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The pelvic floor lies low at rest. A vaginal ring pessary is present. At commencement of evacuation, the anal canal opens with rapid expulsion of the paste, with circumferential infolding of the full thickness of the upper and mid rectum into the low rectum, but not beyond the anal margin. Despite the presence of the ring pessary, there is a moderate size anterior rectocele which empties towards the end of evacuation. No enterocele.