Full thickness posterior rectal wall prolapse and anterior rectocele
Possible rectal prolapse.
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At the onset of evacuation, there is global pelvic floor descent, predominantly involving the posterior compartment. There is immediate formation of a moderate sized anterior rectocele which has a prominent perineal component. The anorectal angle opens appropriately and there is slow expulsion of the gel. The external prolapse predominantly involves the posterior wall where the low rectal wall intussuscepts out through the anal canal.
Imaging plays a role when a patient has symptoms of an intermittent rectal prolapse that can't be reproduced in clinic on examination. Prolapses are shown to a greater degree on dynamic imaging that requires evacuation - the pressures on the pelvic floor in this context are more akin to real life activity, whereas the straining techniques used in clinic apply less pressure to the pelvis and therefore underestimate the size of prolapses.