In our experience, the specificity of MRI versus conventional radiology is of a 100%; the sensibility of MR-D in the detection of an omentocele, sigmoidocele, and enterocele is, respectively, 95%, 82%, and 65%, showing an inferior diagnostic capacity if compared with conventional radiology [
29,
30]. The prevalence of MPH ranged from 38% among all the enrolled patients to 51% in the patients reporting previous hysterectomy. These data are in agreement with the available literature and emphasize the role of previous pelvic surgery in the genesis of MPH [
24]. The most frequent hernia is enterocele (70%), followed by sigmoidocele (21%), and omentocele (9%). On the other hand, the most frequent hernia development modality is in Douglas' space (78.9%), whereas the Retzius' and retrorectal hernias represent only occasional findings. The development of the hernias in the posterior vaginal wall or in the anterior rectal wall is observed in 9% and 12% of cases, respectively. Despite their low prevalence, their detection is important in the planning of the correct therapeutic approach. Conventional radiology is currently considered as the gold standard [
5,
7,
8], because is a cost-effective procedure, simple to perform, and widely available [
19]; however, it is an invasive procedure, especially if it is performed with four contrast that uses ionizing radiation and visualizes only the lumen of the opacified organs. MRI Defecography was first described by Yang et al. in 1991 [
7,
31], is a less-invasive imaging modality that allows a multiplanar and multiparametric evaluation of the three pelvic compartments, also visualizing soft tissue, in a single procedure without exposure to ionizing radiation. After this, several studies were performed to compare the diagnostic efficacy of dynamic MRI defecography versus that of conventional radiology in a patient with pelvic floor disorders, with variable results [ 5, 8, 18, 20, 32-34]. In our experience, conventional radiology has higher sensitivity in detecting both the content and the developmnet of pelvic floor hernias if compared with dynamic MRI Defecography. However, the prevalence of enterocele, sigmoidocele, edrocele, elytrocele, and Douglas' hernias at conventional radiology is significantly higher than at MRI Defecography. These findings, in accordance with other authors [
5,
20], emphasize the role of conventional radiology in the diagnosis of pelvic floor hernias in female pelvic floor disorders, whereas MRI defecography could be more useful to clarify the intra-pelvic interaction of multiple organ prolapse [
33] and to better define the pelvic anatomy and functioning in patients planned for surgery [
34,
35]. Moreover, MRI defecography is a safe, noninvasive exam and free from ionizing radiation[
32,
36] that is able to correctly define the large bowel loop content of a retrorectal hernia, previously misdiagnosed as an enterocele at coventional radiology [
37‐
40]. The lower sensitivity of MRI Defecography in the detection of pelvic floor hernias may be related to the supine position of the patients [
41] and defecation also plays a role by ensuring that intra-abdominal pressure is adequately elevated. A solution on MRI defecography is to repeatedly encourage patients to strain maximally or to monitor intra-abdominal pressure [
20].