This document discusses pelvic floor laxity, its causes and risk factors such as being multiparous or menopausal. It describes quantitative assessments of the pelvic floor including pubococcygeal and H/M lines. Abnormal descent of organs greater than 1cm indicates laxity and greater than 2cm requires surgical repair. Dynamic MR is recommended to assess cystocele, prolapse, enterocele and rectocele. Reporting should include descriptions of fascial compartments, levator muscles and organ positions relative to reference lines. A case example is given of a 70 year old female with cystocele, rectocele and uterine descent beyond the labia, indicating severe pelvic floor laxity

1. PELVIC FLOOR LAXITY PATIENT COMPLAINTS Menstrual Stress incontinence Uterine prolapse Constipation Incomplete defacation MERCURY IMAGING INSTITUTE SEC 9C SCO172-173 MERCURY IMAGING CENTRE SEC 20D SC0 16-17 RISK FACTORS Multiparous Menopausal Obesity

2. Quantitative Assesement Pubococcygeal 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).

3. RADIOLOGICAL RESPONSIBILITY Define and look for ? Dynamic MR to be done Cystocele Uterine / vaginal vault prolapse Enterocele Rectocele Anterior buldge of the rectum Thinning / tears of the puborectaliliococcygeal muscles. Bladder neck / vaginal orifice / anorectal junction All three should be above or at the pubo-coccygeal line. 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 valsalvaemaneuvour)

4. What to report ? Myofascial compartments Endopelvic fascia Levatorani Iliococcygeal Puborectal muscle Axial image Entirety of levator sling with similar thickness / homogenous low signal intensity. Appreciate pubovesicleligamants. 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 ).

5. CASE-70 yr femlae Clinical brief Post menopausal cystocele/ rectocele/ third degree cervical descent . Cervical biopsy : microinvasivesquamous cell carcinoma of cervix with high grade squamous intraepithelial lesion.

6. Quantitative assesment

7. HYSTEROTOSIS PUBO COCCYGEAL LINE H LINE M LINE

8. 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

9. HYSTEROTOSIS PUBO COCCYGEAL LINE. H LINE M LINE

10. PUBO-COCCYGEAL SLING PROLAPSE CONTENTS IN THE LABIA

11. PROLAPSED CONTENTS IN THE LABIA

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