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• Clinical Article •
Risk factor analysis of severe rectocele in females based on dynamic magnetic resonance defecography
QUAN Jing  KANG Jing  ZHAO Junfang 

DOI:10.12015/issn.1674-8034.2026.05.014.


[Abstract] Objective Identify clinical (total number of pregnancies) and radiological risk factors (M-line length at maximum abdominal pressure, bladder base position during the Valsalva maneuver) associated with the severity of rectal prolapse in women, and develop a nomogram model to predict severe rectal prolapse in women.Materials and Methods A retrospective analysis was conducted on 90 female patients with pelvic floor dysfunction disorders who underwent dynamic magnetic resonance defecography. According to the depth of rectal protrusion (≥ 20 mm was classified as the severe group, < 20 mm as the mild group) and MRI diagnosis, they were divided into the mild rectal prolapse group (n = 69) and the severe rectal prolapse group (n = 21). Parity and pregnancy history, pelvic floor muscle morphology, H-line, M-line, and dynamic indicators of the anterior, middle, and posterior pelvic compartments were compared between the two groups. Single-factor and multivariate logistic regression were used to identify predictive factors and construct a nomogram model. The model's discriminatory power was assessed using the area under the receiver operating characteristic curve (AUC). Calibration curves were plotted using the bootstrap method to evaluate model calibration, and clinical net benefit was assessed through decision curve analysis.Results Compared with the mild group, the severe group had significantly higher total number of pregnancies and deliveries (P < 0.05), significantly longer M-line at maximum abdominal pressure phase [(33.9 ± 12.5) mm vs. (25.8 ± 13.8) mm, Cohen's d = 0.62, P = 0.019], closer position of the bladder base to the pubococcygeal line (PCL) during Valsalva maneuver (P = 0.028), and significantly smaller anorectal angle (ARA) at maximum abdominal pressure phase (P = 0.035). Logistic regression analysis finally identified the total number of pregnancies, M-line length at maximum abdominal pressure phase, and bladder base position during Valsalva maneuver as independent influencing factors. The nomogram model constructed based on these factors had a predictive area under the curve (AUC) of 0.862 with good calibration, and decision curve analysis (DCA) showed high clinical net benefit.Conclusions Severe rectal prolapse is independently associated with cumulative obstetric trauma, dynamic pelvic floor descent, and weakened multi-compartmental support. Total number of pregnancies, M-line length during maximum abdominal pressure, and bladder base position during the Valsalva maneuver are independent predictors of severe rectal prolapse. The nomogram developed in this study may aid in early risk stratification and treatment decision-making.
[Keywords] rectal prolapse；pelvic floor dysfunction；dynamic magnetic resonance defecography；magnetic resonance imaging；line graph model；risk factors

QUAN Jing   KANG Jing*   ZHAO Junfang  

Department of Medical Imaging, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi 830000, China

Corresponding author: KANG J, E-mail: 47117006@qq.com

Conflicts of interest   None.

Received  2025-12-20
Accepted  2026-04-10
DOI: 10.12015/issn.1674-8034.2026.05.014
DOI:10.12015/issn.1674-8034.2026.05.014.

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