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Difficult to defecate with straining. 61-year-old female. CLINICAL INFORMATION: possible rectocele... Fecal incontinence. TECHNIQUE: Multiplanar, multisequence MR images of the pelvis without and with 8 mL of catalyst for intravenous contrast enhancement. Dynamic bowel summer maneuver images were also obtained. FINDINGS: There is abnormal the descent and bulging of the anterior vaginal wall caused by the urinary bladder with Valsalva maneuver. The posterior wall of the urinary bladder descend along an arc, initially moving posteriorly and inferiorly to deforming the anterior wall of the vagina and then bulging forward as it exited the introitus. The bladder is below the pubic symphysis by 5.3 cm with maximum Valsalva maneuver. The uterus is atrophic. No pelvic lymphadenopathy or mass lesion seen. The sigmoid colon and rectum are unremarkable. The visualized bony structure and bilateral hip joint and sacroiliac joints are unremarkable. IMPRESSION: 1. Large cystocele, only visualized upon Valsalva maneuver. The urinary bladder descends 5.3 cm below the symphysis pubis, resulting in obstruction of the rectosigmoid colon, likely explaining patient's symptom of unable to defecate with Valsalva maneuver. 2. Otherwise, unremarkable MR study of the pelvis without and with contrast enhancement. No evidence of tumor process or lymphadenopathy. No adnexal mass lesion seen.