Lessons from Magnetic Resonance Defecography in Obstructed Defecation Syndrome: A Cornerstone for Adequate Surgical Planning

Abstract Background: Obstructed defecation syndrome (ODS) is associated with both anatomical and functional pelvic floor abnormalities. Magnetic resonance defecography (MRD) is a dynamic imaging technique that plays a crucial role in assessing these anatomical defects and understanding their contribution to ODS. Objectives: Evaluate MRD findings in patients with ODS and discuss how these findings impact surgical treatment strategies. Design: Retrospective observational study. Patients and Methods: This study included all women diagnosed with ODS who underwent surgical intervention between March 2018 and December 2022. MRD findings analyzed included perineal descent, cystocele, central compartment prolapse, rectocele, rectal intussusception, enterocele, and pelvic floor dyssynergia. Organ prolapses were evaluated at maximal strain. Association between different pelvic floor defects were analyzed. Main Outcome Measure: Rate of pelvic floor defects observed on MRD in patients with ODS. Sample Size: A total of 41 women were included. Results: Descending perineum and anterior rectocele were the most common abnormalities, observed in 38 (92.7%) patients. The third most common defect was cystocele, present in 37 (90.2%) patients. Rectal intussusception was identified in 33 (80.5%) patients. Central compartment prolapse was present in 30 (73.2%) patients, and enterocele was diagnosed in 18 (43.9%). The most common defect combination was perineal descent with simultaneous rectocele, observed in 36 (87.8%) patients. Among the 41 patients, 38 (92.7%) presented with bicompartmental prolapse. No patient presented with an isolated anatomical defect, as patients who did not have bicompartmental prolapse had posterior pelvic defects in association with descending perineum. Twenty-seven (65.9%) patients presented with tricompartmental prolapse. Patients with central compartment prolapse had the highest rate of associated tricompartmental prolapse (90.0%). Only four (9.8%) patients presented with pelvic floor dyssynergia. Conclusion: ODS is a multifactorial constipation syndrome associated with the coexistence of multiple compartment anatomical defects. None of the patients presented with a single abnormality, highlighting the importance of simultaneously assessing all pelvic floor defects. Limitations: Due to its retrospective nature, this study has inherent limitations primarily related to data collection. Conflict of Interest: None.