Comparison of Erect Sitting and Supine MRI Proctography in Women with Pelvic Organ Prolapse and Defecatory Symptoms.

This retrospective study of 333 women with pelvic organ prolapse and defecatory symptoms asked whether MRI proctography performed in an erect sitting position detects pelvic floor abnormalities differently from the conventional supine position. Erect sitting imaging identified significantly more pelvic floor descent (37.0% vs 12.5%), rectal intussusception during straining (49.7% vs 33.3%), and enterocele (4.8% vs 0.7%), while supine imaging detected more impaired defecation (56.9% vs 45.0%). The authors conclude that patient positioning meaningfully influences diagnosis, with the more physiological erect sitting position potentially offering a more accurate assessment of pelvic floor dysfunction.