Defecography is a magnetic resonance imaging (MRI) study of defecation. Defecation means the process of passing out stools from the rectum and anal canal & graphy means the scanning process of defecation. Defecography, or evacuation MRI is a diagnosic test that shows the rectal & anal canal as they change during defecation (having a bowel movement). This test is used to evaluate disorders of the lower bowel that are not evident by tests such as colonoscopy or sigmoidoscopy.

Diagnosis of Constipation

Defecation or having bowel movement is a complex action requiring co-ordination in relaxation & contraction of large number of muscles. It is controlled by the nervous system but is also under voluntary control.The proces of defecation is initiated by the arrival of stool into the rectum and the sensation leads to a chain of events which ends in evacuation of stools from the anus. The act of defecation is voluntarily controlled in healthy,normally function people.
The following is a list of some conditions or symptoms for which Defecography could be used to gather more information about the patients condition or to confirm a correct diagnosis.

  1. Chronic constipation- evaluation for functional obstruction

  2. Rectal prolapse

  3. Rectocele an out pouching of the rectum

  4. Fecal incontinence

  5. Anisvnus

  6. Rectal intussusception

The patients who have the following symptoms for a long duration may have to undergo MRI Defecography

  1. Chronic Constipation

  2. Incomplete Evacuation

  3. Obstruction & Straining during defecation

  4. Fingering during defecation

  5. Patient goes number of times for defecation but does not feel complete satisfaction of evacuation

  6. Daily or alternate day hard stools

  7. Patient has only 2-3 evacuations in a week and defecation is a long and time consuming process

Such disorders may happen due to structural changes in the anorectal region or a misguided behavior during defecation and MRI DEFECOGRAPHY is a perfect diagnostic tool for it

Patient can have meal before the procedure. He should not be wearing any metallic object on the body and as a precaution it has to be noted that he does not have any metallic implants in the body like rod, clip etc A jelly paste around 300-400 ml is inserted in the anal region with the help of a rubber catheter. Patient has to hold the inserted jelly inside the rectum for a while wearing a diaper. Then the patient has to lie down in the MRI scanning machine in the suggested position. Some images are taken in the rest position with the jelly held in the rectum then instructions are given for evacuation during which the patient has to strain first slowly and then with force. All the images during the defecation process are recorded.The MRI scanning technique is a coordinated effort of the doctor, radiologist, trained assisting staff and the patient.

Where

This technologically advanced investigation process is available at a very few places in India. Among them in Maharashtra it is available only in Pune & Mumbai. In pune it is done only at Inamdar Hospital,Fatimanagar under the guidance of Proctosurgeon Dr. Ashwin Porwal and his team of trained doctors and an experienced radiologist.

Time

Only 30-45 minutes without hospitalization in OPD basis is required for the procedure. AGA – American Gastroenterological Association guidelines on constipation (2000) – recommended a systemic approach to patients with constipation. According to this guideline MRI Defecography is a proper diagnostic approach to diagnose ODS among patients with constipation

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MRI Defecography