Functional Disorders of the Pelvic Floor

What are Functional Disorders of the Pelvic Floor?

Functional disorders of the pelvic floor include pelvic organ prolapse, chronic constipation and incontinence. They are common health problems, particularly in women. It is estimated that more than 15% of women who have had 2 or more children are affected by some form of pelvic floor disorder, which significantly affects their quality of life. Patients are often reluctant to seek medical help due to embarrassment or a mistaken perception that nothing can be done.


Why is Dynamic MRI of the Pelvic Floor a useful examination?

Dynamic MRI of the Pelvic Floor, also known as MR Defecating Proctography, is an excellent tool for assessing the entire pelvis and is particularly valuable in identifying which patients might benefit from surgical as opposed to conservative treatment. It can also assist in planning the most appropriate surgical approach. Evaluating the pelvic floor with MRI has the added benefit that patients do not receive radiation.


What disorders can Dynamic MRI of the Pelvic Floor identify?

Dynamic pelvic floor MRI can assist in the diagnosis of the following conditions:


Urethral hypermobility

Uterine or vaginal vault prolapse

Descending perineal syndrome




Rectal invagination and prolapse

Spastic pelvic floor syndrome or anismus


What happens when a patient has a Dynamic MRI of the Pelvic Floor?

Prior to the MRI examination, a radiographer or radiologist will explain the procedure to the patient, answering any questions or concerns they may have. The patient then changes into a hospital gown. In a private room within the radiology department, a phosphate enema will be injected into the patient’s rectum, to help cleanse the rectum prior to the examination. This involves a cupful of clear liquid being injected into the rectum whilst the patient lies on their side. A toilet is located nearby for the patient’s sole use. Once the rectum is empty, the patient enters the MRI scanner, lying down on the scanner bed on top of absorbent paper sheets. The radiologist then fills the patient’s rectum with a clear clean lubricant jelly. Imaging commences with the patient lying still within the MR scanner. After approximately 5 minutes the patient is then asked to empty their bowel on to the absorbent paper whilst we continue to scan their pelvis. Following the examination, the patient will be able to use the toilet again, before getting dressed. There are no restrictions to a patient’s daily activities following this investigation and they may return to their place of work, if they so wish.


Whilst this procedure sounds rather dirty and unpleasant, this is not the case, because the rectum will have been cleansed prior to the procedure with the insertion of the enema and the patient will be passing clean lubricant jelly during the scan.


Dynamic MRI of the Pelvic Floor is supervised and reported by Dr. Kelly MacDonald


Dynamic MRI of the Pelvic Floor is currently available for NHS patients at the Royal United Hospital, Bath and for private patients at BMI Bath Clinic, Combe Down, Bath.

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CT Colonography (Virtual Colonoscopy)

In the UK, colorectal cancer is the second most common cancer in women and the third most common in men. CT Colonography is a very well-established technique that uses a fast CT scanner to produce 2- and 3-dimensional images of the entire colon and rectum. It is fully recognized by NICE as a useful test to detect abnormalities of the large bowel, such as polyps and colorectal cancer, in symptomatic and at-risk screening patients.

CT Colonography is less invasive than optical colonoscopy and is also able to examine the other organs in the abdomen and pelvis. Like optical colonoscopy, the scan is performed after a period of dietary restriction and often bowel cleansing. It involves the introduction of carbon dioxide via a rectal tube to distend the bowel. The examination time is usually about 20 minutes and, since sedation is not used, patients can return to normal activity after the procedure.

The images are reported by specialist abdominal Radiologists, Dr Stephen Hayward, Dr Andrea Phillips, Dr Stewart Redman and Dr Kelly MacDonald.

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Fibroid embolisation

Uterine fibroids are a common condition and may cause symptoms such as heavy menstrual bleeding, pelvic pain or bowel and bladder problems. Various treatment options exist such as intra-uterine coil placement, myomectomy (surgical removal of part of the womb) or hysterectomy (removal of the whole womb). More recently, treatment of uterine fibroids with a minimally invasive x-ray guided technique, uterine fibroid embolisation (UFE) has been available and it is estimated that 50000 women worldwide have received this treatment since it was first performed in the early 1990s.

The aim of UFE is to block the blood vessels supplying blood to the fibroids. Once starved of blood the fibroids reduce in size and the symptoms associated with them generally recede. The procedure involves inserting a plastic tube via the artery at the top of the leg and steering this under x-ray guidance until it is positioned in the blood vessels close to the womb. Once in position, tiny plastic beads are injected through the catheter to lodge in the small arteries of the fibroids. Local anaesthetic and intravenous sedation are used but general anaesthesia is not routinely required.

Patients undergoing UFE usually stay overnight in hospital after the procedure but can return to full activity within about a week. Around 85% of women troubled by heavy menstrual bleeding from fibroids have a significant improvement in their symptoms and around 70% of those with pain, bowel or bladder symptoms are helped. Major complications are rare but include womb infections and premature menopause and careful post procedural monitoring is performed to pick up these problems as quickly as possible.

Further information is available at:

Unfortunately UFE is not currently available for NHS patients in Bath although we hope this will shortly be the case. Currently arrangements can only be made for private patients.

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