Pelvic floor imaging in women with hemorrhoidal disease: An anatomical feasibility study

Objective: To compare pelvic floor muscle and organ structures in women with and without hemorrhoidal disease (HD) using magnetic resonance imaging (MRI).

Material and methods: Pelvic MRI measurements and computer-based medical records of women diagnosed with HD between January 2018 and March 2021 were analyzed. Parameters including pubococcygeal distance, puborectal distance, posterior anorectal angle, obturator internus muscle area, presence of levator ani muscle defect, genital hiatus length, vaginal length, uterocervical angle, cervix-upper vagina angle, and cervix-middle vagina angle were evaluated. The control group consisted of women without HD, matched for age and body mass index.

Results: Puborectal hiatus distance was higher in the HD group (59.2 ​± ​8.7 ​mm vs. 55.5 ​± ​7.1 ​mm, p ​= ​0.03). Similarly, the distance to the M line was greater in the HD group (18.3 ​± ​4.8 ​mm vs. 16 ​± ​4.6 ​mm, p ​= ​0.04). Obturator internus muscle area was found to be lower in the HD group compared to the non-HD group (1721 ​± ​291.4 ​mm² vs. 1897.5 ​± ​352.5 ​mm², p ​= ​0.02). Additionally, the presence of unilateral levator ani muscle defect was higher in HD patients (p ​= ​0.03). There was a negative correlation between birthweight and obturator internus muscle area (r ​= ​-0.388, p ​= ​0.02), and a positive correlation with M line distance (r ​= ​0.344, p ​= ​0.04).

Conclusion: Levator ani muscle defects and obturator internus muscle area, indicators of pelvic floor dysfunction, are more common in patients with hemorrhoidal disease.