Background <p>In addition to clinical examination with rigid rectoscopy, magnetic resonance imaging (MRI) defecography is used to assess the pelvic floor. This radiological examination is complex and expensive. The aim of this analysis is to evaluate possible limitations in the indication for MRI diagnostics against the background of general cost pressures in the healthcare system.</p> Methods <p>A total of 110&#xa0;patients who had undergone a&#xa0;clinical proctological examination followed by MRI defecography were retrospectively included in this study. A&#xa0;comparison of the detection of individual pelvic floor changes in the two modalities was conducted. This allows for recommendations regarding the indication for MRI diagnostics from a&#xa0;health economic perspective.</p> Results <p>There is a&#xa0;statistical correlation in the detection of pelvic floor changes in both examination modalities. No significant differences were found. Conversely, this means that no new findings can be expected from a&#xa0;comprehensive clinical examination using MRI. Especially for the confirmation of isolated rectocele, even with coincident perineal descent, a&#xa0;definite indication for radiological diagnostics can be viewed with scepticism.</p> Conclusion <p>MRI defecography can contribute to a&#xa0;complete assessment of the pelvic floor but does not achieve significantly different results with prior comprehensive clinical examination. When considering the indication for MRI diagnostics, there is a&#xa0;potential cost reduction of up to 51.8%.</p>