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