Fig. 22

Spastic pelvic floor syndrome. (a, b, c) Sagittal midline TrueFISP images of a man at rest (a), during squeezing (b) and evacuation (c), demonstrating a normal ARA angle at rest in (a) (118°), but revealing an increased reduction during squeezing in (b) (85°) and a lack of normal widening in the evacuation phase (c) (120°). During the dynamic evaluation, spastic contractions of the puborectalis muscle during evacuation were noted as well, and an incomplete evacuation with retention of ultrasound gel was present, all signs compatible with paradoxical contraction of the puborectalis muscle