EP732 - More than Images: Patient Experience and Tolerance of MR Defecography

Purpose/Background: MR defecography is a dynamic imaging technique that evaluates rectal evacuation and pelvic anatomy in real-time to assess for pelvic floor and evacuatory disorders. Compared to conventional defecating proctography, MR defecography avoids ionizing radiation while also providing a more comprehensive assessment of pelvic anatomy. As the study quality depends heavily on patient performance during simulated defecation, optimizing patient experience is essential. Distress and anxiety are common during MRI, yet little research has directly examined patient perspectives. This study aimed to evaluate patient experiences during MR defecography and identify factors to enhance comfort and potentially study quality.

Methods/Interventions: Patients undergoing MR defecography between June-August 2025 after evaluation at a tertiary colorectal pelvic floor clinic completed an anonymous post-procedure questionnaire. Domains assessed included demographics, and 19 items on understanding, satisfaction, and embarrassment (5-point Likert scale), plus two open-ended questions for general procedural feedback.

Results/Outcomes: Thirty-one patients (30 female, mean age 60.2 ± 16.4 years) completed the questionnaire. Most patients were referred for pelvic organ prolapse (54.8%), followed by constipation (29.0%) or fecal incontinence (9.7%). With respect to test preparation, whilst the majority of patients understood why they were referred (strongly agree = 77.4%; agree 12.9%), fewer patients had a clear understanding of the risks and benefits of the test (neutral 25.8%, strongly disagree 25.8%) or alternative tests for symptom investigation (strongly disagree 29.0%, disagree 22.6%, neutral 19.4%). During the test itself, most patients strongly agreed or agreed the instructions were clear (96.8%), technical words were explained well (90.0%), it was easy to hear (77.4%), they were comfortable to ask questions (93.6%) and their privacy was respected (100%). However, less than half of participants agreed or strongly agreed that the experience of the test was like what they were expecting (48.4%). Despite this, only 25.9% of patients reported feeling embarrassed during the test (strongly agree 6.5%, agree 19.4%) and the majority reported they would have the test again if it was necessary (strongly agree 64.5%, agree 22.6%). With respect to reproducibility of symptoms during the test, less than half of patients reported being able to defecate as they normally would at home (strongly agree 16.1%, agree 22.6%) or that defecating in the supine position was easy for them (strongly agree 19.4%, agree 22.6). Most patients strongly disagreed (46.7%) or disagreed (20.0%) with the contrast mixture being similar to normal stool (Figure 1).

Conclusion/Discussion: This study evaluated patient experiences during MR defecography. While overall satisfaction and willingness to repeat the test were high, important gaps were identified including limitations in pre-procedure understanding and expectations, difficulty with evacuation in the supine position, and dissatisfaction with the contrast medium as a replica for normal stool. These findings highlight opportunities for enhanced patient and clinician education and support consideration for the introduction of seated MR defecography. Improving the patient experience has the potential to directly improve study quality, diagnostic accuracy, and therefore patient-centered care in pelvic floor disorders.

Figure 1. Patient experiences of MR defecography