstrual

• Stress incontinence

• Uterine prolapse

• Constipation

• Incomplete defacation

RISK FACTORS• Multiparous• Menopausal• Obesity

MERCURY IMAGING INSTITUTE SEC 9C

SCO172-173MERCURY IMAGING CENTRE SEC

20DSC0 16-17

• Pubo coccygeal line.

• H LINE • M LINE • Angle of the levator plate with pubococcygeal line• Descent of the small bowel 2cm between the rectum and

urinary bladder• Degree of descent : (In

relation to puboccoccygeal line)• Organ descent > 1cm ( pelvic floor laxity).• Organ descent > 2cm ( surgical repair indicated).

Quantitative Assesement

RADIOLOGICAL RESPONSIBILITY

Dynamic MR to be done

• MR – Investigation of benefit if multicompartment pelvic floor laxity is there as the surgery then is usually complex

• Sagitttal plane is important (Normal supine). (post valsalvae maneuvour)

Define and look for ?CystoceleUterine / vaginal vault prolapseEnteroceleRectoceleAnterior buldge of the rectumThinning / tears of the puborectal

iliococcygeal muscles.Bladder neck / vaginal orifice /

anorectal junction All three should be

above or at the pubo-coccygeal line.

What to report ?

Myofascial compartmentsEndopelvic fasciaLevator aniIliococcygeal Puborectal muscle

• Axial image Entirety of levator sling with similar

thickness / homogenous low signal intensity. Appreciate pubovesicle ligamants.

• Coronal image Iliococcygeal sling upward convex. Vagina : normal symmetrical orifice

Normal H shape configuration in the coronal scans.

Urethera : slight anterior orientation of the bladder neck.

•

Define the Compartment :Anterior ( Urethera/ bladder neck)Middle ( vagina )Posterior ( rectum ).

CASE-70 yr femlae

Clinical brief • Post menopausal • cystocele/ rectocele/ third

degree cervical descent . • Cervical biopsy :

microinvasive squamous cell carcinoma of cervix with high grade squamous intraepithelial lesion.

Quantitative assesment

HYSTEROTOSIS

PUBO COCCYGEAL LINE

H LINE

M LINE

HYSTEROTOSIS

Uterus descent into the labia and outside. Small bowel descent >2cm into the bldeer/ rectum space. Sharp angulation of urethera with bladder neck is lost

HYSTEROTOSIS

PUBO COCCYGEAL LINE.H LINE

M LINE

PUBO-COCCYGEAL SLING PROLAPSE CONTENTS IN THE LABIA

PROLAPSED CONTENTS IN THE LABIA

EDEMA IN THE PROPALSE CONTENTS IS S/O INFECTION ON FAT SAT