Defecating Proctography

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What is Defecating Proctography?

Defecating Proctography is a technique to examine the lower end of the bowel (the rectum) and assess its shape and function during the process of defecation (opening your bowels). The purpose of the test is to determine the cause of your symptoms such as incontinence or difficulty in evacuating your motions.
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A defecating proctogram can be undertaken in 2 possible ways, firstly using X-rays and secondly using MRI scan. Both techniques obtain information valuable in determining the cause of your problems and help to ensure you receive the most appropriate treatment.

What happens during the X-ray proctogram?

In X-ray defecating proctography, you do not need any special diets or preparation to take at home. You will need to take some barium liquid orally about an hour before the X-ray test. This will allow the radiologist to assess the movement of your small bowel during the examination. 

Following this you will need to change into a gown to ensure there are no personal objects that will confuse the x-ray test when it is undertaken.

​At the time of the test you will be placed on a couch and barium paste (similar consistency to toothpaste) will be inserted into your back passage using a soft tube. The Barium paste helps to highlight more of your lower bowel. If you are female, you may have some dye inserted into your vagina which highlights this area on X-ray and allows us to see everything in more detail.We will then take you into the X-ray room where we will ask you to sit on a specially designed commode (like a toilet) surrounded by a modesty curtain.
Once you feel comfortable, a low dose X-ray is taken in three stages. First, an image is taken at rest. Then we will ask you to squeeze hold of the barium in the bottom. Finally we will ask you to empty your bowels.
We fully appreciate that this procedure requires privacy and we will make every effort to make you feel relaxed and comfortable. 

What happens during the MRI proctogram?

In MRI defecating proctograms, you will need to change into a gown for the examination and about 1 hour before the test an enema is administered in order to empty the lower bowel for the test. you will need to hold onto this enema for about 10 minutes before opening your bowels into the toilet.

Following this, you will be taken into the MRI suite and asked to lie on the examination couch you side and some jelly is placed inside the rectum. After this you will be asked to lie on your back and the scan will commence. The MRI scanner can make some knocking noises during the scan and this is all normal. Some headphones with music will be given to you for the duration of the examination.

During the examination you will be asked to push the jelly like you are trying to open your bowels. This may occur several times during the test. If the jelly is not fully expelled during the test you will be asked to go to the toilet and expel the jelly and then the examination will continue on the MRI scanner.

The test takes approximately 20 minutes in total. After the test you may resume normal eating and drinking, and oral fluid intake is encouraged until the effects of the enema have passed.

What happens after the proctogram?

After the scan the images are carefully examined by a radiologist who specialises in reporting defecating proctograms. Following this a report is written, typed and checked for accuracy by the reporting radiologist. The report is then authorised for release to the requesting doctor.
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Once your report has been received, your doctor may contact you to discuss this further either by phone or by seeing you back in the outpatient clinic. Occasionally the doctor may write to you and your General Practitioner with the results of the scan and possibly with further advice or a recommendation for further assessment or treatment.