Background: Chronic constipation often results from underlying functional pelvic floor disorders, which are frequently underdiagnosed. MRI defecography has emerged as a preferred modality for dynamic evaluation of these disorders due to its high soft tissue contrast and lack of ionizing radiation.

Aim: To evaluate the spectrum of pelvic floor abnormalities in patients with chronic constipation using MRI defecography at a tertiary care hospital.

Materials and Methods: A retrospective observational study was conducted on 25 patients (12 males, 13 females; age range: 21–70 years) referred from the Gastroenterology Department of Noble Hospital Hadapsar Pune from January 2024 to December 2024. All patients underwent MRI defecography using a Magnetom vida 3T scanner. Static and dynamic sequences were acquired and analyzed for structural and functional abnormalities including rectocele, cystocele, enterocele, descending perineum syndrome, and spastic perineum syndrome.

Results: Descending perineum syndrome was identified in 52% of patients, characterized by elongation of the H and M lines and increased anorectal angle during straining and defecation. Rectocele (100%), cystocele (62%), and recto-rectal intussusception (15%) were common associated findings. Spastic perineum syndrome was present in 44% of cases, with persistent puborectalis impression and minimal change in anorectal angle. One patient exhibited isolated hiatal enlargement without associated structural defects.

Conclusion: MRI defecography is a valuable diagnostic tool for evaluating pelvic floor dysfunction in patients with chronic constipation. It provides detailed insights into dynamic anatomical changes and helps guide appropriate clinical management. Its use in tertiary care settings should be encouraged, especially in patients with refractory symptoms.