T2-weighted saggital view. Patient underwent a conventional abdominoperineal excision with primary closure of the pelvic floor. Images are obtained in a supine position with the patient performing a Valsalva. There is abnormal descent (>1 cm) of the pelvic floor with posteroinferior herniation of the bladder (arrowhead) and small bowel (curved arrow) below the pubococcygeal line.