pelic-A common scenario: You have constipation, but the cause is unknown (and may have several underlying factors). What if your physician orders a “DEFECOGRAM?”
This is actually quite a common test, but if you search the internet, it will likely leave you with questions and fears. Dr. Vikas Shah, guest blogger and UK consultant radiologist specializing in gastrointestinal and colorectal imaging, shares information to dispel to the myths about defecograms.
What is a defecogram?
A defecating proctogram, also known as a defecography or a defagram, is used for functional imaging of the muscles and tubular structures used in defecation. It is a study commonly used to demonstrate the functional problem in a person with pelvic floor dysfunction, or a rectocele. These symptoms can be constipation, incomplete evacuation, incontinence, mucous discharge, or perineal pain.
Defecograms are tests surrounded by a lot of confusion. I am going to bust 5 common myths about defecograms:
1. I have to have an enema before my defecogram.
In my practice, and most other centres in the UK doing this test, there is no need to have an enema before the test. You can certainly go to the toilet before the test. What you will end up evacuating will be the barium paste that is used for the test. It really doesn’t matter if in addition to this, a little bit of your normal stool comes out too.
I don’t use a caulk gun, the whole idea sounds horrible! I simply use two 50 ml bladder syringes which have nozzles just the right size for easy insertion into the anal canal, and the whole thing is far cleaner as they are simply disposed afterward.
2. The barium drink is useless, as my problem is with opening my bowels.
Radiologists will have varying practice on this; in my clinic, all women are offered a barium drink to take half an hour before the defecogram. The drink shows up the small bowel. This is usually located in the center of the abdomen, but in some cases, particularly where a woman has had a hysterectomy, the small bowel drops down into the pelvis and presses on the rectum. This is known as an enterocele or small bowel prolapse. So although drink doesn’t show up the rectum, it is important to identify one of the causes of problems with opening of the bowels. People worry that the drink will make them constipated; if you make sure you drink plenty of water for a day or two after the test, it will pass through with no problem. Please note that men aren’t offered the drink as enteroceles are very rare in men due to differences in anatomy.
3. I’ll need a catheter in my bladder for my defecogram
Very few centers will also put contrast (xray dye) in the bladder and vagina to show up bladder or vaginal prolapses, as this is considered too invasive. So you will be highly unlikely to need a catheter in your bladder for contrast. If your doctor wants to look for bladder, vaginal or uterine prolapses, it would be better for you to have a dynamic pelvic MRI.
4. I can’t pee during my defecogram.
The aim of the defecogram is to simulate what you do at home when you go to the toilet. So if you pee while you poop at home, go for it!
5. I find it hard to go toilet so my defecogram won’t show anything.
It doesn’t matter if none of the barium paste comes out. Most women are having the test because they find it hard to go, so its hardly surprising that they can’t go in a hospital xray room. The most important thing is that you try your best, and the xray images will show how things are moving and whether you have problems such as rectoceles or enteroceles. Is a defecogram always the best test? What about dynamic pelvic MRI (MRI procogram) and anal ultrasound?
Test basics: The Chair
What the images look like:
A few more thoughts from Dr. Shah:
I asked Dr. Shah about Dynamic Pelvic Floor MRI (different than a static pelvic MRI) vs. defecogram. It seems that the MRI can show much more than the defecogram. He shared that MR can be good because there’s visualization of the pelvic floor AND better visibility of vagina, bladder, urethra prolapse, and pelvic floor muscle issues (and colorectal) all at the same time (defecogram is primarily colorectal focused). The issues of concern with MR are 1. limited access for many and cost and 2. it is done in a supine position vs. sitting/functional with defecogram.
Endoanal ultrasound as another test to look at the pelvic floor.
If you want to read more about defecograms, please take a look at the pelvic floor imaging pages on my website