Full thickness external rectal prolapse and rectocoele
Long history of difficult defaecation, becoming worse. Feels lump protruding from back passage.
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The pelvic floor lies low at rest. As evacuation progresses, there is circumferential infolding of the full thickness of the upper and mid rectal walls into the low rectum, anal canal and finally beyond the anal verge. There is also a moderate-sized anterior rectocoele with paste trapped within due to the intussusception.
This is a grade V intussusception - full thickness external rectal prolapse, causing trapping of paste within a moderate-sized anterior rectocoele.