RadteraDefecography (Evacuation Proctography)
Fluoro+ ContrastAbdomen & Pelvisverify
Indications
- Obstructed defecation / outlet constipation
- Suspected rectocele, enterocele, sigmoidocele
- Rectal intussusception or prolapse
- Pelvic floor dyssynergia (anismus)
- Fecal incontinence evaluation
- Descending perineum syndrome
Patient prep
- No extensive bowel prep usually required; some protocols give a small cleansing enema
- Explain procedure thoroughly (patient must defecate on a radiolucent commode during fluoroscopy)
- Optional oral barium beforehand to opacify small bowel for enterocele detection; vaginal contrast in women per protocol
Contrast
AgentThick barium paste (potato-starch/high-viscosity barium) to simulate stool; optional oral barium for small bowel and vaginal contrast gel
Routerectal (paste); optional oral and intravaginal
DoseRectum filled with ~200-300 mL barium paste until urge to defecate
TimingDynamic fluoroscopy during rest, squeeze, strain (Valsalva), and evacuation
Technique
- Instill thick barium paste into rectum until adequately filled
- Seat patient on a radiolucent commode, lateral position
- Acquire lateral images/video at rest, during squeeze, during strain, and during evacuation
- Measure anorectal angle and pelvic floor descent at each phase
- Note rectocele size, intussusception, enterocele, perineal descent, and completeness of evacuation
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Rest | Lateral seated | Baseline anorectal angle, pelvic floor position |
| 2 | Squeeze (Kegel) | Lateral seated | Sphincter/puborectalis function — angle narrows |
| 3 | Strain / Valsalva | Lateral seated | Rectocele, enterocele, intussusception, descent |
| 4 | Evacuation | Lateral seated dynamic | Completeness, dyssynergia, prolapse |
| 5 | Post-evacuation | Lateral | Residual, intussusception, enterocele |
Key points
- Patient cooperation and ability to evacuate are essential — coach in private as much as possible to reduce inhibition
- MR defecography is an alternative (no ionizing radiation, multicompartment soft-tissue detail) but is non-physiologic (supine) at many sites
- Opacify small bowel/vagina to detect enterocele and identify peritoneocele
- Measure anorectal angle and pelvic floor descent quantitatively
- Anismus = paradoxical puborectalis contraction with non-relaxing/narrowing angle during attempted evacuation
References
• Radiopaedia: Defecography / evacuation proctography
• ACR Appropriateness Criteria: Pelvic Floor Dysfunction (Female)
• SAR (Society of Abdominal Radiology) pelvic floor consensus
• ACR Appropriateness Criteria: Pelvic Floor Dysfunction (Female)
• SAR (Society of Abdominal Radiology) pelvic floor consensus
Source: Researched — verify against your institution
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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.