This is a 53-year-old multiparous woman with uterine prolapse.

Female pelvic floor dysfunction is a general term applied to a wide variety of clinical conditions, most commonly stress urinary incontinence (SUI), pelvic organ prolapse (POP), and anal incontinence.

Pelvic floor weakness is extremely prevalent in parous women over age 50.

Dynamic imaging is best performed with MR for complex cases.

Static magnetic resonance (MR) imaging is utilized to delineate components of the pelvic organ support system, including the anal sphincter complex. Dynamic (cine) MR imaging with fast sequences enables functional evaluation to assess pelvic floor relaxation and pelvic organ descent.

It is possible to differentiate whether prolapse is due to defects in the endopelvic fascia, to levator muscle weakness, or to abnormalities in both fascia and muscles.

The association between precise anatomic defects in the pelvic organ support system and specific pelvic floor dysfunction allows a defect-specific approach to pelvic floor dysfunction for each patient and helps in the planning of surgery.

Division of the pelvic floor into three compartments aids in analysis. The anterior compartment contains urethra and bladder. The middle contains cervix and uterus. The posterior contains rectum and anus. The muscular support of the pelvic floor is made up largely of the levator ani muscles and associated fascial structures. With thinning or frank disruption of these structures various abnormalities can be visualized.

For this study, 20 cc of ultrasound gel was instilled in the vagina and 100 cc of gel was instilled in the rectum. T2 W mages were acquired in the neutral position and after straining (Valselva maneuver).

The measurement of descent of pelvic organs is usually taken in reference to a line drawn on sagittal sequences from the inferior border of the pubic bone to the last joint of the coccyx, called the pubo-coccygeal line (PCL). Descent below this line in the anterior or middle compartments and significant descent below this line in the posterior compartment is abnormal.