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This is the evacuatory phase of a fluoroscopic defecating proctogram. Multiple attempts have been made at evacuation but none of the barium paste is expelled and there is no appropriate opening of the anorectal angle.
The appearances are suggestive of anismus, also known as anorectal dys-synergy. The same findings can also be caused by situational anxiety; therefore, they must be correlated with the symptoms and examination findings, and other tests such as the balloon expulsion test.
In anismus, there is no appropriate relaxation of the levator sling during evacuation, resulting in maintenance of an acute anorectal angle and no opening of the anal canal.